from the world's big
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.
The mluitfaceted cerebellum is large — it's just tightly folded.
- A powerful MRI combined with modeling software results in a totally new view of the human cerebellum.
- The so-called 'little brain' is nearly 80% the size of the cerebral correct when it's unfolded.
- This part of the brain is associated with a lot of things, and a new virtual map is suitably chaotic and complex.
Just under our brain's cortex and close to our brain stem sits the cerebellum, also known as the "little brain." It's an organ many animals have, and we're still learning what it does in humans. It's long been thought to be involved in sensory input and motor control, but recent studies suggests it also plays a role in a lot of other things, including emotion, thought, and pain. After all, about half of the brain's neurons reside there. But it's so small. But it's not, according to a new study from San Diego State University (SDSU) published in PNAS (Proceedings of the National Academy of Sciences).
A neural crêpe
A new imaging study led by psychology professor and cognitive neuroscientist Martin Sereno of the SDSU MRI Imaging Center reveals that the cerebellum is actually an intricately folded organ that has a surface area equal in size to 78% of the cerebral cortex. Sereno, a pioneer in MRI brain imaging, collaborated with other experts from the U.K., Canada, and the Netherlands.
So what does it look like? Unfolded, the cerebellum is reminiscent of a crêpe, according to Sereno, about four inches wide and three feet long.
The team didn't physically unfold a cerebellum in their research. Instead, they worked with brain scans from a 9.4 Tesla MRI machine, and virtually unfolded and mapped the organ. Custom software was developed for the project, based on the open-source FreeSurfer app developed by Sereno and others. Their model allowed the scientists to unpack the virtual cerebellum down to each individual fold, or "folia."
Study's cross-sections of a folded cerebellum
Image source: Sereno, et al.
A complicated map
Sereno tells SDSU NewsCenter, "Until now we only had crude models of what it looked like. We now have a complete map or surface representation of the cerebellum, much like cities, counties, and states."
That map is a bit surprising, too, in that regions associated with different functions are scattered across the organ in peculiar ways, unlike the cortex where it's all pretty orderly. "You get a little chunk of the lip, next to a chunk of the shoulder or face, like jumbled puzzle pieces," says Sereno. This may have to do with the fact that when the cerebellum is folded, its elements line up differently than they do when the organ is unfolded.
It seems the folded structure of the cerebellum is a configuration that facilitates access to information coming from places all over the body. Sereno says, "Now that we have the first high resolution base map of the human cerebellum, there are many possibilities for researchers to start filling in what is certain to be a complex quilt of inputs, from many different parts of the cerebral cortex in more detail than ever before."
This makes sense if the cerebellum is involved in highly complex, advanced cognitive functions, such as handling language or performing abstract reasoning as scientists suspect. "When you think of the cognition required to write a scientific paper or explain a concept," says Sereno, "you have to pull in information from many different sources. And that's just how the cerebellum is set up."
Bigger and bigger
The study also suggests that the large size of their virtual human cerebellum is likely to be related to the sheer number of tasks with which the organ is involved in the complex human brain. The macaque cerebellum that the team analyzed, for example, amounts to just 30% the size of the animal's cortex.
"The fact that [the cerebellum] has such a large surface area speaks to the evolution of distinctively human behaviors and cognition," says Sereno. "It has expanded so much that the folding patterns are very complex."
As the study says, "Rather than coordinating sensory signals to execute expert physical movements, parts of the cerebellum may have been extended in humans to help coordinate fictive 'conceptual movements,' such as rapidly mentally rearranging a movement plan — or, in the fullness of time, perhaps even a mathematical equation.
Sereno concludes, "The 'little brain' is quite the jack of all trades. Mapping the cerebellum will be an interesting new frontier for the next decade."
What happens if we consider welfare programs as investments?
- A recently published study suggests that some welfare programs more than pay for themselves.
- It is one of the first major reviews of welfare programs to measure so many by a single metric.
- The findings will likely inform future welfare reform and encourage debate on how to grade success.
Welfare as an investment<p>The <a href="https://scholar.harvard.edu/files/hendren/files/welfare_vnber.pdf" target="_blank">study</a>, carried out by Nathaniel Hendren and Ben Sprung-Keyser of Harvard University, reviews 133 welfare programs through a single lens. The authors measured these programs' "Marginal Value of Public Funds" (MVPF), which is defined as the ratio of the recipients' willingness to pay for a program over its cost.</p><p>A program with an MVPF of one provides precisely as much in net benefits as it costs to deliver those benefits. For an illustration, imagine a program that hands someone a dollar. If getting that dollar doesn't alter their behavior, then the MVPF of that program is one. If it discourages them from working, then the program's cost goes up, as the program causes government tax revenues to fall in addition to costing money upfront. The MVPF goes below one in this case. <br> <br> Lastly, it is possible that getting the dollar causes the recipient to further their education and get a job that pays more taxes in the future, lowering the cost of the program in the long run and raising the MVPF. The value ratio can even hit infinity when a program fully "pays for itself."</p><p> While these are only a few examples, many others exist, and they do work to show you that a high MVPF means that a program "pays for itself," a value of one indicates a program "breaks even," and a value below one shows a program costs more money than the direct cost of the benefits would suggest.</p> After determining the programs' costs using existing literature and the willingness to pay through statistical analysis, 133 programs focusing on social insurance, education and job training, tax and cash transfers, and in-kind transfers were analyzed. The results show that some programs turn a "profit" for the government, mainly when they are focused on children:
This figure shows the MVPF for a variety of polices alongside the typical age of the beneficiaries. Clearly, programs targeted at children have a higher payoff.
Nathaniel Hendren and Ben Sprung-Keyser<p>Programs like child health services and K-12 education spending have infinite MVPF values. The authors argue this is because the programs allow children to live healthier, more productive lives and earn more money, which enables them to pay more taxes later. Programs like the preschool initiatives examined don't manage to do this as well and have a lower "profit" rate despite having decent MVPF ratios.</p><p>On the other hand, things like tuition deductions for older adults don't make back the money they cost. This is likely for several reasons, not the least of which is that there is less time for the benefactor to pay the government back in taxes. Disability insurance was likewise "unprofitable," as those collecting it have a reduced need to work and pay less back in taxes. </p>
What are the implications of all this?<div class="rm-shortcode" data-media_id="ceXv4XLv" data-player_id="FvQKszTI" data-rm-shortcode-id="3b407f5aa043eeb84f2b7ff82f97dc35"> <div id="botr_ceXv4XLv_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/ceXv4XLv-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/ceXv4XLv-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/ceXv4XLv-FvQKszTI.js"></script> </div> <p>Firstly, it shows that direct investments in children in a variety of areas generate very high MVPFs. Likewise, the above chart shows that a large number of the programs considered pay for themselves, particularly ones that "invest in human capital" by promoting education, health, or similar things. While programs that focus on adults tend to have lower MVPF values, this isn't a hard and fast rule.</p><p>It also shows us that very many programs don't "pay for themselves" or even go below an MVPF of one. However, this study and its authors do not suggest that we abolish programs like disability payments just because they don't turn a profit.</p><p>Different motivations exist behind various programs, and just because something doesn't pay for itself isn't a definitive reason to abolish it. The returns on investment for a welfare program are diverse and often challenging to reckon in terms of money gained or lost. The point of this study was merely to provide a comprehensive review of a wide range of programs from a single perspective, one of dollars and cents. </p><p>The authors suggest that this study can be used as a starting point for further analysis of other programs not necessarily related to welfare. </p><p>It can be difficult to measure the success or failure of a government program with how many metrics you have to choose from and how many different stakeholders there are fighting for their metric to be used. This study provides us a comprehensive look through one possible lens at how some of our largest welfare programs are doing. </p><p>As America debates whether we should expand or contract our welfare state, the findings of this study offer an essential insight into how much we spend and how much we gain from these programs. </p>
Why mega-eruptions like the ones that covered North America in ash are the least of your worries
- The supervolcano under Yellowstone produced three massive eruptions over the past few million years.
- Each eruption covered much of what is now the western United States in an ash layer several feet deep.
- The last eruption was 640,000 years ago, but that doesn't mean the next eruption is overdue.
The end of the world as we know it
Panoramic view of Yellowstone National Park
Image: Heinrich Berann for the National Park Service – public domain
Of the many freak ways to shuffle off this mortal coil – lightning strikes, shark bites, falling pianos – here's one you can safely scratch off your worry list: an outbreak of the Yellowstone supervolcano.
As the map below shows, previous eruptions at Yellowstone were so massive that the ash fall covered most of what is now the western United States. A similar event today would not only claim countless lives directly, but also create enough subsidiary disruption to kill off global civilisation as we know it. A relatively recent eruption of the Toba supervolcano in Indonesia may have come close to killing off the human species (see further below).
However, just because a scenario is grim does not mean that it is likely (insert topical political joke here). In this case, the doom mongers claiming an eruption is 'overdue' are wrong. Yellowstone is not a library book or an oil change. Just because the previous mega-eruption happened long ago doesn't mean the next one is imminent.
Ash beds of North America
Ash beds deposited by major volcanic eruptions in North America.
Image: USGS – public domain
This map shows the location of the Yellowstone plateau and the ash beds deposited by its three most recent major outbreaks, plus two other eruptions – one similarly massive, the other the most recent one in North America.
The Huckleberry Ridge eruption occurred 2.1 million years ago. It ejected 2,450 km3 (588 cubic miles) of material, making it the largest known eruption in Yellowstone's history and in fact the largest eruption in North America in the past few million years.
This is the oldest of the three most recent caldera-forming eruptions of the Yellowstone hotspot. It created the Island Park Caldera, which lies partially in Yellowstone National Park, Wyoming and westward into Idaho. Ash from this eruption covered an area from southern California to North Dakota, and southern Idaho to northern Texas.
About 1.3 million years ago, the Mesa Falls eruption ejected 280 km3 (67 cubic miles) of material and created the Henry's Fork Caldera, located in Idaho, west of Yellowstone.
It was the smallest of the three major Yellowstone eruptions, both in terms of material ejected and area covered: 'only' most of present-day Wyoming, Colorado, Kansas and Nebraska, and about half of South Dakota.
The Lava Creek eruption was the most recent major eruption of Yellowstone: about 640,000 years ago. It was the second-largest eruption in North America in the past few million years, creating the Yellowstone Caldera.
It ejected only about 1,000 km3 (240 cubic miles) of material, i.e. less than half of the Huckleberry Ridge eruption. However, its debris is spread out over a significantly wider area: basically, Huckleberry Ridge plus larger slices of both Canada and Mexico, plus most of Texas, Louisiana, Arkansas and Missouri.
This eruption occurred about 760,000 years ago. It was centered on southern California, where it created the Long Valley Caldera, and spewed out 580 km3 (139 cubic miles) of material. This makes it North America's third-largest eruption of the past few million years.
The material ejected by this eruption is known as the Bishop ash bed, and covers the central and western parts of the Lava Creek ash bed.
Mount St Helens
The eruption of Mount St Helens in 1980 was the deadliest and most destructive volcanic event in U.S. history: it created a mile-wide crater, killed 57 people and created economic damage in the neighborhood of $1 billion.
Yet by Yellowstone standards, it was tiny: Mount St Helens only ejected 0.25 km3 (0.06 cubic miles) of material, most of the ash settling in a relatively narrow band across Washington State and Idaho. By comparison, the Lava Creek eruption left a large swathe of North America in up to two metres of debris.
The difference between quakes and faults
The volume of dense rock equivalent (DRE) ejected by the Huckleberry Ridge event dwarfs all other North American eruptions. It is itself overshadowed by the DRE ejected at the most recent eruption at Toba (present-day Indonesia). This was one of the largest known eruptions ever and a relatively recent one: only 75,000 years ago. It is thought to have caused a global volcanic winter which lasted up to a decade and may be responsible for the bottleneck in human evolution: around that time, the total human population suddenly and drastically plummeted to between 1,000 and 10,000 breeding pairs.
Image: USGS – public domain
So, what are the chances of something that massive happening anytime soon? The aforementioned mongers of doom often claim that major eruptions occur at intervals of 600,000 years and point out that the last one was 640,000 years ago. Except that (a) the first interval was about 200,000 years longer, (b) two intervals is not a lot to base a prediction on, and (c) those intervals don't really mean anything anyway. Not in the case of volcanic eruptions, at least.
Earthquakes can be 'overdue' because the stress on fault lines is built up consistently over long periods, which means quakes can be predicted with a relative degree of accuracy. But this is not how volcanoes behave. They do not accumulate magma at constant rates. And the subterranean pressure that causes the magma to erupt does not follow a schedule.
What's more, previous super-eruptions do not necessarily imply future ones. Scientists are not convinced that there ever will be another big eruption at Yellowstone. Smaller eruptions, however, are much likelier. Since the Lava Creek eruption, there have been about 30 smaller outbreaks at Yellowstone, the last lava flow being about 70,000 years ago.
As for the immediate future (give or take a century): the magma chamber beneath Yellowstone is only 5% to 15% molten. Most scientists agree that is as un-alarming as it sounds. And that its statistically more relevant to worry about death by lightning, shark or piano.
Strange Maps #1041
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