Asbestos: the killer that still surrounds us

Andrew Lawson was the kind of man whose force of personality could shake things up, even in a gargantuan organisation like the NHS. A consultant anaesthetist, he devoted his career to sparing the sick both the agonies of illness and the torments of treatment. Among those who sought him out, his wife remembers, was an MI6 officer who had to live with the crippling after-effects of torture.

Lawson understood that while doctors are captivated by diagnoses and diseases, those being treated are overwhelmingly concerned with something else entirely: pain.

One day in 2007, however, he was the one who began to suffer. “I have not felt myself,” he wrote in May that year. “I’ve had difficulty in energising myself.” Struggling with flu-like symptoms, he found himself impatiently berating his wife, Juliet. “I want everything to happen sooner rather than later,” he noted. When Juliet went away on business for a week, Lawson found himself unusually, and unaccountably, upset. Something was up.

He got a colleague to perform a chest X-ray. Just two weeks earlier he had been skiing in the French Alps. The results of the X-ray came back. He had mesothelioma, an incurable cancer that affects the pleura, or lining of the lung.

With most cancers, it is hard to know the exact cause. Though some smokers get lung cancer, for example, not all lung cancer sufferers have smoked. But mesothelioma is different. In almost every case, the cause is exposure to asbestos – a fibrous building material once dubbed “miraculous”, but now known to be mortally dangerous.

For most of us, mesothelioma has been an easy disease to ignore. Asbestos, after all, is a product of the past. The most dangerous type of asbestos has not been used in Britain since the 1960s, when a voluntary industry ban came into effect. Even when it was used, only people in specific industries worked closely with it – pipe laggers, builders, carpenters and shipyard workers, for example. An industrial toxin from another era, it hardly seems cause for concern today.

But such complacency is misplaced. Britain, it turns out, is today at the peak of a mesothelioma epidemic. There are more mesothelioma deaths here than in any other country on the planet. With an annual toll of about 2,500, more than twice as many people die of the disease as die in accidents in motor vehicles.

Glorious alt text
Mesothelioma annual deaths since 1980 and projected future deaths in Great Britain

The reason that we are feeling its deadly effects now is that, though asbestos use has been illegal for years (all types of asbestos were eventually banned by law in 1999), it usually takes decades for mesothelioma to develop. And the mesothelioma scourge is not confined to veterans of industrial building jobs. Asbestos has been, and in many cases still is, embedded in the homes we live in, the offices we work in, the schools we are educated in, and the stores we shop in. As a result, mesothelioma is no respecter of class, wealth, occupation, or age. The bastions of privilege, from smart London department stores to public schools, have proved no refuge. The Houses of Parliament are riddled with asbestos. Even the hospitals that are meant to make us better have been reservoirs of this deadly carcinogen.

Andrew Lawson was not old. Nor was he a pipe lagger. In fact, he struggled to think where he might have come into contact with asbestos. Then he put his finger on it. “It seems that there may have been a lot of asbestos in the tunnels at Guy’s Hospital where I spent six years training,” he wrote. “Everybody – students, nurses, doctors and porters – used the tunnels. One wonders how many of my contemporaries will get the same disease?”

It was a question to which, sadly, he was able to provide a partial answer. “Of four doctors who trained at Guy’s Hospital and who subsequently developed mesothelioma in the past five years,” he noted in a letter in 2010, “I am the only one left alive.”

How many of us will get this disease?

Andrew Lawson was diagnosed with mesothelioma when he was 48. When he died, on February 17 this year, he was 55. To survive so long is unusual. Fifty per cent of mesothelioma sufferers are dead 8 months after diagnosis. It is always fatal.

So now we can only echo Lawson’s question: “How many of us will get the same disease?”

According to Britain’s leading expert on mesothelioma, Professor Julian Peto, our best guess is that between 1970 and 2050, when the asbestos epidemic in Britain should have played itself out, some 90,000 people will have died. Most currently have no idea that they will die this way.

Glorious alt text
An asbestos mine in Quebec, Canada Alamy

A quick glance at the reports from the courts, where those affected often turn for compensation, shows how far the scourge of mesothelioma has spread. This June, for example, Marks & Spencer admitted negligently exposing Janice Allen to asbestos. She worked for the chain for nine years, from 1978 to 1987, supervising clothes sections at two sites – one of which was the flagship store on Oxford Street. Mrs Allen was only 18 when she started working at M&S. Now she has two children in their 20s.

“Before this happened,” she says, “I had never heard of mesothelioma, I barely knew about asbestos. I never would have dreamed that I would be affected by it.”

Few people do know much about asbestos. In fact, asbestos describes not one substance but a group of six minerals. They get their name from the word “asbestiform” – which describes the fibrous structure which endows them with strength and flexibility. Of the six, three have commonly been used in the building trade.

Chrysotile, commonly known as White Asbestos, is by far the most frequently found in buildings today. It was used in roofing panels, floor tiles, pipe insulation, boiler seals, even brake linings in cars. It is less lethal than other forms of asbestos, but it’s still considered a “major health hazard” that can kill by the EU and WHO.

More dangerous, however, are Brown Asbestos (amosite) and Blue Asbestos (crocidolite). Britain was once the world’s largest importer of Brown Asbestos, and experts suggest that “there is strong but indirect evidence that this was a major cause of the uniquely high mesothelioma rate [in the UK]”.

Glorious alt text
A Marks & Spencer employee was exposed to asbestos at its flagship store in Oxford Street, London Alamy

Janice Allen may not have thought of herself as a typical victim of mesothelioma, but Julian Peto’s work suggests that her story is far from uncommon. He has produced a study of sufferers which suggests that “a substantial proportion of mesotheliomas with no known occupational or domestic exposure were probably caused by environmental asbestos exposure.”

Much of that exposure, he says, is due to “normal occupation and weathering” of our buildings. No one, it seems, can be sure that they are safe.

A report from Goddard Consulting, which looked at the Palace of Westminster, shows how people, even in the heart of government, might have been exposed unawares. In 2009 Goddard reported that service shafts and piping ducts behind Parliamentary committee rooms were contaminated with asbestos, whose lethal fibres could be disturbed by something as innocuous as “strong currents of air”.

MPs are frequently accused of looking after their own interests, but in this case it seems the opposite may have been true. While the Parliamentary Works Services Directorate insisted that the Palace of Westminster had been given “a clean bill of health”, it is now accepted £1bn of work lasting several years is required to overhaul Parliament, upgrading electrics and removing asbestos, and that after the 2015 general election MPs may sit in the nearby QE2 Conference Centre rather than on the Green Benches at Westminster.

The Goddard report noted that “the presence of asbestos has not been managed in accordance with the various regulations”. It is impossible to know if this mismanagement will cost lives. All anyone can do now is wait.


One person who has never been able to pinpoint his exposure to asbestos is Graham Abbott, a GP. Like Andrew Lawson, Abbott, 50, suspects that he was exposed to asbestos while working in hospitals. “I have worked at a hospital where positive asbestos claims have been made,” he says, “But I can’t prove it in my case. It’s so hard to remember all the places one has worked in, and the dates.”

What he remembers clearly is the day early in December in 2009 when he was overcome with what felt like a fever. He was 45, and in the middle of a late evening surgery. “Suddenly I started feeling shivery. It came on very quickly. I felt dreadful. I didn’t think I was going to be able to drive all the way home.”

Being a doctor, Abbott knew that the pain was coming from the pleura, the lining around his lungs. But like Janice Allen, he simply had no reason to suspect mesothelioma. He ended up spending a month off work. Puzzled doctors gave him chest X-rays, and administered pleural catheters to draw off fluid from the lungs and send it for assessment. Yet the condition went undiagnosed.

Slowly his health improved and he went back to work. But from time to time the same symptoms returned, often after he took exercise and was breathing hard. In 2011, one of Abbott’s patients arrived at his GP’s surgery with similar symptoms to him, and was subsequently diagnosed with mesothelioma. But even then Abbott didn’t make the connection with his own case. After all, his patient was decades older, and had worked directly asbestos. The link in that case was clear.

In September 2011, Abbott’s condition worsened again, and his consultant took his CT scans and X-rays to a panel of experts. In December 2011, exactly two years after Abbott started feeling unwell, a probe, equipped with a camera, was fed into the cavity between the lining of his chest and the lining of his lung.

“I’m an optimist. I tend just to plod along,” he says. “I hadn’t worried about it too much to be honest. But Rachel, my wife, was worrying.” The result of the biopsy came in the week between Christmas and New Year: “I was told it was mesothelioma.”

Suddenly Abbott was plunged into meetings with Macmillan nurses, one of whom suggested that he should get in touch with a lawyer. That was when he realised the scale of the epidemic.
“It turns out that asbestos was widely used, particularly in big public buildings which quite often had asbestos lagging on the pipes,” he says. “People who were exposed to asbestos in those buildings are now coming down with the disease. So mesothelioma is now affecting younger people not in the typical professions.”The most dangerous asbestos-lagged pipes in hospitals were below ground level, so patients are unlikely to have been affected. But many staff, walking in pedestrian tunnels to get from one building to another (like Andrew Lawson), or eating in basement canteens (as Graham Abbott frequently did) almost certainly did come into contact with the toxic substance. For several decades after the war, it turns out, hospitals were potentially life-saving places for patients, but life-threatening places for the doctors who treated them. It is still being removed today.

Pupils perched their Bunsen burners on asbestos mats

And it is not just hospitals. Asbestos was frequently used in offices, shops, libraries and town halls for its marvellous insulating and flame-retarding properties. Schools too. In fact many people will have been first exposed to asbestos in the classroom. Up and down the country, in myriad chemistry lessons, pupils have perched their Bunsen burners on asbestos mats. Websites have sprung up to address the issue of asbestos in schools.Meanwhile, in our homes, items as innocuous as floor tiles or shed roofs have routinely contained asbestos.

“It’s an industrial poison built into large amounts of our housing stock,” notes Andrew Morgan, the lawyer who represented Andrew Lawson in his case against Guy’s Hospital. “In one case the only contact the woman sufferer could think of was pulling down a garden shed in the 1970s. So be careful how you pull down the garden shed.”

The impact of diagnosis, knowing that the disease is incurable, is huge. “It takes a while to sink in,” says Graham Abbott. “I went back to work and tried to carry on but realised that I couldn’t concentrate on what I was doing. I was at the surgery for two weeks. Then I realised that I would have to leave and sort myself out.”

“Well, I won’t see Christmas again”

One of the hardest things was moving from the position of doctor to that of patient. Like countless patients before him, he remembers feeling bewildered by the amount of information to get to grips with. “It was hard to take everything in,” he says. “I asked my consultant ‘what is my likely survival?’ I was quoted about 12 months. I remember thinking ‘Well, I won’t see Christmas again. That’s it.’”

Mesothelioma is particularly pernicious, because it is the mechanics of how we stay alive – the very act of breathing – that causes the cancer that kills.

Glorious alt text
‘Most Mesothelioma cases are caused by exposure to asbestos. Asbestos is made up of tiny fibres.’
Glorious alt text
‘When the asbestos is disturbed and the fibres are inhaled, they can become embedded in the pleura, the lining of the lungs. Asbestos fibres irritate the pleura and can cause cell mutations.’
Glorious alt text
‘Over the course of years (usually decades) this can develop into the cancer, mesothelioma. Once at this stage, the progression of the disease can be very quick, with most people dying within a year of diagnosis.’Dr Keith Prowse,
British Lung Foundation

“The problem comes from inhaled needle-shaped fibres of asbestos,” Professor Tom Treasure, a cardio-thoracic surgeon who moved in 2001 to Guy’s Hospital. (The very hospital where Andrew Lawson suspected he was exposed to asbestos is now, ironically, a leading centre in treating mesothelioma). Treasure knew Lawson, and treated some others who are likely to have been exposed while training at the hospital.Once the asbestos needles get into the lung tissue, says Treasure, “the act of breathing pushes them on the periphery, which is where the lining is. It is by its nature invasive from the very beginning.”

The normal options for treating other forms of cancer work less well with mesothelioma. The effectiveness of surgery, for example, is hotly debated. Some feel it is worth trying. Treasure disagrees. “You can’t excise the pleura,” he says. ”You can’t get your knife round it.” Meanwhile the cancer “is not very responsive to chemotherapy”, which “has an effect” but does not cure. “Every now and again you get long survivors,” says Treasure. “But in the end they all die.”

Happily, some patients do live far, far beyond expectations. The author Stephen Jay Gould died 20 years after diagnosis. Two-and-a-half years after his own diagnosis, Graham Abbott is still battling on.

After contacting mesothelioma Abbott was put in touch with Andrew Lawson, who, four years after his diagnosis, had become a one-man support and advice bureau for fellow sufferers. “Hello, Cancer Central,” he would announce cheerily when they called.

“He was very positive,” says Abbott. “He had been diagnosed 4 years before and was still very active.” Initially, Abbott had been offered six cycles of chemotherapy that would take four months, and likely prolong his life by just one month. “I felt desperate,” he says. “I felt like giving up.” Lawson, however, “managed to put a slightly better tint on things.”

After seeing several consultants, Abbott decided to pursue his treatment with Prof Loic Lang-Lazdunski, professor in thoracic surgery at Guy’s. “We had an advantage in that I didn’t wait to be referred, I just rang them up and they saw me,“ Graham admits. “The average patient would have to get a referral and have funding approved.”

Money is crucial for those with mesothelioma to pursue the best available treatments. But when those treatments eventually, inevitably, fail, many sufferers are faced with another financial worry – about the future of the families they will leave behind. And so they turn to the courts in pursuit of compensation.

Andrew Lawson contacted Andrew Morgan, from Field Fisher Waterhouse LLP. “It has been known that asbestos is noxious to health since 1898,” says Morgan. “But what changed in the 1960s is that it was realised that even very low levels could be a risk to health. That is where company negligence came in.”

Andrew Lawson and Guy’s hospital eventually settled their case, but it was not what Morgan calls a “full-value settlement” since Lawson could not prove definitively that his mesothelioma was down to asbestos exposure at Guy’s. After the inquest into his death, a spokesman for Guy’s did confirm, however, that “the asbestos in the basement area concerned was removed in the 1990s”. That was too late for Andrew Lawson.

In fact, pinning lethal asbestos exposure on one company or place of work – usually decades after the fact – has proved a huge problem for mesothelioma sufferers seeking compensation. Many of their former employers have changed hands or gone out of business. Insurance records may have been lost. And those defending themselves from claims know they have time on their side, which the claimants certainly do not.

In response, this year has seen major new legislation which makes it easier for those with mesothelioma to claim compensation even if their former employers can no longer be traced. The law has created a £350m pot of money, funded by the insurance industry, for those diagnosed after July 2012 who can prove exposure but have no one to sue. In these cases sufferers will be awarded 80 per cent of what a court might have awarded in a normal compensation case – about £120,000. About 300 successful claims to the scheme are expected each year.

Andrew Morgan, like many involved with mesothelioma sufferers, thinks that £350m represents “a very good job” for the insurance industry. “It’s a deal written by insurers for insurers” he says, suggesting that the sum is a quarter of what insurers would have had to pay if the passage of time had not intervened, and mesothelioma sufferers were able to track down companies and sue them in the normal way. Even Mike Penning, then Works and Pensions minister, admitted that the law was “not perfect”. But both Penning and Morgan admit that, with seven victims dying each day, quick action was needed. “People are suffering so much, and need help today,” said Penning during the Mesothelioma Bill’s second reading in December last year.

By then, Graham Abbott had been in the hands of Prof Loic Lang-Lazdunski for 19 months. After their initial consultations, Lang-Lazdunski advised surgery which, in contrast to Tom Treasure, he believes has a positive effect. This was followed by radiotherapy and chemotherapy – a tri-therapy for which Lang-Lazdunski can boast five year survival rates as high as 40 per cent. Abbott felt empowered. “That of course is one of the most important things,” says Abbott. “You see it in patients all the time. There is some drive that keeps you going. When you give up you can deteriorate very quickly.”

Graham Abbott went in for surgery in March 2012. By the end of August he had completed the last of his six cycles of chemotherapy. Follow-up scans revealed no sign of the disease.

“Then I had my scan in March [2014]. There was multiple spotting [of cancer] around my chest. I was just about to turn 50.”

“It’s not life threatening. It’s life ending.”

Once again Abbott put himself through six cycles of chemotherapy. Now there is no sign of the tumours. But the process is both physically and emotionally gruelling.

“You have to think about practical things – about the finances when I’m gone for example, or showing my wife how the boiler timer works. When you get bad news you start getting negative. You have to look forward.” As the father of Ellie, 16, and Tamsin, 14, that is not always easy.

“It’s hard as a parent,” he says. “It is difficult to know what to say and how much to say. When I was first diagnosed I told the girls that I had a condition that meant I wasn’t going to become old. They reacted very differently. Tamsin is very sociable and boisterous. She told her friends and we got lots of calls very quickly. Ellie was more reserved. She didn’t say much.”

Such conversations are something that all cancer patients must face. But for mesothelioma sufferers such discussions are not leavened by hope, by even a glimmer of a possibility of survival. The disease carries with it (even as it did, eventually, for Stephen Jay Gould) a grim certainty. As Andrew Morgan says, “mesothelioma is not life threatening. It’s life ending.”

Bodies of embalmed Pharaohs wrapped in asbestos cloths. Asbestos fibres used to strengthen cooking pots and provide greater heat resistance.
1st century BC
Pliny the Elder describes asbestos. “a linen has now been invented that is incombustible. I have seen napkins made of it glowing on the hearths at banquets”
Modern commercial asbestos use begins in Italy, where it is used to make paper (even bank notes) and cloth.
Major asbestos mines open in Canada and South Africa, and soon after in America, Itlay and Russia. It is an ideal insulator for the steam engines and and turbines of the Industrial Revolution.
Global asbestos production rises to more than 30,000 tons annually.
Statisticians with Prudential identify premature mortality among those working with asbestos, who are subsequently refused life insurance.
Nellie Kershaw dies in Rochdale. Dr William Cooke testifies that asbestos particles in the lungs “were beyond reasonable doubt the primary cause of death”. It is the first case of its kind. Kershaw’s employers, Turner Bros Asbestos, do not admit liability. No compensation is paid.
World War Two sees intensive shipbuilding, one of the deadliest occupations for asbestos exposure.
Voluntary industry ban on the import of Blue asbestos
Court of Appeal confirms the first successful personal injury claim in Britain as a result of asbestos exposure.
Global asbestos production rises to more than 4,213,000 tons annually. UK imports 139,000 tons.
Health and Safety Executive in Britain requires all contractors working with asbestos to be licensed.
Import and use of Blue and Brown asbestos banned by law in Britain.
All asbestos use banned in Britain.
Mesothelioma Act passed in the UK. A £350m compensation scheme is announced.
Asbestos is banned in more than 50 countries, but white asbestos is still used as a cheap building material in many parts of the world. Global production hovers around 2m tons annually.

China plans world’s largest supercollider.

Chinese scientists are designing a particle-smashing collider so massive it could encircle a city.


Beijing, China – Chinese scientists are racing to complete plans for a supergiant particle collider that, when built, will dwarf every other accelerator on the planet.

The underground particle-smashing ring aims to be at least twice the size of the globe’s current leading collider – the Large Hadron Collider (CERN) outside Geneva. With a circumference of 80 kilometres, the Chinese accelerator complex would encircle the entire island of Manhattan.

A preliminary conceptual design for this leading-edge particle physics laboratory is now being drafted by China’s elite sphere of physicists, joined by a circle of Western counterparts.

Called the Circular Electron Positron Collider (CEPC), China hopes it will shine as a symbol of the country’s rise as a global superpower in terms of pure scientific research.

“This machine is by and for the world,” explains Professor Gao Jie, one of the leaders of the project at the Institute of High Energy Physics in Beijing.

Beijing plans to speedily expand cooperation between China’s foremost physicists and their European and American counterparts with the new collider.

The new collider research outpost, situated on the Avenue of Eternal Peace in the centre of Beijing, is aiding in the conceptual design that plans to be submitted to China’s top leadership in December, according to Professor Arkani-Hamed, a scholar at Princeton’s Institute for Advanced Study, the one-time home of Albert Einstein.

Fundamental changes to science

The collider complex is initially designed to smash together electrons and their anti-matter counterparts, and later more massive protons, at velocities approaching the speed of light. This process hopes to recreate, inside the accelerator, the hyper-energy conditions that dominated following the Big Bang. Physicists aim to explore the origins of matter, energy, and space-time. China’s bigger collider will ultimately be able to reach higher energy levels than CERN; this might help physicists discover a new range of particles beyond those already charted in the Standard Model of Particle Physics.

Arkani-Hamed says that a perfect circle-shaped city, hosting the globe’s leaders in experimental particle physics, new-technology firms and other future-oriented scholars and designers, could be created inside the massive Chinese collider complex. The Collider complex would also host a multipurpose science-technology campus aimed at conducting secondary and supplemental science experiments.

With the unveiling of the new collider, he forecasts, “China will without question become the world leader in the field [of physics]”.

This collider will also act as the newest star in the firmament of particle physics, and leading scientists worldwide will rapidly gravitate toward it, says Arkani-Hamed, “for original approaches to outstanding problems in particle physics, including the proposal of large extra dimensions, new theories for the Higgs boson, novel realizations of super symmetry [and] theories for dark matter”.

Gerard ‘t Hooft, winner of the Nobel Prize in Physics in 1999, told Al Jazeera that China’s collider project “will bring hundreds, probably thousands of top class scientists with different specialisations, from pure theory to experimental physics and engineering from abroad to China”.

A theoretical physicist at Utrecht University in the Netherlands, Professor ‘t Hooft has been a central figure in the development of the Standard Model of Particle Physics, whose theories on the fundamental building blocks and forces of nature have been tested over the last half century at powerful colliders in the US and Europe.

The next stage in the revolution of understanding these primary particles and forces, and their interactions, Professor ‘t Hooft predicts, could partially unfold in China with the construction of the electron accelerator and then the more powerful proton collider.

Within the same 80km tunnel, the collider complex plans to be divided between two different super colliders. The Circular Electron Positron Collider (CEPC) smashes together electrons and anti-electrons, while the Super Proton Proton Collider (SPPC) will be used to study the super-speed collisions of protons. The CEPC is designed to study with precision the Higgs boson and how it decays following a collision. The SPPC might uncover a new range of particles beyond those already known.

Professor Gao Jie, formerly a visiting scholar at the French Laboratoire de l’Accélérateur Linéaire, says both the Circular Electron Positron Collider and the Super Proton Collider will be global projects.

“China welcomes participation from the world on machine design, construction, and experiments for sure,” he says.

Global participation

Professor Arkani-Hamed has already started inviting leading scientists in particle and accelerator physics to sojourn and lecture at Beijing’s new Center for Future High Energy Physics.

The centre is set to ramp up exchanges with scholars around the world as they explore the mysteries remaining within and beyond the Standard Model, he says.

China’s colossal collider could attract thousands of American scientists focused on high-energy experimental physics, he says, because the US has lost its edge in terms of constructing world-leading accelerators.

When the US abandoned contstructing the Superconducting Super Collider as a result of balloon costs, many experimental physicists in the US relocated to the Large Hadron Collider on the Swiss-French border. And “the US has not put forward an ambitious agenda for driving the future of fundamental physics in the 21st century,” he says.

Many US physicists, Arkani-Hamed predicts, will be drawn into the orbit of China’s supergiant accelerator ring even before it starts operations.

Chinese and Western scholars at the Center for Future High Energy Physics are now sketching out rough designs for the CEPC. They will initially focus on deepening understanding of the Higgs boson, discovered at the CERN complex in 2012, and the mechanism underlying the origin of mass of subatomic particles.

Although CERN has also begun exploring the potential to construct a super collider, its scheduled deadline for completing a preliminary conceptual design for the project is not until 2018 – fours years behind China’s timetable.

Meanwhile, he says that with an 80km collider complex, “you could actually build a city inside the ring”.

Scientists, Internet entrepreneurs, software designers and museum operators from around the world might stake claims in this Chinese collider cosmopolis of the future, says Arkani-Hamed.

“This could be a scientific utopia,” he adds.

Doctors enlisted to turn the tide on antibiotic resistance .

It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them…. 

—Alexander Fleming, discoverer of penicillin, in his 1945 Nobel Prize lecture

The bacterium Clostridium difficile

Fleming’s remarks were spot-on. Since the heady days of penicillin’s discovery, an overuse of antibiotics has spawned bacterial resistance to the drugs and threatened to erase decades of success. Every prescription that misses the mark or throws excess drugs at a bacterium gives bystander bacteria a good look at those antibiotics and a head start in resisting their effects, as Fleming noted.

Some microbes are changing faster than antimicrobials can kill them. As a result, it’s once again possible to get a bacterial or fungal infection for which there is no sure cure. That’s how roughly 23,000 people die in the United States each year.

As hopes fade that new antibiotics will save the day, many treatment centers are taking a surprisingly low-tech approach: They are changing the behavior of prescribing physicians. The goal of this tactic, called antimicrobial stewardship, is to curb antibiotic resistance by speeding diagnoses, getting the most appropriate drug to each patient, limiting intravenous drug delivery and avoiding use of broad-spectrum antibiotics — scattershot drugs that hit more than one kind of microbe. Evidence shows that antimicrobial stewardship can shorten a patient’s hospital stay and lower drug expenses. Fighting resistance may not be futile.

Antimicrobial stewardship requires an agile response from institutions that are not known for changing quickly. But it mainly demands human investment: training, diligence and doctors’ agreement to abide by guidelines and relinquish some control over prescribing. Consumers also have to do their part. The days of demanding antibiotics at the doctor’s office may soon be history.

It won’t be easy. Ending antibiotic resistance, or even getting the upper hand, will take more than antimicrobial stewardship: It will demand the relentless use of infection-control measures such as hand-washing and “gowning and gloving” in hospitals and clinics. Pharmaceutical companies will need to develop new antibiotics. Plus, doctors will need prompt access to top-line diagnostics to identify ever-changing microbes (see sidebar), the high-tech piece of the puzzle.

In the early antibiotic era following World War II, a stream of drugs from Big Pharma kept bacteria at bay. But the pipeline is running dry. “Pharma is not producing antibiotics at a rate that allows us to stay ahead of the problem,” says physician Scott Flanders of the University of Michigan in Ann Arbor. There’s not much profit in creating drugs if bacteria are just going to outsmart them. The deck seems stacked against a supply-side solution.

Some new drugs are likely to get approved in coming years, but prescribing behavior will have to change to take advantage of them, says physician Dennis Maki of the University of Wisconsin–Madison. “The development of new antibiotics without having mechanisms to ensure their appropriate use is much like supplying your alcoholic patients with a finer brandy.”

Antibiotic overload

Well-known bacteria such as Staphylococcus, Streptococcus, Escherichia coli, Salmonella and Neisseria gonorrhoeae are increasingly dodging the effects of drugs as are other less-known but dangerous microbes, the World Health Organization reported in April. Antibiotic resistance frequently shows up in patients with tuberculosis, pneumonia, wounds and urinary tract infections.

Resistant infections send doctors searching for another pill that will work. More than half of patients discharged from U.S. hospitals received antibiotics during their stay in 2010, the U.S. Centers for Disease Control and Prevention estimated in a report released in 2014. The report suggests that antibiotic prescriptions for some ailments could be cut by more than one-third with key interventions.

“Our goal is not in any way to limit necessary antibiotic use,” says study coauthor Arjun Srinivasan, a CDC physician. “We are seeking to improve the use of antibiotics so they remain effective for patients who need them down the road.”

The kind of controlled use CDC is aiming for would logically start in hospitals, especially in the intensive care unit — resistance central. Patients who land in the ICU are already in trouble, and doctors tend to medicate them thoroughly. ICU patients have the highest antibiotic use in hospitals, says Nick Daneman, an infectious disease physician at the University of Toronto.

Those patients also have the highest resistance rates, he says. For example, bloodstream infections in patients, which can trigger a lethal condition called sepsis, were traceable to multidrug-resistant pathogens in 23 percent of patients analyzed at nine hospitals in the southeastern United States, according to a report in the March 18 PLOS ONE.

Antibiotics taken unnecessarily are not harmless, says physician Jeffrey Linder of Harvard Medical School. He points toClostridium difficile as an example of what can go wrong. C. diff, for short, is a bacterium that can establish itself in the gut and cause debilitating diarrhea when it overgrows. Good microbes that dwell in the intestines normally suppress levels of C. diff, but the microbe circulates in hospitals and strikes patients who are on antibiotics that have wiped out some of those protective gut bacteria. When C. diff takes hold, it’s hard to treat (SN Online: 10/4/13).

To illustrate, physician Timothy Sullivan of Mount Sinai Hospital in New York City describes a recent case of C. diff in August’s JAMA Internal Medicine: A woman in her 80s with diabetes arrived at a hospital emergency room with an infected cut on her arm. She got three antibiotics and treatment for the wound. A soft tissue infection required surgery to remove dead tissue. She stayed in the hospital and received broad-spectrum antibiotics for three weeks as the surgical site healed. The day after her antibiotics were stopped, she developed a C. diff infection, with diarrhea, fever, dropping blood pressure and signs of kidney failure. Despite best efforts, she died.

People entering a hospital with an indeterminate-but-serious infection often get antibiotics immediately because, if the infection really is bacterial, the patient might die without the drugs, Flanders says.

CDC recommends a stewardship review of prescriptions within 48 hours after the first dose by an impartial source, such as an infectious disease doctor or pharmacist. More than second-guessing the prescribing doctors, these audits offer a chance to fine-tune the treatment if the diagnosis has changed, says Daneman.

He and his colleagues conducted a study of critical care patients in which they intervened as necessary three days after the first dose of antibiotics and again at day 10. The diagnosis for many patients had changed. A stewardship pharmacist spoke with the doctors attending the patient regarding antibiotic use. Doctors accepted 82 percent of those recommendations. As a result, broad-spectrum antibiotics use at the large hospital was reduced from earlier rates and, most importantly, ICU cases of C. difforiginating in the hospital decreased. The study appeared in Infection Control and Hospital Epidemiology in 2012.

At Blount Memorial Hospital in Maryville, Tenn., pharmacist Brad Crane evaluates prescriptions and recommends changes. Prescribers accepted more than 90 percent of 977 recommendations made by Crane and colleagues in the first two years of the hospital’s stewardship program. Antimicrobial costs per patient have dropped from an average of about $29 to $22 per day, a sign of more efficient use of the drugs. Crane says the results show that stewardship can work at community hospitals, not merely at large facilities affiliated with universities. He reported early findings at a medical meeting in 2013.

Blount Memorial Hospital uses a strategy typical of stewardship programs. The aim is to steer doctors away from intravenous drugs, since IV lines can get infected, and discourage broad-spectrum antibiotics in favor of narrowly focused drugs.

“We tend to use antibiotics too long and at too-high doses,” says Neil Fishman, an infectious disease doctor at the University of Pennsylvania. Antibiotic stewardship can improve quality of care and cut costs, he says, so it’s not difficult to convince hospital administrators of the programs’ value. Flanders notes that hospitals are increasingly judged on how many hospital-origin infections they have. Any program that lowers that number is welcome, he says.

Outpatient clinics

Hospitalized patients are typically quite sick and many have bacterial infections. In those cases, the stewardship challenge is to determine the correct antibiotic. The question facing doctors in out-patient clinics is often different: “Does this patient need any antibiotic at all?” says Ralph Gonzales, a physician at the University of California, San Francisco.

Outpatients walk in under their own power, often with nondescript symptoms they have researched on the Internet. Some ask for drugs up front. Bronchitis is a common complaint, and antibiotics typically don’t help because more than 90 percent of the time the illness is caused by a virus, says Linder, the Harvard physician. With or without drugs, he says, “it’s gone by day 20.” Even so, more than half of U.S. patients with bronchitis are prescribed antibiotics. “There’s this magical thinking that an antibiotic prescription will treat a viral infection.”

To test whether stewardship interventions can clean up prescribing in clinics, Gonzales and his colleagues enlisted 33 clinics in central Pennsylvania for a study. Eleven received a large poster for the examination room showing low-to-high likelihood of a patient having bacterial pneumonia — which would merit antibiotics — or a viral ailment. Eleven other clinics received decision-making guidelines electronically that doctors and nurses could consult when diagnosing respiratory infections. The last 11 clinics got neither.

Over six months, rates of antibiotic prescribing dropped from 80 percent to 68 percent in clinics showing the posters and from 74 percent to 61 percent in those getting computerized guidance. Prescriptions were largely unchanged in the control group, where about three-fourths of patients got antibiotics for respiratory infections, the researchers reported in 2013 in JAMA Internal Medicine. While that reduction might seem modest, Gonzales says, “across the population that accounts for a lot.”

Doctors’ chief concern when testing a patient with a respiratory ailment is pneumonia, he says. The electronic guidance helps them sort that out, he says, providing details on symptoms that point to pneumonia and away from myriad other respiratory ailments.

The posters help them counsel patients. Adults coming in with a cough-related illness often are in some kind of denial, Gonzales says. “I tell them this drug could do more harm than good, and they say, ‘That’s OK, I’ll take my chances.’ ” He adds, “[The poster] helps to provide some collective norms about proper antibiotic use.”

Going a step further, some researchers have asked prescribers to sign and post a commitment letter about antibiotic use in the exam room. Jason Doctor, a psychologist at the University of Southern California in Los Angeles, tested the effect of a letter stating that antibiotics can make bacteria more resistant and that getting them needlessly can cause problems.

“This was a powerful motivator,” he says. Having the letter visible in 14 exam rooms coincided with an average drop in inappropriate prescribing from 44 percent to 34 percent. The key was getting the doctors to sign and post the letter. It made them more accountable, Doctor says. “Precommitment ties you to the mast.” The report appeared in JAMA Internal Medicine in March.

Prescriptions in doctors’ offices are harder to track than in hospitals. But prescribers doled out antibiotics for sore throats in about 60 percent of adult cases between 1997 and 2010 in the United States, even though only about 10 percent of sore throats in adults are due to strep bacteria and require the drugs. In clinics, doctors face pressure “to appease the patient” even when an antibiotic isn’t needed, says Ohio State University pharmacist Debra Goff.

There are other pressures, too. “It takes a minute to write a script,” Fishman says. “It takes 15 minutes to not write one, to provide education.”

And even when strep throat is correctly diagnosed, Linder says, some doctors treat it with the broad-spectrum antibiotic azithromycin, sold as Z-Pak, to which Streptococcus pyogenes has shown resistance. Use of penicillin, to whichS. pyogenes has never been resistant, “has dwindled off,” he says. Z-Pak requires a shorter course than penicillin. People and doctors have this perception that newer is better, Linder says. “Z-Pak sounds cool.”

Turning the Titanic

Antibiotics deserve a big share of the credit for improved health care in the 20th century, but now their sporadic failure risks sabotaging those gains. Hospitals have changed from healing centers to risky stopovers where one is advised to get in and get out before catching a superbug. Not even Alexander Fleming could have predicted that.

The medical community was caught off guard. “We used to consider antibiotics as all value-added, not harmful at all,” says Sara Cosgrove, an infectious disease physician at Johns Hopkins Hospital in Baltimore. “Nobody really believed it would get to this point.”

It will take more than antimicrobial stewardship programs to reverse the trend. Resistance is a global phenomenon with antibiotics sold over the counter in many countries. In Mexico, Gonzales and his colleagues found that about half of 101 insured individuals who visited a family medicine clinic with a respiratory ailment were already on antibiotics, 20 of whom were self-treating. When interviewed, many mistakenly thought common cold remedies were antibiotics.

Ultimately, patients need to know better, Linder says, but he can sympathize with them. People often take a half-day off work to go to a clinic with a respiratory infection. “I spend 10 minutes with them, tell them there are no drugs and that they’ll be sick for two weeks. It’s all very unsatisfying,” he says. “No wonder the prescriptions get written a lot.”

Creative approaches might work. Gonzales and his colleagues used computer screens at kiosks in hospital emergency rooms to quiz people, in English or Spanish, on what they know about antibiotics. Of 686 people coming in with respiratory infections, only 22 percent initially doubted they needed antibiotics. That fraction rose to 49 percent after using the kiosk, the scientistsreported in Patient Education and Counseling in 2011.

The key to establishing the value of such antimicrobial stewardship programs, whether aimed at doctors or patients, will be to show they actually slow or stop resistance. These data are just starting to trickle in. Daneman and his colleagues pored over 24 studies of stewardship programs and found that after being in place for more than six months, many showed a reduction in resistance, particularly in ICUs. The rate of decrease varied among microbes. And last month, at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, D.C., researchers at New York Hospital Queens in Flushing, N.Y., reportedreduced rates of multi-drug-resistant Klebsiella pneumoniae, Acinetobacter baumannii andStaphylococcus aureus after two years of a stewardship program. The hospital is also seeing fewer readmissions within 30 days for infections, physician Nishant Prasad said.

Antimicrobial stewardship, widely applied, could curb resistance at the source, Fishman says. But wide-scale adoption will take time.

“We’re turning the Titanic,” Linder says. Even so, a 2012 survey by the Children’s Hospital Association found that 31 of 43 hospitals surveyed either had a stewardship program in place or were planning one. Anationwide survey of doctors found that about half worked in facilities with formal programs in place, and more than 90 percent were using some form of stewardship techniques. And a California surveyrevealed that half of hospitals there had a stewardship program and another 30 percent planned one.

The Obama administration appears ready to push the issue. At a July meeting of the President’s Council of Advisors on Science and Technology, panel cochair Eric Lander raised the possibility of requiring hospitals to have a stewardship program to receive Medicaid and Medicare
reimbursement. “We believe that having an antibiotic stewardship program is a reasonable expectation,” he said.

This kind of hammer is necessary, says Fishman, otherwise some doctors could continue to dish out drugs without regard for their macro effect on the microbe population.

“This really is a ‘tragedy of the commons,’ ” says Jason Doctor, the psychologist, referring to the classic tale of farmers overgrazing their animals on community land until it was lost to use. “Clinicians are using the public ‘space’ to prescribe big antibiotics. The potential harm to the greater good is devastating. We’re going to really be in trouble if we don’t manage this issue.”

Delays matter

A fast, accurate diagnosis can aid antimicrobial stewardship by curbing the drug-bug mismatches that add to resistance:

Polymerase chain reaction (PCR) Staphylococcus aureus hangs out innocently in most people, but it can also cause infection and gain resistance to the antibiotic methicillin. Ohio State University pharmacist Debra Goff and her colleagues tested 74 people at OSU Medical Center in 2008 using standard S. aureus diagnostics, which took about three days. In 2009, the researchers repeated the test on 82 patients, using PCR after the initial blood culture, to amplify the bacteria’s DNA and discern within an hour if a patient had methicillin-resistant S. aureus. Those patients got the right meds 1.7 days sooner on average than the 2008 group, the scientists reported in Clinical Infectious Diseases in 2010. “We saved $21,000 per episode of staph,” Goff says.

Mass spectrometry Researchers at Houston Methodist Hospital analyzed 265 patients with gram-negative bacteria infections. Patients treated before the researchers had mass spec, a rapid chemical analysis, waited more than 80 hours to get optimal anti­biotic therapy. When mass spec was available, patients received the correct drug within 30 hours, asreported in the Journal of Infection in September. Only 9 percent of patients aided by mass spec died compared with 21 percent who got the slower diagnosis.

Procalcitonin test This peptide appears in the blood during bacterial infections, which can lead to sepsis, a lethal condition. At Mercy Medical Center in Des Moines, Iowa, researchers checked procalcitonin levels in 35 patients with suspected sepsis or pneumonia. Those patients, on average, needed only 10 days of treatment versus 14 days in a similar group that didn’t get the test, according to a 2013 report.

Rapid antigen detection test A quick test to distinguish strep throat from a viral sore throat is available in many clinics. It can rule out strep — and the need for antibiotics — in about 10 minutes. The test has the most utility in children, who are more prone to strep than adults. — Nathan Seppa

Are we the most successful species on earth?

How successful are we compared to other species? Take a look at out how our numbers stack up to some other domains of life. It turns out that biomass, or what things weigh, can be more important than how many of something there are. Find out how our numbers stack up against everything from bugs to bacteria, and get ready for some mind-blowing numbers!

Check out this video to learn amazing, mind flowing facts, such as:

1 in 5 mammals on Earth is a bat

All ants put together account for 15% of the world’s animal biomass

At 6,600 tons, the heaviest organism on Earth is an 80,000 year old clonal aspen grove named Pando

There are more or less 8 X 10^24 bacteria in cow stomachs

Viruses make up 5% of the ocean’s biomass

This video will make you realize just how out-numbered humans really are!

Protecting yourself against Middle East respiratory syndrome coronavirus (MERS-CoV) | .

Coronaviruses are a large family of viruses that cause a range of illnesses in humans, from the common cold to severe acute respiratory syndrome (SARS). Viruses in this family also cause a number of animal diseases.

The strain of coronavirus that causes MERS was first identified in 2012 in Saudi Arabia. WHO’s understanding of the virus and the disease it causes is continuing to evolve. The greatest global concern is about the potential of this new virus to spread. This is partly because the virus has already caused severe disease in multiple countries, and although the number of those infected is small, the virus has persisted in the Region since 2012.

WHO has developed informational posters to provide important and preventive information for the general public, hajj and umrah pilgrims and health care workers on MERS-CoV.

National authorities in countries are urged to use the posters a part of preparatory lessons for hajj or umrah pilgrims.

10 Things You Didn’t Know About Yeast Infections .

It’s hard to live in a living world without some living organisms taking residence on or inside of your body. It might not be the most pleasant idea, but everyone is carrying bugs of some sort. Harmful organisms in the intestines and bacteria in the gut are among the most common. Another is Candida albicans. If you’ve ever experienced a yeast infection, then you probably know this one well. Although everyone has Candida, problems are unlikely to arise if it’s kept in balance. However, if an imbalance occurs, so may a yeast infection. Yeast infections can affect the mouth, skin and genitals (and that includes women AND men) and range in severity from inconvenient and uncomfortable to life-threatening. Additionally, overgrowth in the gastrointestinal tract may be a catalyst for serious problems if the fungus enters the blood stream.

Let’s take a look at a few other must-know facts about yeast infections.


1. Yeast Infections May Occur Orally

Gross. Really? Yes, oral yeast infections are commonly called thrush. This infection is common in newborns but typically passes quickly. Babies are not the only ones affected, a recent study found that oral Candida overgrowth occurs in one out of every four adults. Poor oral hygiene is often a primary factor. Researchers identified the presence of plaque, tartar, and amalgam fillings as significantly related to the degree of Candida present. [1] The best defense? Proper, and regular, oral hygiene.

2. Vaginal Yeast Infections Can Be Tricky

Practicing good hygiene is a very good deterrent for yeast infections. However, this isn’t always the case. Frequent douching has been associated with higher incidences of yeast infections. So has wearing tight nylon or synthetic underwear. Oddly enough, over-the-counter anti-fungal medications have also been associated with stubborn occurrences of vaginal candiadosis. [2] The use of intrauterine contraceptive devices also show a statistically significant increase in Candida infection. [3]

3. Use of an Asthma Inhaler May Contribute to Candida

A Brazilian study of adults using inhalers for longer than 6 months identified oral candidiasis as one of several adverse effects. [4] Anyone using an inhaler, or any other oral appliance (such as mouth guards, retainers, or dentures) should be aware of the possibility of Candida exposure.

4. Candida Naturally Occurs On and In Humans

Microbiota like Candida occur naturally on human skin and in the human gastrointestinal tract. In healthy individuals, the immune system and symbiotic bacteria help keep these fungal species in check. Not surprisingly, persons with compromised immune systems are among the most susceptible to Candida overgrowth.

5. The Connection Between Diabetes and Candida

Individuals with diabetes are more likely to develop genital yeast infections, both women and men. The high blood glucose levels of diabetics encourage yeast growth. And, because it inhibits immune response, the risk of recurring infection is higher. Women are more likely to suffer infection from Candida alibicans and Candida glabrate. Uncircumsized men may experience infection from Candida balaritis. [5]

6. Candida Often Accompanies HIV

Research has shown nearly 90% of HIV positive patients suffer from oral Candiadisis. In contrast, these patients do not experience an increase in genital yeast infection. [6]

7. Candida Loves Carbohydrates

While Candida occurs naturally in the human digestive tract, how much is present depends quite a bit on diet. Studies have identified that persons whose diets are high in carbohydrates are more susceptible than persons whose diets are high in amino acids, proteins and fatty acids. Candida levels increase most immediately following consumption of carbohydrates.[7]

8. You Can Protect Yourself With Probiotics

Intestinal yeast infections, or Candida overgrowth, have been associated with the development of several Irritable Bowel Diseases (IBDs) such as Crohn’s disease. Protecting intestinal health has become a major focus for research. One study identified a probiotic strain as successful for improving cellular defense against Candida. [8]

9. Presents an Increased Risk of MS

This one is an unforeseen doozy to most — Candida infection has been associated with increased odds of multiple sclerosis (MS). A case-control study evaluated the relationship of MS and Candida infection and discovered that MS patients showed higher overall blood serum levels of Candida than the control group. [9]

10. Potential Remedy for Warts?

Perhaps not all facts about Candida infections are bad. One study found positive benefits from using a purified C. albicans antigen solution for persistent warts. This has led researchers to suggest intralesional Candida immunotherapy may provide an effective treatment for warts resistant to other forms of destruction. [10]

-Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM

Updated September 2014

Article References:

  1. Muzurovic S, Babajic E, Masic T, Smajic R, Selmanagic A. The relationship between oral hygiene and oral colonisation with Candida species. Med Arh. 2012;66(6):415-7.
  2. Ekpenyong CE, Inyang-etoh EC, Ettebong EO, Akpan UP, Ibu JO, Daniel NE. Recurrent vulvovaginal candidosis among young women in south eastern Nigeria: the role of lifestyle and health-care practices. Int J STD AIDS. 2012 Oct;23(10):704-9. doi: 10.1258/ijsa.2012.011382.
  3. Güdücü N, Gönenç G, Içi H, Yi?iter AB, Basüllü N, Dünder I. Clinical importance of detection of bacterial vaginosis, trichomonas vaginalis, candida albicans and actinomyces in Papanicolaou smears. Clin Exp Obstet Gynecol. 2012;39(3):333-6.
  4. Pinto CR, Almeida NR, Marques TS, Yamamura LL, Costa LA, Souza-Machado A. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma. J Bras Pneumol. 2013 Jun-Aug;39(4):409-17. doi: 10.1590/S1806-37132013000400003.
  5. PNyirjesy P, Sobel JD. Genital mycotic infections in patients with diabetes. Postgrad Med. 2013 May;125(3):33-46. doi: 10.3810/pgm.2013.05.2650.
  6. Fidel PL Jr. Immunity to Candida. Oral Dis. 2002;8 Suppl 2:69-75.
  7. Hoffmann C, Dollive S, Grunberg S, Chen J, Li H, Wu GD, Lewis JD, Bushman FD. Archaea and fungi of the human gut microbiome: correlations with diet and bacterial residents. PLoS One. 2013 Jun 17;8(6):e66019. doi: 10.1371/journal.pone.0066019. Print 2013.
  8. Rizzo A, Losacco A, Carratelli CR. Lactobacillus crispatus modulates epithelial cell defense against Candida albicans through Toll-like receptors 2 and 4, interleukin 8 and human β-defensins 2 and 3. Immunol Lett. 2013 Oct 10. pii: S0165-2478(13)00158-2. doi: 10.1016/j.imlet.2013.08.013.
  9. Benito-León J, Pisa D, Alonso R, Calleja P, Díaz-Sánchez M, Carrasco L. Association between multiple sclerosis and Candida species: evidence from a case-control study. Eur J Clin Microbiol Infect Dis. 2010 Sep;29(9):1139-45. doi: 10.1007/s10096-010-0979-y. Epub 2010 Jun 17.
  10. Majid I, Imran S. Immunotherapy with Intralesional Candida Albicans Antigen in Resistant or Recurrent Warts: A Study. Indian J Dermatol. 2013 Sep;58(5):360-365.

Vitamin B1 deficiency can cause permanent brain damage and coma, but is rarely diagnosed.

Thiamine, or vitamin B1, is one of eight distinct members of the B complex, which helps maintain or improve brain and nervous system functioning and liver health, and resist the effects of stress on the immune system. Thiamine was named B1 simply because it was the first of the B complex series discovered.

You need it to form adenosine triphosphate (ATP), which every cell of the body uses for metabolic energy. One of the signs of B1 deficiency is fatigue, but that symptom covers many other deficiencies as well. There are other more distinct attributes of vitamin B1 deficiency that have been isolated.

B complex vitamins are water soluble and cannot be stored in the body, except for one form of thiamine that is fat soluble known as benfotiamine. Its application will be discussed later in this article.

Loyola neurologists report the extremes that vitamin B1 deficiency can lead to

Researchers at the Loyola University Medical Center in Maywood, Illinois, published a report in the journal Scientific American Medicine explaining how thiamine deficiency can lead to permanent brain damage from which there may be no recovery.

Wernicke encephalopathy is a brain disease that’s caused by metabolic disorders and toxic substances, which can occur from a lack of sufficient vitamin B1. In first-world countries, this malnutrition disorder is rare in our culture and occurs mostly in alcoholics, anorexics, Crohn’s victims, people who use diuretics and those undergoing kidney dialysis.

But the Loyola neurologists claim that Wernicke encephalopathy is underdiagnosed. Many victims slip under the radar. They estimate that perhaps 3 percent of Americans suffer from the extremes of Wernicke that lead to Korsakoff syndrome (KS).

“Toxic and metabolic encephalopathies may range in severity from the acute confusional state to frank coma,” wrote Loyola neurologists Matthew McCoyd, MD, Sean Ruland, DO, and Jose Biller, MD. “As permanent injury may occur, an organized approach is needed to make an accurate and rapid diagnosis.”

Permanent injury can occur after the rapid onset of acute encephalopathy with symptoms of confusion, hallucinations, coma, loss of muscle coordination and double vision or involuntary eye movements. If ignored and not diagnosed as a vitamin B1 or thiamine deficiency that can be remedied by supplementation, it can lead to late stage Wernicke.

Then things get really delusional. Untreated, Wernicke encephalopathy can lead to KS, characterized by profound memory loss and an inability to form memories leading to confabulation (making up memories). The 2000 movie Memento offers an entertaining example of extreme memory loss and confabulation.

About 80 percent of Wernicke encephalopathy patients develop KS, and once this occurs, only about 20 percent of those patients recover. Then brain damage can induce coma and death. Prior to that, B1/thiamine supplementation usually turns things around.

The pharmacist who came in from the cold

Pharmacist Stuart Lindsay had submitted an article to titled “Confessions of a Frustrated Pharmacist” in which he explains how he had abandoned conventional chemical solutions and used supplements to overcome his own diabetes type 2 symptoms, especially the neuropathy that was affecting his feet.

Orthomolecular medicine uses high-dose supplements while eschewing pharmaceutical drugs. After getting frustrated by fellow graduate pharmacy students and teachers shunning his vitamin discoveries, Stuart posted his article at

His symptoms of peripheral neuropathy affected the feet and lower legs with unwanted tingling sensations, pain or a lack of any sensation at all from numbness. Big Pharma offered him no solutions. This can lead to the barbaric solution of amputation if unchecked.

Neuropathy is a less life-threatening neurological disorder than Wernicke, but it can progress to more extreme complications such as Wernicke or KS. Thus, the B1/thiamine solution was the same, except Stuart chose to use the fat-soluble benfotiamine for supplementing thiamine to optimize results and eliminate his neuropathy.



Researchers have created camouflage material that auto-matches your surroundings

Inspired by octopus skin, the new remote-controlled material changes colour, fluorescence and texture to keep you hidden in any environment.


Scientists from the Massachusetts Institute of Technology (MIT) and Duke University in the US have developed a stretchy, skin-like synthetic material that takes us a step closer to invisbility-cloak-like camouflage.

The material was inspired by cephalopods, the class of animals containing the very-well-camouflaged octopuses, squids and cuttlefish. These amazing sea creatures change texture, pattern and colour in milliseconds in response to new backdrops, thanks to tiny pigment sacks inside their skin. By expanding or contracting their muscles, they can control how much light bounces off these pigments and change their colours.

The new material acts in a similar way, as Sarah Zhang explains for Gizmodo. The polymer has dyes embedded in it, and when voltage is applied to the material it causes the polymer to crease up, changing its texture and colour. This means it can immediately become fluorescent red or bumpy, and even change its pattern, as shown in the images above. The researchers explainin an MIT press release that there’s no reason the range of colours couldn’t be increased – but for now they have still only managed to produce one type of pattern. Their results are published in Nature Communications.

“The texturing and deformation of the elastomer [the polymer that makes up the material] further activates special mechanically responsive molecules embedded in the elastomer, which causes it to fluoresce or change colour in response to voltage changes,” said Stephen Craig, one of the lead researchers from Duke University, in a press release. “Once you release the voltage, both the elastomer and the molecules return to their relaxed state — like the cephalopod skin with muscles relaxed.”

Also in the past month, a separate group of researchers in the US also tried to mimic the camouflage abilities of cephalopods, and created a four-layer material that dynamically responds to light to change up its black-and-white pattern. While both teams have used different materials, the breakthroughs show that we’re closer than we’ve ever been to creating camouflage that can adapt to any background. And that’s really exciting.

Researchers achieve highest resolution ever with X-ray microscopy

A record-setting X-ray microscopy experiment may have ushered in a new era for nanoscale imaging. Working at the U.S. Department of Energy (DOE)’s Lawrence Berkeley National Laboratory (Berkeley Lab), a collaboration of researchers used low energy or “soft” X-rays to image structures only five nanometers in size. This resolution, obtained at Berkeley Lab’s Advanced Light Source (ALS), a DOE Office of Science User Facility, is the highest ever achieved with X-ray microscopy.

Using ptychography, a coherent diffractive imaging technique based on high-performance scanning transmission X-ray microscopy (STXM), the collaboration was able to map the chemical composition of lithium iron phosphate nanocrystals after partial dilithiation. The results yielded important new insights into a material of high interest for electrochemical energy storage.

“We have developed diffractive imaging methods capable of achieving a that cannot be matched by conventional imaging schemes,” says David Shapiro, a physicist with the ALS. “We are now entering a stage in which our X-ray microscopes are no longer limited by our optics and we can image at nearly the wavelength of our X-ray light.”

Shapiro is the lead and corresponding author of a paper reporting this research in Nature Photonics. The paper is titled “Chemical composition mapping with nanometer resolution by soft X-ray microscopy.”

In ptychography (pronounced tie-cog-raphee), a combination of multiple coherent diffraction measurements is used to obtain 2D or 3D maps of micron-sized objects with high resolution and sensitivity. Because of the sensitivity of to electronic states, ptychography can be used to image chemical phase transformations and the mechanical consequences of those transformations that a material undergoes.

In this soft X-ray ptychography set-up, a 60 nm width outer-zone-plate focuses a coherent soft X-ray beam onto the sample, which is scanned in 40 nm increments to ensure overlap of the probed areas. Credit: Image courtesy of Berkeley Lab

“Until this work, however, the spatial resolution of ptychographic microscopes did not surpass that of the best conventional systems using X-ray zone plate lenses,” says Howard Padmore, leader of the Experimental Systems Group at the ALS and a co-author of the Nature Photonics paper. “The problem stemmed from the fact that ptychography was primarily developed on hard X-ray sources using simple pinhole optics for illumination. This resulted in a low scattering cross-section and low coherent intensity at the sample, which meant that exposure times had to be extremely long, and that mechanical and illumination stabilities were not good enough for high resolution.”

Key to the success of Shapiro, and his collaborators were the use of soft X-rays which have wavelengths ranging between 1 to 10 nanometers, and a special algorithm that eliminated the effect of all incoherent background signals. Ptychography measurements were recorded with the STXM instruments at ALS beamline 11.0.2, which uses an undulator x-ray source, and ALS beamline, which uses a bending magnet source. A coherent soft X-ray beam would be focused onto a sample and scanned in 40 nanometer increments. Diffraction data would then be recorded on an X-ray CCD (charge-coupled device) that allowed reconstruction of the sample to very high spatial resolution.

“Throughout the ptychography scans, we maintained the sample and focusing optic in relative alignment using an interferometric feedback system with a precision comparable to the wavelength of the X-ray illumination,” Shapiro says.

Lithium iron phosphate is widely studied for its use as a cathode material in rechargeable lithium-ion batteries. In using their ptychography technique to map the chemical composition of lithium crystals, Shapiro and his collaborators found a strong correlation between structural defects and chemical phase propagation.

David Shapiro is shown with the STXM instrument at ALS beamline Credit: Photo by Roy Kaltschmidt, Berkeley Lab

“Surface cracking in these crystals was expected,” Shapiro says, “but there is no other means of visualizing the correlation of those cracks with at these scales. The ability to visualize the coupling of the kinetics of a phase transformation with the mechanical consequences is critical to designing materials with ultimate durability.”

Shapiro and his colleagues have already begun applying their ptychography technique to the study of catalytic and magnetic films, magnetotactic bacteria, polymer blends and green cements.

For the chemical mapping of they used the STXM instrument at ALS beamline which required up to 800 milliseconds of exposure to the X-ray beam for each scan. Next year, they anticipate using a new ALS beamline called COSMIC (COherent Scattering and MICroscopy), which will feature a high brightness undulator source coupled to new high-frame-rate CCD sensors that will cut beam exposure times to only a few milliseconds and provide spatial resolution at the wavelength of the radiation.

“If visible light microscopes could only achieve a resolution that was 50 times the wavelength of visible light, we would not be able to see most single celled organisms,” Shapiro says. “Where would the life sciences be with such a limitation? We are now approaching the point where we will have X-ray microscopes of comparable quality to today’s visible light instruments for the study of nanomaterials.”

A nanosized hydrogen generator

Researchers at the US Department of Energy’s (DOE) Argonne National Laboratory have created a small scale “hydrogen generator” that uses light and a two-dimensional graphene platform to boost production of the hard-to-make element.

The research also unveiled a previously unknown property of graphene. The two-dimensional chain of not only gives and receives , but can also transfer them into another substance.

Hydrogen is virtually everywhere on the planet, but the element is typically bonded with other elements and must be separated from oxygen in H2O to produce free hydrogen. The commercial separation process uses natural gas to react with superheated steam to strip away hydrogen atoms producing , but also carbon dioxide —a greenhouse gas byproduct which escapes into the atmosphere.

Argonne’s early-stage generator, composed of many tiny assemblies, is proof that hydrogen can be produced without burning fossil fuels. The scale is small, a little smaller than the diameter of spider silk. Scaling this research up in the future may mean that you could replace the gas in your cars and generators with hydrogen—a greener option, because burning hydrogen fuel emits only water vapor.

“Many researchers are looking to inorganic materials for new sources of energy,” said Elena Rozhkova, chemist at Argonne’s Center for Nanoscale Materials, a DOE Office of Science (Office of Basic Energy Sciences) User Facility. “Our goal is to learn from the natural world and use its materials as building blocks for innovation.”

For Rozhkova, this particular building block is inspired by the function of an ancient protein known to turn light into energy. Researchers have long known that some single-celled organisms use a protein called bacteriorhodopsin (bR) to absorb sunlight and pump protons through a membrane, creating a form of chemical energy. They also know that water can be split into oxygen and hydrogen by combining these proteins with titanium dioxide and platinum and then exposing them to ultraviolet light.

There is just one downside: titanium dioxide only reacts in the presence of ultraviolet light, which makes up a mere four percent of the total solar spectrum. If the researchers wanted to power their generators with sunlight, they’d need to improve on that.

In order to produce greater amounts of hydrogen using , the researchers looked for a new material. The new material would need enough surface area to move electrons across quickly and evenly and boost the overall electron transfer efficiency. The researchers also needed a platform on which biological components, like bR, could survive and connect with the titanium dioxide catalyst: in short, a material like graphene.

Graphene is a super strong, super light, near totally transparent sheet of carbon atoms and one of the best conductors of electricity ever discovered. Graphene owes its amazing properties to being two-dimensional.

“Graphene not only has all these amazing properties, but it is also ultra-thin and biologically inert,” said Rozhkova. “Its very presence allowed the other components to self-assemble around it, which totally changes how the electrons move throughout our system.”

Rozhkova’s mini-hydrogen generator works like this: both the bR protein and the graphene platform absorb visible light. Electrons from this reaction are transmitted to the titanium dioxide on which these two materials are anchored, making the titanium dioxide sensitive to visible light.

Simultaneously, light from the green end of the solar spectrum triggers the bR protein to begin pumping protons along its membrane. These protons make their way to the platinum nanoparticles which sit on top of the . Hydrogen is produced by the interaction of the protons and electrons as they converge on the platinum.

Examinations using a technique called Electron Paramagnetic Resonance (EPR) and time-resolved spectroscopy at the Center for Nanoscale Materials verified the movements of the electrons within the system, while electrochemical studies confirmed the protons were transferred. Tests also revealed a new quirk of graphene behavior.

“The majority of the research out there states that graphene principally conducts and accepts electrons,” said Argonne postdoctoral researcher Peng Wang. “Our exploration using EPR allowed us to prove, experimentally, that graphene also injects electrons into other materials.”

Rozhkova’s generator proves that nanotechnology, merged with biology, can create new sources of clean energy. Her team’s discovery may provide future consumers a biologically-inspired alternative to gasoline.

“These are the types of discoveries we can make at Argonne,” said Rozhkova. “Working in the basic energy sciences, we were able to demonstrate an energy-rich biologically-inspired alternative to gas.”