The looming superbug crisis: Politics, profit, and Big Pharma
Here's how we stop a health crisis before it wreaks havoc on us.
MATT MCCARTHY: Yeah, the discovery of antibiotics is one of the most remarkable stories in medicine. There was this young military physician named Alexander Fleming who was taking care of injured soldiers in 1914 at a makeshift military hospital in France. And he noticed that many of the soldiers had infections that were not getting better with the tools that he had to treat them, which was largely his surgical scalpel and also antiseptic fluid. And he was just 34 years old at the time, but Fleming recognized that there had to be a better way. And after the war was over, he went back to his laboratory at St. Mary's Hospital and started tinkering around. And it wasn't until nearly 15 years later that he stumbled upon this fungus that was producing a chemical that was so extraordinary that it could kill almost every bacteria in its path. And the chemical that that fungus was producing is what we now know is penicillin.
What's interesting about that story is that the discovery did not lead to a commercially available drug right away. In fact, Alexander Fleming didn't realize that he was on the cusp of some incredible discovery. It took another World War, and teaming up with the burgeoning pharmaceutical industry and a number of other researchers at Oxford University, before everyone fully recognized what he had stumbled upon in his laboratory in the late 1920s. And that discovery of penicillin ushered in what we now know of as the golden era of antibiotic development. The 1950s was a period when there was a new drug being discovered seemingly every few months. And the life expectancy of humans shot up because of all of these fantastic discoveries. But then there was a problem, which is that we were so successful finding new antibiotics, that a number of prominent physicians and scientists came out and said, we got this infectious disease issue kicked. It's time to look for more pressing issues like heart disease and cancer.
And so we started focusing our attention on treating those diseases just as the bacteria were being exposed to our precious arsenal of antibiotics. And that set up a very difficult situation, which is that the bacteria were mutating when we took our eye off the ball. And we didn't recognize the scope of the problem until the 1990s. And that's when we first recognized that there were all of these drug resistant bacteria around us, which we now think of as superbugs. Yeah, so when we talk about bacteria evolving into superbugs, what we mean is that they are mutating to develop machinery and enzymes that can evade even our most powerful antibiotics. My favorite one is something called an efflux pump. And it's a microscopic vacuum cleaner that bacteria have developed that can suck up an antibiotic and spit it out. One of the other things I really like are these enzymes that they have created that chew up antibiotics. And they scavenge for metals, like zinc. And they can chop up even the most complex or nuanced medication that we throw at them.
And so bacteria are constantly doing this whether we recognize it or not. And so what's been fascinating to see is how quickly they can evolve. This is a remarkable insight that we can now discover this. But it also sets up a very perilous situation for the companies that want to create new antibiotics. They know that, if they make a new drug, the bacteria will eventually figure out a way to outfox them and become resistant to it. And that's a problem. We count on the pharmaceutical industry to help us make new drugs. And increasingly, they're saying it's simply not worth it. It's too risky. And the reason for that is, if you compare an antibiotic to, say, a blood pressure medication, a blood pressure medication is prescribed by a doctor like me. And I say, "Take this every day." And you may take it the rest of your life. That's a great business model. Now compare that to an antibiotic where doctors are stingy about doling them out. We only prescribe them in short courses. And eventually, even that best new antibiotic is going to wear out its welcome when the bacteria become resistant.
So this has created a crisis really, which is that at a time when we desperately need new antibiotics, the companies that make them are saying no thanks. Well, some antibiotics are economically viable. If you happen to hit on a broad spectrum antibiotic that has minimal side effects, you're going to make your money back. But the problem is most antibiotics, to go from discovery in a laboratory to a hospital somewhere, costs roughly $1 billion and takes at least 10 years of trials to show that it's safe and effective. The problem with that is that not all drugs succeed. And we have found that many of the companies are saying, it's simply not worth it for us to take this risk. And they point to a company called a Achaogen. Achaogen spent years and millions of dollars developing a new antibiotic called plazomicin, which was finally approved by the FDA in June of 2018. And it was approved to much fanfare. And in April of 2019, the company filed for bankruptcy. And that's because people like me weren't using the drug. And people like me weren't using the drug because it wasn't available in hospitals. Because the company got approval for urinary tract infections, but we don't really need a new drug for urinary tract infections. We need a new drug for ventilator acquired pneumonia or for bloodstream infections. And the company didn't receive that approval. And that was a disaster for them and for the whole enterprise.
And so when we talk about small companies developing new antibiotics, they're very nervous about doing so. And they point to Achaogen and say, we want to do something else with our time and our money and our resources because the risk is just so great. And this to me is the most important political issue that no one is talking about. There are a number of new incentives and financial enticements that are on the table that we're going to be hearing about in the coming months and years that are going to be brought up before Congress that we all should be informed on before we go and vote on them. And the two most common types of incentives are called push incentives and pull incentives. Now a push incentive is when you go to a company let's suppose, Merck, a large multinational pharmaceutical company and we say, hypothetically, your corporate tax rate is 20 percent. What if we cut that to 15% provided you promise to take a portion of the excess profits and invest in new antibiotics? So this is a surefire way to pump more money into the antibiotic pipeline.
The problem is that you're suddenly giving a tax break to a multibillion dollar pharmaceutical company. And when people look into the finances of how pharmaceutical companies are doing, they may not be enthusiastic to do that. My stomach turns when I look at some of the comments from pharmaceutical CEOs who jack up the prices of their drugs. One notably increased the price of an antibiotic for urinary tract infections by 5,000 percent. And he justified it by saying he had an ethical mandate to charge as much money as possible for antibiotics because he's ultimately accountable to shareholders and not patients. So the idea of giving a tax cut to a company like that is tough to stomach. On the other hand, it would give us more investment in something we desperately need. So those are called push incentives because it would push the company to do it. By contrast, there's something called a pull incentive. That is to say to a company, if you take on the risk of developing a new drug and it succeeds, rather than giving you five to seven years of market exclusivity, we'll give you 25 years, which means that generics can't challenge you.
That's a way that the company could charge more money for a longer time for their drug. Pull incentives are more popular among a lot of academics because it forces the companies to take the risk head first. And if they're successful, then they get to make money on the back end. Whether companies will go for this is unclear. But these push and pull incentives are the type of topics that we need to be talking to our politicians about. And then adding yet another layer to the complexity here is that, when an antibiotic is approved by the FDA, there's no guarantee that a hospital is going to use it. And in fact, I found that many top hospitals are not using the latest antibiotics that are approved. The reason for that is that the drugs take so long to get approved and are so expensive to produce that the companies are charging thousands of dollars per dose. And the hospitals are saying, no. We're not going to pay the ransom for these drugs. That leaves patients in the lurch. I've been in front of patients for whom there was no treatment option, knowing that there were antibiotics out there that would probably work. But they were not widely available because of dollars and cents, that the hospitals could not afford these drugs. And what make gives me pause is that we don't always see that with cardiovascular drugs or with chemotherapeutic drugs. We routinely give patients with cancer a chemotherapeutic drug that will cost tens of thousands of dollars that will extend their life by just a few weeks or months.
But we aren't taking that same kind of financial risk with infectious diseases, and that's got to change. So I've talked to people from across the political spectrum about this. People on the right who typically would be hesitant to have the government more involved in health care and making these financial deals are also open to tax cuts for corporations because they believe in the innovation of these companies. And they want to have antibiotics when they come to the hospital. And if a tax cut will get them there, that's fine with them. I've also talked to people on the left who are enthusiastic about coming up with these tax breaks as well because they recognize this is a problem. But on the left, there is also more interest for socializing the production of antibiotics. Now in England and in other parts of Europe, they've said, we recognize the antibiotic market is broken. Let's disentangle profits from the entire process. These are public goods, like electricity or water. We shouldn't think about them in terms of dollars and cents and that the key here is that we should all invest in these drugs, meaning countries should pool together their resources. And when the drugs are approved, we should all use them, and we shouldn't be looking at profit margins. We should be thinking about patients' lives.
Anyone who's looked at this issue knows the market will not solve it strictly because we're producing a product that doctors try not to prescribe. So the traditional laws of supply and demand don't work here. And something has to be done. This is called a market failure. And with market failures, you need government intervention. The controversial part is how the government should intervene. Many people are fearful of nationalizing the production because they think it will stifle innovation that, if you have the government involved in investing, then the top people will not go into this will not go into drug discovery. Drug discovery is the most exciting part of this entire process that people aren't really talking about either, that many of the best new antibiotics that we're discovering are in the soil beneath our feet. And that's something that has been lost on the lay press. It turns out that there are bacteria in the soil all around us. And those bacteria, just like Fleming's fungus, are producing chemicals to kill the other organisms in the environment, the other microbes. And it turns out that those chemicals that are being produced everyday beneath our feet can be harnessed and turned into antibiotics.
The challenge is finding where those are. And not far from where I work in Prospect Park, they recently found that the soil under the park had antibiotics and other potential medications. And what we're doing now, the next frontier, is using big data and artificial intelligence to sift through the proverbial needle in the haystack to find the next life saving drugs. The challenge is, once we identify that molecule in the soil, it costs $1 billion and 10 years of research to make sure it is safe and effective for humans. And we have to find someone, whether it's the government or whether it's a private company, that's willing to take on the risk because often those trials fail. When you find something in the soil, you've got to test it in a test tube and in animals, in healthy human volunteers, and then in patients who are sick. And that's a high wire act that people don't recognize how challenging it can be. But the pharmaceutical industry recognizes that it is a very perilous business model to rely on, that lengthy process to turn a profit. Our current antibiotics are waning in efficacy.
And we have an opportunity to invest in the future and to invest in the next generation of lifesaving antibiotics. But we cannot expect that this will take care of itself. And in fact, many people compare this to something like global warming, where there are things that people can do on a small scale, individuals, and there are things that countries and that corporations can do on a large scale. And even comparing that is fraught with controversy. But on a small scale, what we can do is that doctors like me cannot overprescribe antibiotics. And in fact, we found that dentists too are overprescribing antibiotics. Up to 80 percent of the antibiotics prescribed by dentists are inappropriate. So we can be better about prescribing. We can also be better as patients where, if a doctor says take seven days of antibiotics, you don't take two days and stop after you feel better. That gives the bacteria a whiff of the drug and gives them just enough of it to figure out how to evolve to escape it the next time around. So those are small things that we can do.
And then on a larger scale, we can make sure that we're not using antibiotics inappropriately in commercial agriculture and farming. For example, we're using some of our best tuberculosis and syphilis drugs in orange groves. We're using powerful antifungal drugs in tulip gardens. We're pumping meat producing animals full of antibiotics. We've gotten better about curbing that. But these are things that we have misused antibiotics for a generation. And that has allowed the bacteria to evolve in a way where they are now these superbugs.
- Alexander Fleming discovered a fungus that produced a chemical that could stop nearly every bacteria in its path.
- The 1950s are known as the Golden Era of Antibiotic Development. However, today, there is a looming superbug crisis because bacteria has mutated whilst we've focused on treating other diseases, such as cancer and heart disease.
- Many companies in the pharmaceutical industry don't want to take on the expensive risk of finding another antibiotic drug. However, a potential superbug crisis may compel us to use tax-break and patent policies to incentivize them to do so.
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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
Antique old clock abstract fractal spiral
Antique old clock abstract fractal spiralNewwup 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 acid 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 acid 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 acid 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 acid 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, acid 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 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.
LSD on paperYurok 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 wrote.
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."
Futuristic view from inside of a fractalLopyriev via Adobe Stock
Hope for HPPD
Since experiencing his first 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."
Studies show that religion and spirituality are positively linked to good mental health. Our research aims to figure out how and why.
- Neurotheology is a field that unites brain science and psychology with religious belief and practices.
- There are several indirect and direct mechanisms that link spirituality with improved mental health.
- Compassion and love are positive emotions that will make your brain healthier.
The field of neurotheology continues to expand from its early origins several decades ago to the present day. In its simplest definition, neurotheology refers to the field of scholarship that seeks to understand the relationship between the brain and our religious and spiritual selves. As I always like to say, it is important to consider both sides of neurotheology very broadly. Thus, the "neuro" side includes brain imaging, psychology, neurology, medicine, and even anthropology. And the "theology" side includes theology itself, but also various aspects related to religious beliefs, attitudes, practices, and experiences.
The mental health benefits of spirituality
Neurotheology also ranges from considering very esoteric concepts including questions around free will, consciousness, and the soul, to very practical concepts such as understanding how the brain functions and the relationship between spirituality and physical and mental health. This latter topic might be called "applied neurotheology." Applied neurotheology, therefore, seeks to understand the health-related aspects pertaining to our brain and our spiritual selves. In particular, we can try to understand how being religious or spiritual, or performing various spiritual practices, might be beneficial to our overall health and well-being. In our latest book, entitled Brain Weaver, we consider this important dimension of human brain health.
Even for those who are not religious, pursuing practices such as meditation and prayer — even when secularized — can be beneficial for reducing stress and anxiety.
A growing number of studies have shown how spirituality and mental health are linked. Importantly, studies have shown that those who are religious and spiritual tend to have lower rates of depression, anxiety, and suicide. This is true across the age spectrum with studies of adolescents showing that religious and spiritual pursuits are protective against mental health problems. And many adults cite religious and spiritual beliefs as important for coping with various life stressors.
If there is a relationship between spirituality and positive mental health, we might question what the mechanism of action might be. I have typically divided the mechanisms into indirect and direct ones. The indirect mechanisms have to do with specific aspects of a given tradition that end up having ancillary mental health benefits. For example, going to church or other social events that are part of a religious tradition can be beneficial because social support, in and of itself, is beneficial to our mental health. The more people that we have in our social support network, the better we are at coping with various life stressors including problems with jobs, relationships, or health.
Most religions also teach people to avoid a lot of high-risk behaviors that can be very detrimental to our mental health and well-being. For example, most religions teach us to avoid alcohol and drugs, to not be promiscuous, and to try to be compassionate and charitable to others. By following these teachings, people will naturally avoid mental health problems such as substance abuse and tend toward being more optimistic and less depressed. These effects have nothing to do with being religious per se and everything to do with following a religion's advice.
Another interesting indirect mechanism of action related to religion has to do with diet and nutrition. Diet and nutrition are frequently overlooked when it comes to good mental health, even though research increasingly indicates they are essential. Many traditions ask individuals to follow certain dietary guidelines. For example, Hindus tend to have vegetarian diets, and most research to date shows that eating a more plant-based diet with a lot of low-inflammatory foods is good not only for your body but for your brain as well. In fact, we are currently performing a study with patients who have chronic concussion symptoms to determine the effect of dietary improvements on overall brain function.
The direct mechanisms of action have to do with specific spiritual practices and even a person's personal sense of spirituality. Much of my research over the past 30 years has been to study the brain while people engage in different practices such as meditation or prayer. We have even observed brain changes associated with unique spiritual practices such as speaking in tongues or trance states. The brain effects related to these practices are quite remarkable and diverse. It should come as no surprise since these practices affect people on many different levels, such as the way people think, feel, and experience the world around them. Thus, we should expect to observe physiological differences in the parts of the brain involved with these practices.
Meditation and prayer, for example, activate the frontal lobes as well as the language areas of the brain, and research demonstrates that this occurs not only while the practice is performed but over the long-term as well. Our study of Kirtan Kriya meditation showed improvements of about 10 to 15 percent in cognition as well as reductions in stress, anxiety, and depression. These were associated with baseline changes to the brain's frontal lobe functions, which regulate these cognitive processes and modulate emotional responses.
More recent research has been exploring the effects of these practices on larger brain networks, and perhaps more important, specific neurotransmitter systems. One of our recent studies of a spiritual retreat program showed significant changes to the areas of the brain that release dopamine and serotonin. These are areas known to be involved in both cognition and emotional health. And there are a growing number of clinical studies which have documented the value of various spiritual practices or religiously oriented therapies for helping people manage a variety of mental health conditions including depression, anxiety, and ADHD as well as neurological conditions like Alzheimer's and seizure disorders.
Finally, a personal sense of spirituality may be protective in and of itself. When people feel connected to all of humanity, a higher power, or the entire universe, that experience gives people a sense of meaning and purpose in life and an optimistic perspective on what the future holds. A number of research studies have shown that having such faith can be beneficial to your overall physical and mental health.
Improving brain health with applied neurotheology
Applied neurotheology can teach us the value of exploring our religious and spiritual side as a way of improving our mental health and well-being. Even for those who are not religious, pursuing practices such as meditation and prayer — even when secularized — can be beneficial for reducing stress and anxiety. Connecting with the larger world — by going on a nature walk, socializing with friends and family, or trying to make your neighborhood a better place by helping others — leads to a greater sense of compassion and love, positive emotions that will make your brain healthier.
Dr. Andrew Newberg is a neuroscientist who studies the relationship between brain function and various mental states. He is a pioneer in the neurological study of religious and spiritual experiences, a field known as "neurotheology." His latest book is Brain Weaver.
Even with six months' notice, we can't stop an incoming asteroid.
- At an international space conference, attendees took part in an exercise that imagined an asteroid crashing into Earth.
- With the object first spotted six months before impact, attendees concluded that there was insufficient time for a meaningful response.
- There are an estimated 25,000 near-Earth objects potentially threatening our planet.
The asteroid 2021 PDC was first spotted on April 19, 2021 by the Pan-STARRS project at the University of Hawaii. By May 2, astronomers were 100% certain it was going to strike Earth somewhere in Europe or northern Africa. On October 20, 2021, the asteroid plowed into Europe, taking countless lives.
There was absolutely nothing anyone could do to deflect it from its deadly course. Experts could only warn a panicking population to get out of the way as soon as possible, if it was possible.
The above scenario is the result of a recently concluded NASA thought experiment.
The question the agency sought to answer was this: If we discovered a potentially deadly asteroid destined to hit Earth in six months, was there anything we could do to prevent a horrifying catastrophe? The disturbing answer is "no," not with currently available technology.
While Europe can breathe easy for now, the simulation conducted by NASA/JPL's Center for Near Earth Object Studies and presented at the 7th IAA Planetary Defense Conference is troubling. Space agencies spot "near-Earth objects" (NEOs) all the time. Many are larger than 140 meters in size, which means they're potentially deadly.
Credit: ImageBank4U / Adobe Stock
"The level [at] which we're finding the 140-meter and larger asteroids remains pretty stable, at about 500 a year. Our projection of the number of these objects out there is about 25,000, and we've only found a little over one-third of those so far, maybe 38% or so," NASA's Planetary Defense Office Lindley Johnson tells Space.com.
With our current technology, spotting an NEO comes down to whether we just happen to have a telescope pointing in its direction. To remove humanity's blind spot, the Planetary Society — the same organization that deployed Earth's first light sails — is developing the NEO Surveyor spacecraft, which they plan to deploy in 2025. According to the Planetary Society, it will be able to detect 90 percent of NEOs of 140 meters or larger, a vast improvement.
How to move an asteroid
The DART spacecraft will attempt to deflect an asteroid.Credit: NASA
The NASA/JPL exercise made clear that six months is just not enough time with our current technology to prepare and launch a mission in time to nudge an NEO off its course. (Small course adjustments become significant over great distances, which is why "nudging" an asteroid is a potential strategy.)
What would such a mission look like? Hollywood aside — remember Armageddon?— we know of no good way to redirect an NEO headed our way. Experts believe that shooting laser beams at an incoming rock, exciting as it might look, is not a realistic possibility. Targeted nuclear blasts might work, but forget about landing Bruce Willis, Ben Affleck, and Liv Tyler on an asteroid to set off a course-altering bomb, especially just a month after its discovery (as was the case in the movie).
Another thing that might work is crashing a spacecraft into an NEO hard enough to shift its course. That's the idea behind NASA's Double Asteroid Redirection Test (DART). This mission will shoot a spacecraft at the (non-threatening) asteroid Dimorphos in the fall of 2022 in the hope of changing its trajectory.
The deadly asteroid's journey
The asteroid "2021 PDC" hit Europe in NASA's simulation.Credit: NASA/JPL
The harrowing "tabletop exercise," as NASA/JPL called it, took place across four days at the conference:
- Day 1, "April 19" — The asteroid named "2021 PDC" is discovered 35 million miles away. Scientists calculate it has a 1-in-20 chance of striking Earth.
- Day 2, "May 2" — Now certain that 2021 PDC will hit Earth, space mission designers attempt to dream up a response. They conclude that with less than six months to impact, there's not enough time to realistically mount a mission to disrupt the NEO's course.
- Day 3, "June 30" — Images from the world's four largest telescopes reveal the area in Europe that will be hit. Space-based infrared measurements narrow the object's size to between 35 and 700 meters. This would pack a similar punch as a 1.2-megaton nuclear bomb.
- Day 4, "October 14" — Six days before impact, the asteroid is just 6.3 million km from Earth. Finally, the Goldstone Solar System Radar has been able to assess the size of 2021 PDC. Scientists calculate the blast from the asteroid will be primarily confined to the border region between Germany, Czechia, Austria, Slovenia, and Croatia. Disaster response experts develop plans for addressing the human toll.
"Each time we participate in an exercise of this nature," says Johnson, "we learn more about who the key players are in a disaster event, and who needs to know what information, and when."
Practically speaking, little can be done to hurry technological development along other than budgeting more money toward that goal. Maybe we should have Bruce Willis on call, just in case.
This spring, a U.S. and Chinese team announced that it had successfully grown, for the first time, embryos that included both human and monkey cells.
In the novel, technicians in charge of the hatcheries manipulate the nutrients they give the fetuses to make the newborns fit the desires of society. Two recent scientific developments suggest that Huxley's imagined world of functionally manufactured people is no longer far-fetched.
On March 17, 2021, an Israeli team announced that it had grown mouse embryos for 11 days – about half of the gestation period – in artificial wombs that were essentially bottles. Until this experiment, no one had grown a mammal embryo outside a womb this far into pregnancy. Then, on April 15, 2021, a U.S. and Chinese team announced that it had successfully grown, for the first time, embryos that included both human and monkey cells in plates to a stage where organs began to form.
As both a philosopher and a biologist I cannot help but ask how far researchers should take this work. While creating chimeras – the name for creatures that are a mix of organisms – might seem like the more ethically fraught of these two advances, ethicists think the medical benefits far outweigh the ethical risks. However, ectogenesis could have far-reaching impacts on individuals and society, and the prospect of babies grown in a lab has not been put under nearly the same scrutiny as chimeras.
Mouse embryos were grown in an artificial womb for 11 days, and organs had begun to develop.
Growing in an artificial womb
When in vitro fertilization first emerged in the late 1970s, the press called IVF embryos “test-tube babies," though they are nothing of the sort. These embryos are implanted into the uterus within a day or two after doctors fertilize an egg in a petri dish.
Before the Israeli experiment, researchers had not been able to grow mouse embryos outside the womb for more than four days – providing the embryos with enough oxygen had been too hard. The team spent seven years creating a system of slowly spinning glass bottles and controlled atmospheric pressure that simulates the placenta and provides oxygen.
This development is a major step toward ectogenesis, and scientists expect that it will be possible to extend mouse development further, possibly to full term outside the womb. This will likely require new techniques, but at this point it is a problem of scale – being able to accommodate a larger fetus. This appears to be a simpler challenge to overcome than figuring out something totally new like supporting organ formation.
The Israeli team plans to deploy its techniques on human embryos. Since mice and humans have similar developmental processes, it is likely that the team will succeed in growing human embryos in artificial wombs.
To do so, though, members of the team need permission from their ethics board.
CRISPR – a technology that can cut and paste genes – already allows scientists to manipulate an embryo's genes after fertilization. Once fetuses can be grown outside the womb, as in Huxley's world, researchers will also be able to modify their growing environments to further influence what physical and behavioral qualities these parentless babies exhibit. Science still has a way to go before fetus development and births outside of a uterus become a reality, but researchers are getting closer. The question now is how far humanity should go down this path.
Chimeras evoke images of mythological creatures of multiple species – like this 15th-century drawing of a griffin – but the medical reality is much more sober. (Martin Schongauer/WikimediaCommons)
Human–monkey hybrids might seem to be a much scarier prospect than babies born from artificial wombs. But in fact, the recent research is more a step toward an important medical development than an ethical minefield.
If scientists can grow human cells in monkeys or other animals, it should be possible to grow human organs too. This would solve the problem of organ shortages around the world for people needing transplants.
But keeping human cells alive in the embryos of other animals for any length of time has proved to be extremely difficult. In the human-monkey chimera experiment, a team of researchers implanted 25 human stem cells into embryos of crab-eating macaques – a type of monkey. The researchers then grew these embryos for 20 days in petri dishes.
After 15 days, the human stem cells had disappeared from most of the embryos. But at the end of the 20-day experiment, three embryos still contained human cells that had grown as part of the region of the embryo where they were embedded. For scientists, the challenge now is to figure out how to maintain human cells in chimeric embryos for longer.
Regulating these technologies
Some ethicists have begun to worry that researchers are rushing into a future of chimeras without adequate preparation. Their main concern is the ethical status of chimeras that contain human and nonhuman cells – especially if the human cells integrate into sensitive regions such as a monkey's brain. What rights would such creatures have?
However, there seems to be an emerging consensus that the potential medical benefits justify a step-by-step extension of this research. Many ethicists are urging public discussion of appropriate regulation to determine how close to viability these embryos should be grown. One proposed solution is to limit growth of these embryos to the first trimester of pregnancy. Given that researchers don't plan to grow these embryos beyond the stage when they can harvest rudimentary organs, I don't believe chimeras are ethically problematic compared with the true test–tube babies of Huxley's world.
Few ethicists have broached the problems posed by the ability to use ectogenesis to engineer human beings to fit societal desires. Researchers have yet to conduct experiments on human ectogenesis, and for now, scientists lack the techniques to bring the embryos to full term. However, without regulation, I believe researchers are likely to try these techniques on human embryos – just as the now-infamous He Jiankui used CRISPR to edit human babies without properly assessing safety and desirability. Technologically, it is a matter of time before mammal embryos can be brought to term outside the body.
While people may be uncomfortable with ectogenesis today, this discomfort could pass into familiarity as happened with IVF. But scientists and regulators would do well to reflect on the wisdom of permitting a process that could allow someone to engineer human beings without parents. As critics have warned in the context of CRISPR-based genetic enhancement, pressure to change future generations to meet societal desires will be unavoidable and dangerous, regardless of whether that pressure comes from an authoritative state or cultural expectations. In Huxley's imagination, hatcheries run by the state grew a large numbers of identical individuals as needed. That would be a very different world from today.
Sahotra Sarkar, Professor of Philosophy and Integrative Biology, The University of Texas at Austin College of Liberal Arts