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.
If you ask your maps app to find "restaurants that aren't McDonald's," you won't like the result.
- The Chinese Room thought experiment is designed to show how understanding something cannot be reduced to an "input-process-output" model.
- Artificial intelligence today is becoming increasingly sophisticated thanks to learning algorithms but still fails to demonstrate true understanding.
- All humans demonstrate computational habits when we first learn a new skill, until this somehow becomes understanding.
It's your first day at work, and a new colleague, Kendall, catches you over coffee.
"You watch the game last night?" she says. You're desperate to make friends, but you hate football.
"Sure, I can't believe that result," you say, vaguely, and it works. She nods happily and talks at you for a while. Every day after that, you live a lie. You listen to a football podcast on the weekend and then regurgitate whatever it is you hear. You have no idea what you're saying, but it seems to impress Kendall. You somehow manage to come across as an expert, and soon she won't stop talking football with you.
The question is: do you actually know about football, or are you imitating knowledge? And what's the difference? Welcome to philosopher John Searle's "Chinese Room."
The Chinese Room
Searle's argument was designed as a critique of what's called a "functionalist" view of mind. This is the philosophy that argues that our mind can be explained fully by what role it plays, or in other words, what it does or what "function" it has.
One form of functionalism sees the human mind as following an "input-process-output" model. We have the input of our senses, the process of our brains, and a behavioral output. Searle thought this was at best an oversimplification, and his Chinese Room thought experiment goes to show how human minds are not simply biological computers. It goes like this:
Imagine a room, and inside is John, who can't speak a word of Chinese. Outside the room, a Chinese person sends a message into the room in Chinese. Luckily, John has an "if-then" book for Chinese characters. For instance, if he gets <你好吗>, the proper reply is <我还好>. All John has to do is follow his instruction book.
The Chinese speaker outside of the room thinks they're talking to someone inside who knows Chinese. But in reality, it's just John with his fancy book.
What is understanding?
Does John understand Chinese? The Chinese Room is, by all accounts, a computational view of the mind, yet it seems that something is missing. Truly understanding something is not an "if-then" automated response. John is missing that sinking in feeling, the absorption, the bit of understanding that's so hard to express. Understanding a language doesn't work like this. Humans are not Google Translate.
And yet, this is how AIs are programmed. A computer system is programmed to provide a certain output based on a finite list of certain inputs. If I double click the mouse, I open a file. If you type a letter, your monitor displays tiny black squiggles. If we press the right buttons in order, we win at Mario Kart. Input — Process — Output.
Can imitation become so fluid or competent that it is understanding.
But AIs don't know what they're doing, and Google Translate doesn't really understand what it's saying, does it? They're just following a programmer's orders. If I say, "Will it rain tomorrow?" Siri can look up the weather. But if I ask, "Will water fall from the clouds tomorrow?" it'll be stumped. A human would not (although they might look at you oddly).
A fun way to test just how little an AI understands us is to ask your maps app to find "restaurants that aren't McDonald's." Unsurprisingly, you won't get what you want.
The Future of AI
To be fair, the field of artificial intelligence is just getting started. Yes, it's easy right now to trick our voice assistant apps, and search engines can be frustratingly unhelpful at times. But that doesn't mean AI will always be like that. It might be that the problem is only one of complexity and sophistication, rather than anything else. It might be that the "if-then" rule book just needs work. Things like "the McDonald's test" or AI's inability to respond to original questions reveal only a limitation in programming. Given that language and the list of possible questions is finite, it's quite possible that AI will be able to (at the very least) perfectly mimic a human response in the not too distant future.
What's more, AIs today have increasingly advanced learning capabilities. Algorithms are no longer simply input-process-output but rather allow systems to search for information and adapt anew to what they receive.
A notorious example of this occurred when a Microsoft chat bot started spouting bigotry and racism after "learning" from what it read on Twitter. (Although, this might just say more about Twitter than AI.) Or, more sinister perhaps, two Facebook chat bots were shut down after it was discovered that they were not only talking to each other but were doing so in an invented language. Did they understand what they were doing? Who's to say that, with enough learning and enough practice, an AI "Chinese Room" might not reach understanding?
Can imitation become understanding?
We've all been a "Chinese Room" at times — be it talking about sports at work, cramming for an exam, using a word we didn't entirely know the meaning of, or calculating math problems. We can all mimic understanding, but it also begs the question: can imitation become so fluid or competent that it is understanding.
The old adage "fake it, 'till you make it" has been proven true over and over. If you repeat an action enough times, it becomes easy and habitual. For instance, when you practice a language, musical instrument, or a math calculation, then after a while, it becomes second nature. Our brain changes with repetition.
So, it might just be that we all start off as Chinese Rooms when we learn something new, but this still leaves us with a pertinent question: when, how, and at what point does John actually understand Chinese? More importantly, will Siri or Alexa ever understand you?
With the rise of Big Data, methods used to study the movement of stars or atoms can now reveal the movement of people. This could have important implications for cities.
- A treasure trove of mobility data from devices like smartphones has allowed the field of "city science" to blossom.
- I recently was part of team that compared mobility patterns in Brazilian and American cities.
- We found that, in many cities, low-income and high-income residents rarely travel to the same geographic locations. Such segregation has major implications for urban design.
Almost 55 percent of the world's seven billion people live in cities. And unless the COVID-19 pandemic puts a serious — and I do mean serious — dent in long-term trends, the urban fraction will climb almost to 70 percent by midcentury. Given that our project of civilization is staring down a climate crisis, the massive population shift to urban areas is something that could really use some "sciencing."
Is urbanization going to make things worse? Will it make things better? Will it lead to more human thriving or more grinding poverty and inequality? These questions need answers, and a science of cities, if there was such a thing, could provide answers.
Good news. There already is one!
The science of cities
With the rise of Big Data (for better or worse), scientists from a range of disciplines are getting an unprecedented view into the beating heart of cities and their dynamics. Of course, really smart people have been studying cities scientifically for a long time. But Big Data methods have accelerated what's possible to warp speed. As "exhibit A" for the rise of a new era of city science, let me introduce you to the field of "human mobility" and a new study just published by a team I was on.
Credit: nonnie192 / 405009778 via Adobe Stock
Human mobility is a field that's been amped up by all those location-enabled devices we carry around and the large-scale datasets of our activities, such as credit card purchases, taxi rides, and mobile phone usage. These days, all of us are leaving digital breadcrumbs of our everyday activities, particularly our movements around towns and cities. Using anonymized versions of these datasets (no names please), scientists can look for patterns in how large collections of people engage in daily travel and how these movements correlate with key social factors like income, health, and education.
There have been many studies like this in the recent past. For example, researchers looking at mobility patterns in Louisville, Kentucky found that low-income residents tended to travel further on average than affluent ones. Another study found that mobility patterns across different socioeconomic classes exhibit very similar characteristics in Boston and Singapore. And an analysis of mobility in Bogota, Colombia found that the most mobile population was neither the poorest nor the wealthiest citizens but the upper-middle class.
These were all excellent studies, but it was hard to make general conclusions from them. They seemed to point in different directions. The team I was part of wanted to get a broader, comparative view of human mobility and income. Through a partnership with Google, we were able to compare data from two countries — Brazil and the United States — of relatively equal populations but at different points on the "development spectrum." By comparing mobility patterns both within and between the two countries, we hoped to gain a better understanding of how people at different income levels moved around each day.
Mobility in Brazil vs. United States
Socioeconomic mobility "heatmaps" for selected cities in the U.S. and Brazil. The colors represent destination based on income level. Red depicts destinations traveled by low-income residents, while blue depicts destinations traveled by high-income residents. Overlapping areas are colored purple.Credit: Hugo Barbosa et al., Scientific Reports, 2021.
The results were remarkable. In a figure from our paper (shown above), it's clear that we found two distinct kinds of relationship between income and mobility in cities.
The first was a relatively sharp distinction between where people in lower and higher income brackets traveled each day. For example, in my hometown of Rochester, New York or Detroit, the places visited by the two income groups (e.g., job sites, shopping centers, doctors' offices) were relatively partitioned. In other words, people from low-income and high-income neighborhoods were not mixing very much, meaning they weren't spending time in the same geographical locations. In addition, lower income groups traveled to the city center more often, while upper income groups traveled around the outer suburbs.
The second kind of relationship was exemplified by cities like Boston and Atlanta, which didn't show this kind of partitioning. There was a much higher degree of mixing in terms of travel each day, indicating that income was less of a factor for determining where people lived or traveled.
In Brazil, however, all the cities showed the kind of income-based segregation seen in U.S. cities like Rochester and Detroit. There was a clear separation of regions visited with practically no overlap. And unlike the U.S., visits by the wealthy were strongly concentrated in the city centers, while the poor largely traversed the periphery.
Data-driven urban design
Our results have straightforward implications for city design. As we wrote in the paper, "To the extent that it is undesirable to have cities with residents whose ability to navigate and access resources is dependent on their socioeconomic status, public policy measures to mitigate this phenomenon are the need of the hour." That means we need better housing and public transportation policies.
But while our study shows there are clear links between income disparity and mobility patterns, it also shows something else important. As an astrophysicist who spent decades applying quantitative methods to stars and planets, I am amazed at how deep we can now dive into understanding cities using similar methods. We have truly entered a new era in the study of cities and all human systems. Hopefully, we'll use this new power for good.
A small percentage of people who consume psychedelics experience strange lingering effects, sometimes years after they took the drug.
- LSD flashbacks have been studied for decades, though scientists still aren't quite sure why some people experience them.
- A subset of people who take psychedelics and then experience flashbacks develop hallucinogen persisting perception disorder (HPPD), a rare condition in which people experience regular or near-constant psychedelic symptoms.
- There's currently no cure for the disorder, though some studies suggest medications may alleviate symptoms.
In February 2021, Josh was in his room and looking at his phone when he was struck by a strange feeling.
"The room looked normal, nothing was moving, but I felt as though I was under the influence of a psychedelic," he told Big Think.
As a teenager, Josh had experimented with LSD, mushrooms, and other psychedelics a couple dozen times. Now 25, he had been sober for about a year. He brushed off the incident.
But soon, Josh, which is not his real name, was struck again by the same strange feeling.
"I had no idea what was going on in my brain at that time and the anxiety and paranoia grew so intense that I became fearful I had developed everything from brain cancer to schizophrenia," he said.
The physical and psychological symptoms he began suffering were "devastating."
"The world [looked] crooked and out of focus, pictures had an eerie quality to them, things would go in and out of focus, at night while falling asleep I would experience vivid and terrifying hypnagogic hallucinations that made rest impossible."
After three weeks, Josh said his visual symptoms amplified with "unbelievable intensity."
"The floors would [breathe], paint on the walls looked wet, visual snow was so intense [that] pure black looked like it was glowing, at night I would see tracers everywhere, halos appeared around text. [...] I did not sleep, my thoughts were anxious and at times deranged, I had unbelievably intense dereliction that made the world seem fake."
What Josh experienced is commonly called an LSD flashback. It's a mysterious phenomenon in which someone who's previously taken a hallucinogenic drug suddenly and temporarily experiences the effects of that drug days, weeks, or even years after consuming it.
Flashbacks can occur after taking a wide range of psychedelic drugs. But compared to other hallucinogens, flashbacks seem to be most common among people who have consumed LSD, according to studies.
Credit Newwup via Adobe Stock
People have reported acid flashbacks for decades. The earliest recorded case may be
Havelock Ellis' 1898 report of taking mescaline and then experiencing sustained heightened sensitization to "the more delicate phenomena of light and shade and color."
But it wasn't until the 1950s, little more than a decade after Albert Hoffman first synthesized LSD, that scientists started researching LSD and its potential long-term effects. While studies have illuminated some aspects of how psychedelics affect the brain, scientists still have much to learn about the nature of LSD flashbacks, what causes them, and how to treat them.
What's certain, however, is that a small percentage of people who consume psychedelics report bizarre and sometimes debilitating effects that emerge long after taking hallucinogens.
Symptoms of LSD flashbacks
Among the most common symptoms of LSD flashbacks are visual distortions. In a 1983 study titled " Visual Phenomenology of the LSD Flashback," the psychiatrist and LSD researcher Dr. Henry David Abraham described 16 common visual disturbances reported by people with LSD flashbacks. To name a few:
- Acquired color confusion: The color of objects changed or presented a newly discovered problem of color confusion.
- Difficulty reading: Text may appear jumbled or leave afterimages of the type against the background of the page.
- Geometric phosphenes: Phosphenes, or eigengrau, are non-specific luminous perceptions that occur when the eyes are closed and may originate from entopic (i.e., arising from within the eye itself) stimuli in normal persons. They also may be induced by gentle pressure on the closed eyelid.
- Pareidolias: This is literally an image within an image. These were described when a subject gazed into a finely reticulated design in linoleum, veneer, or a cloud formation. Besides the abstract pattern of the linoleum, subjects often would be able to see a series of concrete images as well, such as "a fish," "a face," and "a little boy."
- Macropsia: Macropsia is the perception of an object larger than it really is. A characteristic description of this phenomenon came from a subject who noticed that his hand was enormous and then of normal size a few seconds later.
- Micropsia: Micropsia is the perception of an object smaller than reality. One subject said, "My feet looked so tiny, like they were a million miles away."
The effects of LSD flashbacks aren't limited to visual distortions. In a 1970 study called "Analysis of the LSD Flashback," researchers sorted LSD flashbacks into three broad categories: perceptual, somatic (meaning of the body), and emotional.
The emotional flashback is "far more distressing" than the other two, the researchers wrote, providing a case study of a 21-year-old woman who was suffering from LSD flashbacks:
"The patient had these frightening flashbacks during the day, while walking down the street, after smoking marijuana or drinking wine, during the night, and occasionally even while asleep. In one situation she awoke during the middle of the night with a feeling of panic and began running around her house fleeing an imagined threat she could not identify or comprehend. She had taken LSD a number of times, but her last few trips were bad ones with panic and fright followed by loneliness to the point of suicidal despair when she 'came down.' The combination of bad trips and emotional flashbacks made her seek professional help because of her fear that she would harm herself."
To be sure, LSD flashbacks aren't always emotionally distressing. A 2010 survey of 600 hallucinogen users found that, of the minority of users who reported experiencing at least one flashback, only 3 percent described it as a negative experience. In fact, some people enjoyed their flashbacks. On the website Erowid, which promotes research of psychedelic drugs, one user wrote:
"After 2 years of my last acid trip, while on vacation in a very nice wilderness place I was sitting on a rock and then I experienced a clear acid high. I was looking at a very steep hill and suddenly it started moving in nice patterns, exactly as one sees patterns while on acid. It wasn't something uncomfortable. In fact it was really pleasant and there was absolutely no trace of the nasty anxiousness after effects common to LSD. It lasted approximately 2 minutes and I enjoyed it very much."
But some LSD flashbacks are neither brief nor pleasant. A subset of people who use psychedelics develop hallucinogen persisting perception disorder (HPPD), a rare and poorly understood condition in which people experience omnipresent or recurring flashbacks. While the symptoms of HPPD vary, the condition can cause intense pain, irreversible perceptual distortions, emotional and psychological distress, and even suicidal thoughts.
HPPD: The never-ending trip
HPPD is estimated to affect between one to five percent of LSD users, though the actual figure is impossible to determine without better data. The disorder was first described formally in 1986 by the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R). The current edition of the manual (DSM-5) says patients need to meet several criteria to be diagnosed with HPPD:
- Patients must reexperience perceptual symptoms they experienced while intoxicated with the hallucinogen.
- These symptoms must cause "significant distress or impairment in social, occupational, or other important areas of functioning."
- These symptoms aren't due to a separate medical condition or mental disorder.
So, what's the difference between a flashback and HPPD? Mainly frequency and duration. A 2017 review published in Frontiers in Psychiatry noted that while "a flashback is usually reported to be infrequent and episodic, HPPD is usually persisting and long-lasting."
A 2014 review published in the Israel Journal of Psychiatry and Related Sciences outlined two types of HPPD. The first, HPPD I, is the "flashback type," which is a generally short-term, non-distressing, benign and reversible state accompanied by a pleasant affect. The severity of HPPD I varies, with some people describing their mild flashbacks as annoying, while others say it's like getting "free trips."
But HPPD II is a different beast. The condition can be permanent, with perceptual distortions and other symptoms manifesting irregularly or almost constantly.
"The symptoms usually include palinopsia (afterimages effects), the occurrence of haloes, trails, akinetopsia, visual snows, etc.," according to the aforementioned 2017 review. "Sounds and other perceptions are usually not affected. Visual phenomena have been reported to be uncontrollable and disturbing. Symptomatology may be accompanied by depersonalization, derealization, anxiety, and depression."
What causes flashbacks and HPPD?
When asked what causes flashbacks and HPPD, Dr. Abraham told Popular Science, "I've spent my life studying this problem and I don't know, is the short answer."
But researchers have proposed explanations. One centers on memory. Because psychedelics can cause extremely powerful and emotional experiences, it's theoretically possible that certain environmental stimuli can remind people of those experiences, and then memory "transports" them back into that subjective mindset — similar to how a soldier with post-traumatic stress disorder might suffer an episode after hearing a loud, sudden noise.
Another hypothesis involves how LSD interacts with the brain's visual processing center. Dr. Abraham proposed that HPPD may arise due to "disinhibition of visual processing related to a loss of serotonin receptors on inhibitory interneurons," which may be caused by consuming LSD.
The basic idea is that LSD somehow changes the way the brain interprets visual stimuli. That might explain why people with HPPD have difficulty properly "disengaging" from the things they see around them. For example, a red stoplight might appear not as a discrete red circle but as a streak of red light painted across their field of vision; or a strobe light might not appear as a flickering light but a light that's constantly on.
Credit Yurok Aleksandrovich via Adobe Stock
"Such a locking of visual circuitry into an 'on' position following perception of a visual stimulus would explain such diverse complaints as trailing, color intensification, positive afterimages, phosphenes, and color confusions, each of which may represent a failure of the respective visual function to turn off the brain's response to the stimulus once the stimulus is gone," Dr. Abraham
It's also possible that people are genetically predisposed to HPPD and that ingesting LSD is the key that unlocks the disorder. This hypothesis would help explain why people have reportedly developed HPPD after taking a single, moderate dose of LSD.
Ultimately, the exact causes of HPPD are unclear. Partially as a result, there's currently no cure for the disorder, though studies show that people with HPPD have reported improvements in symptomatology after taking benzodiazepines. There's also anecdotal evidence that fasting can alleviate the disorder.
Despite uncertainty over the causes of HPPD, researchers do have a good idea of what can trigger "flare-ups" of HPPD. Dr. Abraham's 1983 study listed the most common triggers, some of which include:
- Emergence into a dark environment
- Intention (intentionally inducing visual aberrations by, say, staring at a blank wall)
People with HPPD describe the condition
To get a better understanding of HPPD, Big Think posted a questionnaire to the HPPD community on Reddit. Here are some of the responses:
How did HPPD first manifest for you?
"First I noticed highly enhanced creativity and intense visuals when [high on] weed and I really enjoyed that part. The realization that this is not going to go away soured the whole experience tho."
"My enhanced creativity left me after about a week and what I was left with was mild visual snow. I hardly knew anything about HPPD at the time and just didn't really care about my symptoms and still thought they were just going to vanish at some point, which they didn't. I kept taking drugs simply because I was addicted and felt like life is no fun without them. My HPPD got gradually worse over time and more symptoms appeared. First, I noticed mild tracers, which got worse over time (again due to continued drug use) and then tinnitus and brain fog. But primarily my symptoms are visual."
Are your symptoms episodic or constant?
"Both constant and episodic," wrote user LotsOfShungite. "A stressful event can trigger my symptoms off into the deep end."
"Except the brain fog and head pressure that varies, my visual disturbances are constant. The most debilitating ones are the visual snow, especially when I'm inside except if I watch the TV since it filters some of it out. It's also VERY frustrating that I no longer can focus on objects/details (can't stare) and the astigmatism-like symptoms that I got, like blurriness, especially in the distance and ghosting (double vision) plus starbursts from strong light sources. When I'm outside, the pattern glare is really annoying, same with the excessive amount of floaters that came with this. I also see halos from light sources."
"My symptoms are mostly constant and only change through rather obvious outside influences, such as certain drugs (almost all drugs), stress, lack of sleep, etc. Although my HPPD is quite pronounced, I have learned to accept it and almost only notice it when I pay attention to it. I always [know] it's there and it somewhat bugs me but I get along."
What are some common misconceptions about HPPD?
"One of if not the biggest 'misconception' is that many people believe that HPPD does not exist. But I guess there is no way to prove to another person that it does, so this is gonna stay the case until HPPD enters the public consciousness of the psychedelic community."
"They usually don't understand anything about it since most haven't heard about it, which really is crazy considering how debilitating this disorder is for many. And as Dr. Abraham said: in the medical field it's highly under- and misdiagnosed. Often as psychosis."
Lopyriev via Adobe Stock
Hope for HPPD
Since experiencing his first acid flashback in February, Josh has found a few helpful strategies to minimize symptoms, including seeing a psychologist, staying sober, getting enough sleep, staying productive, and talking regularly with friends. He seemed optimistic about the future:
"The symptoms will lessen with time and sobriety, and HPPD provides an opportunity to improve yourself. That being said, because thoughts of suicide are apparently common with people that have HPPD, the medical community should take the condition seriously. Especially given how many people use psychedelics today."
While the future of HPPD research remains unclear, general psychedelic research is going through something of a renaissance. In recent years, researchers have published a growing body of studies showing how psychedelics like psilocybin, LSD, and MDMA can help treat conditions like depression, anxiety, post-traumatic stress disorder, and existential distress.
But, among people with HPPD, opinions on the utility of psychedelics vary. Josh advised caution:
"I would not recommend [hallucinogenic] drugs be taken for recreational purposes. They are tools to help us treat illnesses and should be treated as such. If someone has depression or other mental health issue, maybe psychedelics administered in a clinical setting by a doctor is appropriate, but otherwise, playing with your brain like it's a chemistry playset is asking for trouble down the road."
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