Lung cancer is the deadliest cancer in the world, largely because so many patients are diagnosed late.
Screening more patients could help, yet screening rates remain critically low. In the United States, only about 6% of eligible people get screened , according to the American Lung Association. Contrast that with screening rates for breast, cervical, and colorectal cancer, which all top 70%.
But what if lung cancer detection was as simple as taking a puff on an inhaler and following up with a urine test?
Researchers at the Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts, have developed nanosensors that target lung cancer proteins and can be delivered via inhaler or nebulizer, according to research published this month in Science Advances. If the sensors spot these proteins, they produce a signal in the urine that can be detected with a paper test strip.
“It’s a more complex version of a pregnancy test, but it’s very simple to use,” said Qian Zhong, PhD, an MIT researcher and co-lead author of the study.
Currently, the only recommended screening test for lung cancer is low-dose CT. But not everyone has easy access to screening facilities, said the other co-lead author Edward Tan, PhD, a former MIT postdoc and currently a scientist at the biotech company Prime Medicine, Cambridge, Massachusetts.
“Our focus is to provide an alternative for the early detection of lung cancer that does not rely on resource-intensive infrastructure,” said Tan. “Most developing countries don’t have such resources” — and residents in some parts of the United States don’t have easy access, either, he said.
How It Works
The sensors are polymer nanoparticles coated in DNA barcodes, short DNA sequences that are unique and easy to identify. The researchers engineered the particles to be targeted by protease enzymes linked to stage I lung adenocarcinoma. Upon contact, the proteases cleave off the barcodes, which make their way into the bloodstream and are excreted in urine. A test strip can detect them, revealing results about 20 minutes from the time it’s dipped.
Nanosensors that target lung cancer proteins can be aerosolized and delivered with an inhaler or nebulizer.
The researchers tested this system in mice genetically engineered to develop human-like lung tumors. Using aerosol nebulizers, they delivered 20 sensors to mice with the equivalent of stage I or II cancer. Using a machine learning algorithm, they identified the four most accurate sensors. With 100% specificity, those four sensors exhibited sensitivity of 84.6%.
“One advantage of using inhalation is that it’s noninvasive, and another advantage is that it distributes across the lung quite homogeneously,” said Tan. The time from inhalation to detection is also relatively fast — in mice, the whole process took about 2 hours, and Zhong speculated that it would not be much longer in humans.
Other Applications and Challenges
An injectable version of this technology, also developed at MIT, has already been tested in a phase 1 clinical trial for diagnosing liver cancer and nonalcoholic steatohepatitis. The injection also works in tandem with a urine test, the researchers showed in 2021. According to Tan, his research group (led by Sangeeta Bhatia, MD, PhD) was the first to describe this type of technology to screen for diseases.
The lab is also working toward using inhalable sensors to distinguish between viral, bacterial, and fungal pneumonia. And the technology could also be used to diagnose other lung conditions like asthma and chronic obstructive pulmonary disease, Tan said.
The tech is certainly “innovative,” remarked Gaetano Rocco, MD, a thoracic surgeon and lung cancer researcher at Memorial Sloan Kettering Cancer Center, Middletown, New Jersey, who was not involved in the study.
Still, challenges may arise when applying it to people. Many factors are involved in regulating fluid volume, potentially interfering with the ability to detect the compounds in the urine, Rocco said. Diet, hydration, drug interference, renal function, and some chronic diseases could all limit effectiveness.
Another challenge: Human cancer can be more heterogeneous (containing different kinds of cancer cells), so four sensors may not be enough, Zhong said. He and colleagues are beginning to analyze human biopsy samples to see whether the same sensors that worked in mice would also work in humans. If all goes well, they hope to do studies on humans or nonhuman primates.
A collaboration between researchers at New York University’s Grossman School of Medicine and Rocket Pharmaceuticals has produced preclinical evidence that gene replacement therapy successfully halts the progression of a potentially fatal heart disease.
The study, led by co-first authors Chantal J.M. van Opbergen and Bitha Narayanan, suggests that AAV-based gene therapy may help people with arrhythmogenic right ventricular cardiomyopathy (ARVC). Individuals with this progressive cardiac condition, which typically manifests between the ages of 20 and 40, are at high risk of developing potentially fatal arrhythmias. This research paves the way for the future use of gene therapy on a specific group of human patients who could benefit from this approach.
Van Opbergen, Narayanan, and colleagues used an experimental approach to restore the function of plakophilin-2 (PKP2), a gene found primarily in the heart’s muscular wall and responsible for desmosomes that are essential for cell adhesion. Pathogenic variants in the PKP2 gene are the leading cause of gene-positive ARVC in humans.
ARVC is classified as arrhythmogenic cardiomyopathy (ACM), and pathogenic variants in PKP2 account for 20–45% of all ACM cases, with a prevalence estimated to be between 1:1000 and 1:5000 in Europe and North America. While conventional heart failure therapies can be used to treat ARVC, they frequently fail to stop disease progression, and the heart progresses to end-stage failure, leaving cardiac transplantation as the only way to avoid death.
The current study sought to determine whether AAV-mediated delivery of PKP2a in a mouse model of disease can stop the progression of the arrhythmia burden and cardiomyopathy components of the disease while significantly increasing survival. The study assessed the safety and efficacy of delivering the human PKP2 gene into mice with ACM caused by loss of expression of the native PKP2 gene.
These proof-of-principle preclinical studies demonstrated that a single intravenous injection of AAVrh.74-PKP2a delivering the PKP2 gene causes PKP2 production and proper localization in adult cardiac myocytes, halts disease progression, and dramatically shifts survival from 100% lethality to 100% survival in the treated population.
These findings show that PKP2 gene therapy can significantly improve clinical outcomes in an animal model of ARVC, paving the way for cautious research into the utility of PKP2-based gene therapy for human patients suffering from ARVC caused by PKP2 deficiency. While the treatment was well tolerated and effective in the experimental model, additional data from extensive preclinical safety studies are required to ensure safe and successful implementation in treating patients in need.
The WSU researchers measured the stress hormone cortisol in hair samples from 53 women in their third trimester. Of that group, 13 women who had elevated cortisol levels later experienced unpredicted birth complications, such as an early birth or hemorrhaging.
A simple hair test may reveal a pregnant person’s stress level and flag unanticipated birth problems, a study from Washington State University (WSU) suggests. This preliminary finding could lead to a non-invasive test to identify pregnant people at risk for such complications.
The researchers reported their findings in Psychoneuroendocrinology. The study’s senior author is Erica Crespi, a WSU developmental biologist.
“There was otherwise nothing about these women that would suggest a disease or anything else complicating the pregnancy. This confirmed some hypotheses that levels of stress, related specifically to cortisol levels, might be associated with adverse birth outcomes,” said Crespi.
Study participants answered survey questions about their psychological distress levels and their cortisol levels were measured in the third trimester of pregnancy and after they gave birth. The women who experienced unexpected birth complications had elevated cortisol concentrations in their hair, a measure that indicates the stress hormone’s circulating levels in the body during the three months prior to collection. These women also reported feelings of stress, anxiety, and depression, but on average, only high cortisol levels during pregnancy showed a strong link to adverse birth outcomes.
Two months after giving birth, the group that experienced birth complications continued to show elevated cortisol and gave survey answers indicating continued stress, anxiety, and depression. At six months, their cortisol remained elevated, but they started to report lower psychological distress on the survey, which the authors noted might be a sign of recovery.
Cortisol, a steroid hormone, rises in humans and many animals to help regulate the body’s response to stress, but prolonged high cortisol is associated with major health problems, including high blood pressure and diabetes. Throughout pregnancy, cortisol levels naturally rise two to four times and peak during the third trimester, but the measurements in this study showed even more pronounced elevated cortisol levels among the women who had unexpected birth complications.
“If this finding holds up, it could be a non-invasive way to get greater insight into who might be at risk because it is information we didn’t get from the survey,” said co-author Sara Waters, a WSU human development researcher. “This was not something we could find out just from asking people about their stress.”
Finding ways to reduce stress around birth could help improve outcomes for both infants and mothers, the researchers said. They point out that adverse birth outcomes are rising in the country. The U.S. also notoriously has one of the highest maternal mortality rates among developed countries, with deaths disproportionately impacting Black women and other people of color.
This study, the researchers say, is also a reminder to expectant and new mothers to prioritize their health.
“It’s very easy to sacrifice our own health and well-being to prioritize our children’s, especially when it feels like resources are scarce,” said Waters. “But our ability to show up as parents comes from a foundation of getting our needs met too—like the saying, ‘you can’t pour from an empty cup.’”
New findings from the National Institutes of Health (NIH) researchers showed that people who switched to a vegan or ketogenic diet showed rapid and distinct changes in their immune system.
The small study, reported in the journal Nature Medicine, closely monitored the biological responses of people who sequentially ate vegan and ketogenic diets in random order. Those on the vegan diet showed responses that are linked to innate immunity, while the people on the ketogenic diet showed changes in their adaptive immunity, the pathogen-specific immunity that is built via exposures to our daily life and vaccines.
In addition, “both diets significantly and differentially impacted the microbiome and host-associated amino acid metabolism, with a strong downregulation of most microbial pathways following ketogenic diet compared with baseline and vegan diet,” the researchers wrote.
The distinct changes noted in the study related to both diets were observed consistently across the diversity of the participants demonstrating that the dietary changes consistently affect widespread and interconnected pathways in the body.
The investigators noted that nutrition affects all the processes that regulate the human immune system, and that a better understanding of the link between nutrition and host immunity provides an untapped opportunity to develop personalized, diet-based approaches to treating a range of human diseases including inflammatory disorders and cancer. Further, prior research has well established the association between a low-fat vegetarian or vegan diet with decreased inflammation, a reduced risk for cardiovascular disease, and a reduction in overall mortality.
However, the NIH investigators noted that given what is already known about the impact of diet on wellness and the development of disease, there is a significant lack of data on how nutritional interventions impact the human immune system. Further, studies in this area have only explored responses to only one diet at a time. This lack of data hampers the development of meaningful, proven nutritional interventions.
“Based on the highly variable responses of individuals to nutritional interventions and the high number of diets consumed, addressing how individuals respond to different diets remains an important line of research,” the NIH investigators stated in their published research.
The new study was conducted by a team in the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the Metabolic Clinical Research Unit in the NIH Clinical Center. The small, 20-person study represented diverse ethnicity, race, gender, body mass index (BMI), and age. During the four-week study period, the participants ate as much as they wanted of one diet—either vegan or ketogenic—for the first two weeks, followed by as much as they wanted in the following two of the other diet.
People on the vegan diet which comprised roughly 10% fat and 75% carbohydrates chose to consume fewer calories than when they were on the ketogenic diet (76% fat, 10% carbohydrates).
Blood, urine, and stool samples were collected for analysis, which used a multi-omics approach to show the body’s biochemical, metabolic, cellular, and immune responses to the diets. The team also analyzed participants’ microbiome. All 20 people remained on-site for the duration of the study to allow for careful control of the participants’ diets.
Specifically, the vegan diet’s effects to the innate immune system included antiviral responses. The ketogenic diet affected biochemical and cellular processes associated with T cells and B cells, which play roles in adaptive immunity. The ketogenic diets affected the levels of a broader range of proteins in the blood plasma, as well as the proteins in range of other tissues including those in the brain and bone marrow. The ketogenic diet was also associated with changes in amino acid metabolism—an increase in human metabolic pathways for the production and degradation of amino acids and a reduction in microbial pathways for these processes—which might reflect the higher amounts of protein consumed by people on this diet.
The vegan diet promoted more pathways that are linked to red blood cells, such as the heme metabolism, which could be related to the higher iron content of the diet.
The investigators said the data obtained from the study demonstrates how rapidly the immune system responds to nutritional changes and while more research is needed to provide a more detailed understanding of how these dietary changes affect the interconnected pathways in the human body, the results, nonetheless, point to the potential of tailoring diets to either prevent disease development or to complement disease treatments, by slowing processes associated with cancer progression or neurodegenerative disorders.
Cancer ribbons are loops of ribbon that people wear to show their support for those with cancer or to spread awareness about the condition. There are 43 different cancer ribbon colors, such as pink for breast cancer and orange for leukemia.
There are many different types of cancer ribbons, each with its own symbolic color. In this article, we list 26 cancer ribbon colors and their purposes, as well as specific cancer awareness months.
Leukemia is a form of blood cancer that usually starts in the bone marrow. The Leukemia and Lymphoma Society (LLS) states that the relative 5-year survival rate for leukemia has more than quadrupled since 1960. The improvement in outlook may be due to increased awareness of the disease and advances in medication.
September is Leukemia Awareness Month. Leukemia also shares the orange ribbon with kidney cancer.
Kidney cancer is among the 10 most commonTrusted Source cancers in the United States. It is more common in older people, and more men than women tend to develop it. While it is not possible to prevent all cases of kidney cancer, obesity, and smoking increase a person’s risk.
Probably, the most well-known cancer ribbon is the pink ribbon that represents breast cancer. Researchers and organizations use or wear pink throughout their numerous campaigns to highlight their stand against breast cancer.
Endometrial cancer most commonly affects women after menopause, with an average age of 60 at the time of diagnosis, according to the ACSTrusted Source.
September is Gynecological Cancer Awareness Month. During the month, many campaigners come together to raise awareness for preventive testing and funds for research.
A gold ribbon represents all cancers that occur during childhood.
Organizations, such as the American Childhood Cancer Organization, campaign all year round to spread awareness and raise money to support children fighting cancer.
A yellow ribbon represents sarcoma or bone cancer. There are several types of bone cancer. Sarcoma can affect the bones, or it can affect the connective tissues in the body, such as the cartilage or myofascial tissue.
Organizations, such as the Sarcoma Foundation of America, help fund research and increase awareness about the disease.
Non-Hodgkin lymphoma (NHL) affects the lymphatic system. As the LLS notes, around 85–90% of cases start in B lymphocyte cells, which help produce the antibodies that fight infection.
Lymphoma and leukemia are two separate forms of cancer that are commonly grouped together because they both affect the blood.
September is World Lymphoma Awareness Month, which supports people with NHL and other forms of blood and lymph cancer.
According to the National Ovarian Cancer Coalition, ovarian cancer is the fifth leading cause of cancer deaths in women of any age. Researchers estimate that 1 in 78 women will experience ovarian cancer during their lifetimes.
September is Ovarian Cancer Awareness Month. However, May 8th is also World Ovarian Cancer Day, when people around the globe spread awareness of ovarian cancer.
Thanks to early preventive screenings, more people are surviving cervical cancer than ever before. According to the ACSTrusted Source, regular tests, such as the Pap smear, have reduced deaths from the disease significantly.
Regular screening for polyps and signs of cancer has led to an improvement in survival rates in recent years. When doctors treat colon cancer in its early stages, the overall 5-year survival rate for colorectal cancer is 63–67%Trusted Source.
A soft, lavender-blue ribbon is a sign of support for those living with stomach or gastric cancer. The organization No Stomach For Cancer notes that stomach cancer still receives little attention, even though it is the second leading cause of cancer deaths globally.
November is Stomach Cancer Awareness Month, which is vital for promoting greater public knowledge of the disease and raising funds for research.
Pancreatic cancer is difficult to diagnose in the early stages, as there are no preventive screening tests available.
Pancreatic cancer uses a purple ribbon as a tribute to one woman’s love for her mother. A woman named Rose Schneider, whose favorite color was purple, died after battling pancreatic cancer. Her daughter, finding little formal support in her time of need, worked to found the Pancreatic Cancer Action Network (PanCan) to support people with pancreatic cancer.
November is Pancreatic Cancer Awareness Month. During this month, PanCan and other organizations, such as the National Pancreatic Cancer Foundation, work together to raise awareness and funds for pancreatic cancer research.
A lavender ribbon is usually a sign of support for those living with all types of cancer. Sometimes, people wear a rainbow of ribbons or a ribbon with many different colors to symbolize the same thing.
National Cancer Prevention Month and World Cancer Day occur in February each year.
According to the Melanoma Research Foundation, skin cancer is the most common form of cancer in the U.S. In 2022, over 197,000 Americans are predicted to receive a skin cancer diagnosis.
May is Skin Cancer Awareness Month. People can also wear a black ribbon to promote regular skin checks and preventive screenings.
Carcinoid cancer is not as well-known as other cancers. Carcinoid cancer grows very slowly, commonly appearing in the small intestines and bronchial system in the lungs, according to the American Association for Cancer Research.
Some people experience little to no symptoms for a long time, though carcinoid cancer can still be life threatening.
Possibly a reflection of a person’s “gray matter,” a gray ribbon promotes brain cancer awareness.
The National Brain Tumor Society estimates that approximately 688,000 people in the U.S. are living with a brain or central nervous system tumor. While the majority of these tumors are benign, about 37 percent are cancerous.
Lung cancer is the second most common cancer in the U.S. It is responsible for about 25%Trusted Source of all cancer-related deaths, according to the ACS.
Bladder cancer is represented by a blue, yellow, and purple ribbon. The American Bladder Cancer Society states that bladder cancer accounts for 5% of all cancer cases. Men are more likely to develop it than women.
Doctors will diagnose an estimated 43,800 new cases of thyroid cancer in 2022, according to the ACS.Trusted Source
September is Thyroid Cancer Awareness Month, when organizations, such as the American Thyroid Association, promote their work to spread awareness and support for people with thyroid cancer.
How many breast cancer awareness ribbons are there?
There are four breast cancer ribbons:
Breast cancer: Pink
Metastatic breast cancer: Pink, teal, and green
Inflammatory breast cancer: Hot pink
Male breast cancer: Pink and blue
Is there a breast cancer emoji?
There is no official breast cancer emoji, but a yellow “reminder” ribbon is available on most messaging platforms, which people can use to show support for a cause. Some platforms, such as Facebook and Windows provide a pink ribbon emoji to symbolize breast cancer.
Is there a ribbon for leukemia?
The ribbon for leukemia is orange. It is the same color as the kidney cancer ribbon.
Is there a button or badge for pancreatic cancer?
There is no official button to symbolize support for pancreatic cancer but many buttons are available online that show a purple ribbon.
Wearing a specific color or ribbon can help people show their support for a friend or loved one or even help them discuss their own cancer diagnosis with others.
Participating in awareness campaigns, just by wearing a ribbon, can help keep the public informed about cancer research and promote funding for new treatments.
There are many good reasons to emphasize the biological underpinnings of substance use disorders. Perhaps most important, the biologic basis of this chronic disease is a strong argument for parity: that is, treating (and funding treatment for) addiction on par with other “biologic” diseases.
The stigma and shame of addiction has much to do with the perception that people with substance use disorders are weak, immoral, or simply out for a good time at society’s expense. Understanding that addiction impairs the brain in many important ways may reduce such stigma. What’s more, the specific type of brain dysfunction may help identify a range of effective interventions and preventions. For example, during adolescence, the brain is at its most plastic — and vulnerable. This is a time when caution and intervention may prove most valuable. The earlier the drug exposure or trauma to the brain, the greater the damage.
The New England Journal of Medicine recently published a review of the “brain science” related to addiction and its management by Dr. Nora Volkow and her colleagues. It is a great review with terrific graphics. I’ve sent it to several of my colleagues.
It would take many blog posts to summarize in detail what goes on in the article (let alone the brain), so I’ll hit the points that are most meaningful to me as a practitioner and citizen — and forgive me if I get a little personal.
A look into the science of addiction
The most depressing course I took in college was an introduction to behaviorism. The low point was when I came to believe that free will did not exist, though I later came to believe that this was a narrow and false conclusion. Humans, with our over-developed frontal cortices, have the power to choose not to respond the way, for example, a pigeon would in an experiment of rewards and punishments. When I became a doctor, I perceived that people suffering with addiction were stripped of their fundamental liberty to choose to live life as they would want (within social and economic constraints). I can honestly say that helping to restore some of that freedom is among the most rewarding things I do as a doctor. That’s the personal stuff.
An addicted person’s impaired ability to stop using drugs or alcohol has to do with deficits in the function of the prefrontal cortex — the part of the brain involved in executive function. The prefrontal cortex has several important jobs: self-monitoring, delaying reward, and integrating whatever the intellect tells you is important with what the libido is telling you. The difficulty also has to do with how the brain, when deprived of the drugs to which it is accustomed, reacts to stress. The response is usually exaggerated negative emotion, and even despair. In this setting, the strong association of learned environmental cues (for instance, smelling beer at a ball game or seeing the corner where the dealer can be found) exacerbates the craving for the substance. And the flood of intoxicating brain chemicals called neurotransmitters (chiefly dopamine) during drug use makes the brain relatively insensitive to “normal” sources of pleasure — say, a good conversation with a friend or a beautiful sunset.
The brain science behind these observed and measurable processes in addiction helps to clarify the goals of treatment. Agonist medications (such as methadone and buprenorphine) can stabilize the craving brain while the planning and reasoning processes get back in shape.
But how can a person with addiction avoid the cues that set off craving? How can they reliably get help?
What this all means for overcoming an addiction
It is not enough simply to “just say no.”
The person needs to develop alternative sources of joy and reward, and people who have been isolating themselves in order to drink or use drugs without inhibition may need to work in a purposeful way to re-acquire habitual “joy” — social interactions, physical pleasures like a swim or a bike ride, and other healthy, enjoyable rewards.
At the same time, to say that substance use disorders are “all biology” is an over-simplification. Clearly, there are people on the mild end of the spectrum who have the ability to choose to stop or cut back. For these people, when the rewards of not using outweigh those of using, they stop. Some people with a pattern of unhealthy drug or alcohol use that meets criteria for a diagnosis of substance use disorder may also “mature” out of it without formal treatment. However, the more severe the diagnosis (in other words, the more diagnostic criteria that are met), the less likely this is to happen.
I hope for my patients that understanding that there is biology somewhere down deep in these problematic and often life-threatening behaviors can mitigate the self-loathing and guilt that is nearly universal among people with addiction. And to understand that it may even go deeper, to the genes and experiences over which they had no control, may also help. To learn what normal joy is like, to appreciate a sunset for the first time in years, and to have the skills to choose to deny reward of a craving, when repeated, can become a habit. And when we get good at it, maybe, just maybe, we can begin to have the choice to live a life that is acceptable — or even better than we’d imagined.
With the rising threat of antibiotic resistance, healthcare providers must reduce unnecessary antibiotic exposure and ensure better patient outcomes across various surgical infections. During the 2023 annual meeting of the Surgical Infection Society, a trio of experts addressed the need for surgeons to implement evidence-based, tailored antibiotic treatments to combat multidrug-resistant organisms.
Evidence for Shorter Duration of Antibiotics In Surgical Infections
According to Robert G. Sawyer, MD, the department chair of surgery at Western Michigan University School of Medicine, in Kalamazoo, one solution to the problem of antibiotic resistance is shorter duration of antibiotics. As Dr. Sawyer explained, the use of a shorter duration of antibiotics has demonstrated encouraging outcomes in the management of surgical infections, including bone and joint infections, soft tissue infections, ventilator-associated pneumonia, and bloodstream infections.
Among patients with diabetic foot infections without osteomyelitis, a randomized controlled pilot trial of post-debridement antibiotic treatment compared the effectiveness of 10 versus 20 days usage of antimicrobials, focusing on clinical remission after two months (Ann Surg 2022;276[2]:233-238). The investigators found that a significantly shorter period of antimicrobial use could still achieve similar rates of clinical remission.
Dr. Sawyer cautioned that it’s necessary to consider patient characteristics to ensure a personalized, effective treatment plan, but “this example does provide a strong case in support for the short-duration antibiotic regimen,” he said.
For patients with diabetic foot infections without osteomyelitis, a separate randomized controlled trial of six versus 12 weeks of antimicrobial treatment without surgical debridement showed no difference in remission (Diabetes Care 2015;38[9]:e145). Dr. Sawyer called the results “very compelling evidence” favoring a shortened duration of antimicrobial treatment.
Regarding soft tissue infections, Dr. Sawyer presented data supporting the use of seven to 10 days of antibiotics for subcutaneous abscesses (N Engl J Med 2017;376[26]:2545-2555). Compared with incision and drainage alone, the investigators reported that clindamycin or trimethoprim-sulfamethoxazole in conjunction with incision and drainage improves short-term outcomes in patients who have a simple abscess.
For necrotizing soft tissue infections, a 48-hour duration after source control might be adequate, Dr. Sawyer added. One study of more than 300 patients found that shorter duration of antibiotic therapy after final surgical debridement was associated with no difference in recurrence or mortality, and these patients had a shorter hospital length of stay (Surg Infect [Larchmt] 2022;23[4]:357-363).
Dr. Sawyer also reported that treatment duration for ventilator-associated pneumonia caused by all organisms except non-fermenting gram-negative bacteria can be shortened to seven to eight days (JAMA 2003;290[19]:2588-2598). Among those who had received appropriate initial empirical therapy, a randomized controlled trial of more than 400 patients demonstrated comparable clinical effectiveness against ventilator-associated pneumonia with eight- and 15-day treatment regimens, and the eight-day group had less antibiotic use. Nevertheless, Dr. Sawyer warned that longer durations are needed for Pseudomonas aeruginosa ventilator-associated pneumonia to minimize recurrence risk and provide better outcomes.
For bloodstream infections, Dr. Sawyer suggested seven days for uncomplicated gram-negative infections and two to six weeks for Staphylococcus aureus infections, depending on clinical severity and source control.
Patrick Delaplain, MD
Despite the evidence supporting a shorter span of antibiotic administration for certain surgical infections, however, Dr. Sawyer emphasized that this wouldn’t universally apply to all infections. Primarily bacterial or urinary tract infections, for example, may not be most relevant in a surgical context, he said.
“These findings underscore the necessity for clinicians to consider the unique needs of each patient and the specific nature of their infection when determining the optimum duration of antibiotic therapy,” Dr. Sawyer concluded. “Further research into individualized treatment courses is essential for providing optimal patient care.”
The Rise of Multidrug-Resistant Organisms And the Role of Antibiotic Stewardship
In the presentation that followed, Patrick Delaplain, MD, a clinical fellow in pediatric surgery at Boston Children’s Hospital, noted several pressing issues related to the current patterns of antibiotic prescription, underscoring the potential risks of multidrug-resistant organisms. As Dr. Delaplain reported, the CDC estimates 2.8 million antibiotic-resistant infections each year and approximately 35,000 deaths, while C. difficile infections add another 250,000 cases and 13,000 deaths.
Moreover, approximately 15% of hospital admissions are now associated with a multidrug-resistant organism, and the cost of treating these infections has doubled in the past two decades to more than $2 billion annually. Patients grappling with drug-resistant organisms are also confronted with extended hospital stays and higher incidence of mortality compared with those fighting non–drug-resistant infections.
“Bacteremia caused by vancomycin-resistant enterococci significantly increases the risk factor for mortality in patients, and there’s higher case mortality for surgical site infections,” Dr. Delaplain said. “There’s also a rising concern that methicillin-resistant Staphylococcus aureus might be more virulent than methicillin-sensitive Staphylococcus aureus.”
Given these developments, Dr. Delaplain emphasized the importance of antibiotic stewardship. He defined the three principles of antibiotic stewardship as follows:
Only treat bacteria with antibiotics.
Choose the correct antibiotic, which should be targeted to the organism and not overly broad spectrum.
Identify and adhere to the appropriate duration for antibiotic use.
“Of these principles, the focus is usually on limiting the use of broad-spectrum antibiotics,” said Dr. Delaplain, “but there should be an equal emphasis on limiting the overall exposure to antibiotics.”
To achieve effective antibiotic stewardship, Dr. Delaplain discussed the need to overcome deep-seated myths in the medical community that hinder appropriate antibiotic use.
“The most problematic myth associated with antibiotics, which is still pervasive among treating physicians, is that antibiotics are intrinsically safe,” said Dr. Delaplain, who noted that approximately 20% of hospitalized patients experience an antibiotic-related adverse drug event within 90 days of administration. “The truth is that antibiotics are the second most common cause of adverse drug events in emergency rooms.”
Another prevalent misconception is the interpretation of the duration of antibiotic usage. According to Dr. Delaplain, the notion that maintaining a minimum of a 24-hour antibiotic-use period as a standard for surgical prophylaxis is widespread despite a lack of strong evidence supporting this practice. Dr. Delaplain referenced a study by McDonald et al that showed no clear benefit of multiple-dose versus single-dose prophylaxis (Aust N Z J Surg 1998;68[6]:388-396). A separate study by Branch-Elliman et al found that increasing duration of antimicrobial prophylaxis was associated with higher odds of acute kidney injury and C. difficile infection in a duration-dependent fashion, and that extended duration did not lead to additional reduction of surgical site infections (JAMA Surg 2019;154[7]:590-598).
A recent survey distributed to members of the SIS identified diverse patterns of antibiotic prophylaxis for OR procedures, with prophylaxis varying according to the perceived complexity of the case. According to Dr. Delaplain, it was evident that there “lacked a clear consensus” among physicians about the appropriate duration of antibiotic therapy.
“For less complex procedures, single-dose preoperative prophylaxis is considered sufficient, but as the perceived complexity of the case increases, practitioners tend to favor longer durations of antibiotic use,” he explained. “This practice raises concerns about the possible overuse of antibiotics during complex surgical procedures.”
Another myth identified by Dr. Delaplain is that of fixed antibiotic durations. Instead of assessing the patient’s condition and modifying the duration based on the disease progression and patient response, he said the common practice leans toward “weeklong” durations: one week, two weeks or three weeks.
“This mindset is based on an obsolete study that suggested higher reinfection rates if antibiotics were stopped at the end of symptoms,” he said. “However, a reassessment of that data found that those were likely new infections rather than relapses.”
Despite these hurdles, Dr. Delaplain remained optimistic that guidelines and well-designed randomized controlled trials can influence practice patterns. According to the SIS survey, medical practitioners overwhelmingly agreed that antibiotic stewardship was an essential issue, but translating these beliefs into practice shows a marked divergence.
April Mendoza, MD, MPH
“These findings suggest a need for a more robust emphasis on antimicrobial stewardship at both the undergraduate and postgraduate levels of medical education,” Dr. Delaplain said. “As the pace of drug resistance outpaces the development of new antibiotics, it’s more imperative than ever to apply conservative, evidence-based approaches to antibiotic use.
“A shift towards shorter durations may be crucial for the sustainability of effective therapeutics,” Dr. Delaplain concluded. “The challenge lies in balancing prompt treatment initiation for optimal patient outcomes while limiting unnecessary exposure.”
Changing Surgeon Antibiotic-Prescribing Practices
While refining antibiotic-prescribing patterns should be a priority for all healthcare providers, according to April Mendoza, MD, MPH, an associate professor of surgery at the University of California, San Francisco East Bay, antibiotic misuse is particularly prevalent within the field of surgery. As Dr. Mendoza reported, findings from a recent study showed that surgeons prescribe antibiotics more frequently and continue these regimens longer compared with their counterparts in other medical disciplines (Antimicrob Resist Infect Control 2019;8:151). Surgeons were also more likely to escalate antibiotics and less likely to be compliant with local antibiotic-prescribing policies.
In 2014, the CDC put forward a national action plan to combat antibiotic-resistant bacteria by implementing antibiotic stewardship programs in hospitals around the country. The CDC’s goal was to reduce inappropriate outpatient antibiotic usage by 50% by 2020. By 2019, the data showed 18% fewer deaths from resistant infections and a 30% decrease in hospital-acquired resistant infections. With the onset of the COVID-19 pandemic in 2020, however, action plans were disrupted, and there were significant reversals to many of the gains seen in this period.
“Despite the well-intended efforts to enact change, inappropriate outpatient usage was only reduced by 10% by 2021,” Dr. Mendoza said. “We’re nowhere near where we wanted to be.”
According to Dr. Mendoza, the solution to the problem doesn’t lie solely with national initiatives, but within the medical community itself. Local quality improvement initiatives and consortiums, for example, could play a vital role in changing physician behaviors, especially regarding antibiotic prescriptions. One study published in the United Kingdom showed that a 24-month intervention consisting of only two educational sessions per year led to a 5% increase in correct antibiotic choice for surgery and a 20% decrease in antibiotic duration (BMJ Open 2021;11[5]:e046685).
“What was most useful about this intervention was the two crucial time points to target behavior: 1) pre-op and induction and 2) post-op prescribing on the ward,” she explained.
Dr. Mendoza also stressed the need for more specific guidelines tailored to various surgical specialties.
“The guidelines are often nebulous, leaving room for surgeons to use discretion, which can result in more antibiotic usage than necessary and, ultimately, harm to patients,” she said. “We can standardize ourselves. We can police ourselves better. We lack clear practice guidelines, and it’s been too long now.”
According to Dr. Mendoza, involving senior surgeons in the decision-making process and creating a culture of open dialogue between specialties to improve prescribing practices can help lead to change. She also underscored the scarcity of research for handling special populations.
“We have such a large immunocompromised patient population in the U.S.,” Dr. Mendoza said. “There needs to be firmer statements about how to treat these patients along with drains and foreign bodies, and open fractures.”
In conclusion, Dr. Mendoza referenced the CDC’s recommendations at hospital discharge, which emphasize using the most targeted and safe antibiotic, opting for the shortest effective antibiotic duration, documenting structured and timely discharge summaries, and educating patients and caregivers.
“Society at large also needs to be educated and be part of these discussions, advocating for a more concerted and comprehensive effort to improve antibiotic-prescribing practices amongst surgeons both nationally and globally,” she concluded.
A new link is found between Alzheimer’s transmission and discontinued treatments, shedding light on the disease’s enigma.
Conceptual image of scientific analysis of Alzheimer’s disease.
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Alzheimer’s disease is known to be caused by an abnormal build-up of proteins in the brain cells and around it. One of the proteins involved in creating this disease is the amyloid-beta protein, as its deposits form plaques around the brain cells.
Age is a significant risk factor for Alzheimer’s as the likelihood of developing this disease doubles every five years after one hits the 65-year mark. This condition can also be inherited on rare occasions as it is sometimes genetic.
A new study by a team of UCL and UCHL researchers has provided further evidence that this condition could have also been medically acquired due to amyloid-beta protein transmission
The people described in this paper had all received treatments with a type of human growth hormone extracted from the pituitary glands of deceased individuals(cadaver-derived human growth hormone or c-hGH) at an early age. This same treatment was administered to over 1,800 people in the United Kingdom alone between 1959 and 1985.
This treatment was only withdrawn in 1985 after it was recognized that some batches of the c-hGH were contaminated with infectious proteins called prions. Surprisingly, these infectious proteins caused Creutzfeldt-Jakob disease in some people.
Some of the people who got CJD through the c-hGH treatment had prematurely developed deposits of the amyloid-beta protein in their brains as the samples of c-hGH were all contaminated with amyloid-beta.
Study finds rare cases of Alzheimer’s in middle-aged people
This new Nature Medicine paper, reported by a UCL publication, focused on eight people. These people, all of whom had been treated with c-hGH in childhood, were referred to UCLH’s National Prion Clinic at the National Hospital for Neurology and Neurosurgery in London. Five of them had symptoms of dementia, with all five of them meeting the diagnostic criteria for Alzheimer’s.
This happened despite being between 38 and 55 years old when these neurological symptoms first surfaced, proving that their symptoms are not associated with age. The team also ruled out genetic conditions as the reason behind this condition in all five people after testing their samples.
This leaves only the c-hGH treatment they had received as children as the only plausible reason for the Alzheimer’s diagnosis.
Fortunately, there are no new risks of transmitting this disease medically as the c-hGH treatment has been discontinued, and there have been no other medical procedures reported to be linked to Alzheimer’s transmission.
However, these findings have highlighted the importance of properly reviewing measures to eliminate the transmission of infectious proteins implicated in accidental transmission of CJD.
“There is no suggestion whatsoever that Alzheimer’s disease can be transmitted between individuals during activities of daily life or routine medical care. The patients we have described were given a specific and long-discontinued medical treatment, which involved injecting patients with the material now known to have been contaminated with disease-related proteins,” said the lead author of the research, Professor John Collinge, Director of the UCL Institute of Prion Diseases and a consultant neurologist at UCLH, in a press release.
Co-author Professor Jonathan Schott (UCL Queen Square Institute of Neurology, honorary consultant neurologist at UCLH, and Chief Medical Officer at Alzheimer’s Research UK) added:
“It is important to stress that the circumstances through which we believe these individuals tragically developed Alzheimer’s are highly unusual, and to reinforce that there is no risk that the disease can be spread between individuals or in routine medical care.
He noted: “These findings do, however, provide potentially valuable insights into disease mechanisms, and pave the way for further research which we hope will further our understanding of the causes of more typical, late-onset Alzheimer’s disease.”
The benefits of aloe vera were once more widely known than they are today.
You see, six thousand years ago, the ancient Egyptians regarded aloe vera as a miracle plant.
They used it in many ways, from treating burns to reducing fever. A few millennia later, Cleopatra herself used aloe in her daily skin treatments.
The ancient Greek scientists valued aloe as well, regarding the plant as the universal panacea.
And legend has it that Alexander the Great conquered territory off the coast of Africa to secure supplies of aloe vera for his soldiers.
The “miracle plant” was treated like a treasure throughout much of history.
So why, aside from using it for cuts and burns, have we largely forgotten its many benefits today?
It’s time aloe vera regained its throne, so below are the top benefits of this incredibly versatile plant.
The “Burn Plant”
There are at least 420 different plant species of aloe, but the species used most for skin and medicinal purposes is known as “bitter aloe.”
And its most renowned benefit today is helping to heal burns.
In fact, a 2019 study published in the U.S. National Library of Medicine National Institutes of Health found that aloe vera is one of the most effective solutions in treating first- and second-degree burn wounds. This is due to the soothing and moisturizing properties of the plant that help skin retain its integrity.
Moreover, the study concluded that aloe vera is much more effective and less costly compared to the currently available alternative treatments (petroleum jelly, silver sulfadiazine 1% ointment, and framycetin cream).
Another study showed that the average time of healing a partially thick burn wound with aloe gel was 12 days. This was compared to vaseline gauze to treat the same wound which took 18 days.
However, aloe vera’s greatest-known strength may also be its greatest hurdle, because it has become known today as the “burn plant” — which has overshadowed its many other excellent benefits!
The Anti-Aging Benefits of Aloe Vera
In order to understand the anti-aging benefits of aloe vera, you have to understand the plant’s anatomy. Each leaf of the jagged green plant are composed of three layers:
The inner layer is that iconic clear gel. The aloe gel contains 99 percent water with the remainder composed of glucomannans (a type of dietary fiber), amino acids, lipids, sterols, and vitamins.
The middle layer is made of latex and appears as a yellow sap known as aloin. This layer contains glycosides (a compound formed from a simple sugar) and anthraquinones (organic compounds that cause a laxative effect and help with pain relief).
The last and outermost layer is known as the rind. This thick skin protects the plant and synthesizes carbohydrates and proteins.
From a structural standpoint, aloe vera has a lot going on inside — it’s like a candy factory for nutrients.
These components include amino acids, enzymes, vitamins, and minerals, all of which promote a healthy immune system, aid in digestive health, and reduce harmful nitrates.
With all these beneficial compounds, it’s no wonder aloe provides your skin a range of benefits. According to one study, consuming aloe gel may increase collagen synthesis in the body and even change collagen composition.
Collagen is the most abundant protein in your body — making up one-third of our protein content — and is a major building block for our skin, bones, muscles, tendons, and ligaments.
Healthy collagen levels are also a key component behind healthy, young-looking skin.
In short, because of its effect on collagen, aloe may well help your skin look less wrinkled! There’s even evidence that it may improve the appearance of wrinkles when used topically as well.
To continue with the good news, a specific compound in aloe known as aloesin may help to fade the appearance of dark spots (aka age spots) when applied topically. Other compounds known as mucopolysaccharides help to bind moisture to your skin, improving hydration and making it feel softer.
If that wasn’t enough, aloe gel may also aid in the removal of dead skin cells and acne. A 2014 study found that combining conventional acne cream with aloe gel was significantly more effective than acne medication alone.
All of this shouldn’t come as too much of a surprise.
If the “burn plant” can heal first- and second-degree burns, why wouldn’t it also work well aging or sun-damaged skin?
The Nutrition and Anti-Inflammatory Benefits of Aloe Vera
Like other leafy green plants, aloe vera is loaded with an assortment of vitamins, minerals, and amino acids.
Here are a few of the important ingredients inside aloe gel:
Vitamins: Aloe vera contains vitamin A, which aids the immune system and reproduction; B12, which keeps blood cells healthy and helps create new DNA. It also contains vitamins C and E; the former is critical for a healthy immune system and the latter prevents inflammation and promotes skin health.
Amino Acids (The Building Blocks of Protein): There are 20 amino acid proteins that our bodies need for vital processes. Of that 20, there are 9 that our body cannot produce on its own. In other words, we have to find these amino acids in our foods, thus these are dubbed essential amino acids. Aloe gel provides 7 of the 9 essential amino acids.
Digestive Enzymes: Digestive enzymes are critical in breaking down macronutrients like fats, proteins, and carbs into even smaller pieces to be absorbed. Consuming foods high in digestive enzymes helps digestion and leads to better gut health. Some foods that are high in digestive enzymes are kiwis, ginger, avocados, bananas,… and YES, aloe gel, which contains 8 digestive enzymes. These enzymes include aliiase, alkaline phosphatase, amylase, bradykinase, carboxypeptidase, catalase, cellulase, lipase, and peroxidase. Some of these help reduce inflammation, and others help breakdown sugar and fats.
Minerals: Aloe gel provides calcium, chromium, copper, selenium, magnesium, manganese, potassium, sodium and zinc. The particular minerals that aloe gel are higher in promote bone health, regulate blood pressure, and aid metabolic functions.
Anthraquinones: Anthraquinones are compounds that can help protect against kidney disease, liver disease, and cancer. One study found that anthraquinones suppress inflammation and support a healthy gut. Aloe provides 12 unique anthraquinones.
In addition to the aforementioned micronutrients and their benefits, consuming aloe gel may help relieve heartburn.
More specifically, aloe gel may help with gastroesophageal reflux disease (GERD), a digestive disorder that often results in heartburn. A 2015 study from the National Library of Medicine found that ingesting aloe vera syrup twice a day reduced GERD symptoms, with no adverse events requiring withdrawal.
Finally, one of the emerging benefits of consuming aloe vera juice is its effect on lowering blood sugar. A 2015 study suggests that consuming aloe vera gel can help people achieve better fasting blood glucose levels, as well as reduce body fat and weight.
One important caveat with consuming aloe vera — start with a small amount, as some people may experience a laxative effect (likely due to the anthraquinones).
Oral Care Benefits of Aloe Vera
Another little-known benefit of aloe vera is as a natural mouthwash.
There are many studies of aloe vera-based mouthwash being used to treat gingivitis, plaque build-up and soothe mouth irritation.
One that stands out, however, is a 2014 study published in the Ethiopian Journal of Health Sciences.
Researchers found that an aloe vera-based mouthwash can be a safe and effective alternative to store-brand products. Plus, aloe vera does not contain the unwanted chemicals common to store-brand options. And it cost significantly less than those store-brand options!
Truly Obscure Benefit of Aloe Vera — A Natural Preservative!
Another very little-known use for aloe vera gel is its ability to preserve fruits and vegetables when coated on them.
A 2014 study published in the American Journal of Food Science and Technology found that aloe gel has the ability to prolong the shelf life of fruits and vegetables. The plant is able to do this because it has antifungal and antibacterial properties that provide a defensive barrier against microbial contamination of produce.
Yes, aloe vera really is the “Swiss army knife” of plants. Today, researchers are even experimenting to see if aloe-emodin, a compound in the plant’s leaves, can slow the growth of breast cancer. More research is needed to further this theory, though.
Bottom line, and as the ancients seemed to know, the big question with aloe vera seems to be what CAN’T it do?
8 Key Steps for Using Fresh Aloe Vera
Both aloe vera plants and leaves are rather easy to find today. You can find the plants to raise in your home or garden, and the freshly cut leaves if you prefer that route, everywhere from local farmer’s markets to major supermarket chains like Whole Foods and Walmart.
Additionally, aloe-based products are sold in many stores. HOWEVER, please be certain those products are USDA Certified Organic (or the equivalent, such as in other countries) because such products can otherwise be loaded with other toxic or synthetic ingredients.
If you do choose to grow your own aloe vera and harvest it for the gel and juice, remember to:
Cut your leaves close to the stalk, as most of the beneficial nutrients are found at the base of the leaves.
Place the leaves in a jar (cut side down) to drain the aloin (the yellowish latex substance) unless you’re planning on using it
Wash and dry the leaves
If you’re planning on using the aloe for your skin, you can scoop the gel out with your fingers (or a sharp object) and apply directly to your skin.
You can also squeeze out the gel once you’ve trimmed the prickly edges of your leaf
Depending on the size of your aloe plant, 3-4 leaves should leave you with about ½ to ¾ cup of aloe vera gel.
Cut the aloe gel into slices or cubes and refrigerate them ASAP
If you aren’t planning on using your leaf right away make sure to refrigerate it as well
Finally, as for consuming aloe vera, there are many online recipes you will find by searching “aloe vera recipes.”
One of my favorites is simply aloe and cucumber water — just combine some aloe vera juice with cucumber and water (or coconut water) for a healthy and delicious beverage!
The most celebrated genius in human history didn’t just revolutionize physics, but taught many valuable lessons about living a better life.
When it comes to living your best life, Albert Einstein — notorious as the greatest physicist and genius of his time, and possibly of all-time — probably isn’t the first name you think of in terms of life advice. You most likely know of Einstein as a pioneer in revolutionizing how we perceive the Universe, having given us advances such as:
the constancy of the speed of light,
the fact that distances and times are not absolute, but relative for each and every observer,
his most famous equation, E = mc²,
the photoelectric effect,
the theory of gravity, general relativity, that overthrew Newtonian gravity,
and Einstein-Rosen bridges, or as they’re better known, wormholes.
But Einstein was more than just a famous physicist: he was a pacifist, a political activist, an active anti-racist, and one of the most iconic and celebrated figures in all of history.
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He was also known for his unconventional behavior in a variety of ways that flouted social norms, including his unkempt hair, his witty humor, and his unrelenting hatred of socks. But less well-known is Einstein’s freely-given life advice to many of his friends, acquaintances, and contemporaries, which are perhaps even more relevant today, in the 21st century, than when he initially doled out his words of wisdom and compassion. Taken from the book The Einstein Effect, written by the official social media manager of the Einstein estate, Benyamin Cohen, these rules for a better life go far beyond physics and are relevant to us all. Here are, perhaps, the best and most universally applicable lessons from Einstein himself.
Rule #1: Expend your efforts on the things that matter.
When you think of Einstein’s appearance, the word “disheveled” may come to mind. His overgrown, uncombed hair, his ratty, worn-out, often smelly clothing, his shoes without socks, etc., all were notoriously slovenly. But none of that bothered Einstein, who in his later years wore what could be considered almost a uniform: a signature grey suit, sans the traditional sport coat, with a leather jacket in its place. (And, of course, with shoes and no socks.)
This idea, of wearing simple but functional clothing that puts the wearer at ease with themselves, has been made famous in recent years by tech entrepreneurs who have their own signature style:
Mark Zuckerberg, who prefers blue jeans and T-shirts,
Satya Nadella, who typically wears slacks, polo shirts, and Lanvin shoes,
and Jack Dorsey, whose all-black outfits often include a hat, hoodie, or jacket,
is prized for one reason above all others: efficiency.
If you have a lot of decisions to make each day, or a lot of work that requires mental effort in any sense, cutting down on your overall mental load is of paramount importance if you want to avoid what’s known as decision fatigue: where our ability to make good decisions degrades as we become more tired from relentlessly having to make choices.
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As fashion journalist Elyssa Goodman wrote, “Uniform dressing has roots in not just physical but mental efficiency. People who have to make immense decisions every day will sometimes choose a consistent ensemble because it allows them to avoid decision fatigue, where making too many unrelated decisions can actually cause one’s productivity to fall off.”
It’s a way to economize your efforts: to put them where they’re most needed, at the expense of not wasting them on spurious or unimportant matters. In other words, choosing not to put effort into the things that are superfluous to what’s actually important to you is a way to become more mentally efficient, which frees up your mind to focus on what actually matters most to you. Einstein’s lack of effort into his personal presentation extended to his disdain for going to the barber, as well as his often nearly-illegible penmanship. But the rewards, of focusing his mind on what was truly important to him, led him to a rich, fulfilling life.
This 1930 photograph shows Albert Einstein sailing with his step-daughter Ilse and her husband Rudolf Kayser in Germany, less than 3 years before he fled his home country for the United States.
Rule #2: Do things you love, even if you’re terrible at them.
While many of Einstein’s passions extended far beyond physics — including a love of baked goods and a penchant for playing the violin — perhaps the one he enjoyed the most was sailing. As Einstein wrote, “A cruise in the sea is an excellent opportunity for maximum calm and reflection on ideas from a different perspective.” His second wife (and cousin), Elsa, added that “There is no other place where my husband is so relaxed, sweet, serene, and detached from routine distractions; the ship carries him far away.” By focusing on something mundane, Einstein’s mind was free to wander, frequently leading him to exciting new ideas.
Einstein, however, was completely inept at sailing, and was at best a wildly inattentive sailor. He would frequently lose his direction, run his boat aground, or have his mast fall. Other sailing vessels frequently had to beware of Einstein’s ship, as he was a hazard to himself and others, refusing to wear a life vest despite being unable to swim. Boaters and even children routinely rescued him, and having his boat towed back to shore was a frequent occurrence. But the serenity Einstein experienced while sailing was unparalleled, giving him a mental freedom that we should all aspire to for ourselves.
Rule #3: Have a puzzle mindset.
Think about the problems that we face, both as individuals and collectively, as a civilization. These could be financial, environmental, health-related, or political, for example, as those arenas affect us all. Do you view these problems as crises? If you do, you probably feel despair at them, as there’s very little that’s empowering about facing a crisis. But if you view them as a puzzle, you might be inclined to think about a fresh approach to solving them. In this regard, Einstein was pretty much the prototype individual for someone who viewed every difficulty he faced as a puzzle to be solved: in physics and beyond.
Consider his oft-misunderstood but most famous quote, “Imagination is more important than knowledge.” While many people had looked at the puzzle of objects moving near the speed of light before — including other geniuses like FitzGerald, Maxwell, Lorentz, and Poincaré — it was Einstein’s unique perspective that allowed him to approach that problem in a way that led him to the revolution of special relativity. With a flexible, non-rigid worldview, Einstein would easily challenge assumptions that others couldn’t move past, allowing him to conceive of ideas that others would unceremoniously reject out-of-hand.
The identical behavior of a ball falling to the floor in an accelerated rocket (left) and on Earth (right) is a demonstration of Einstein’s equivalence principle. If inertial mass and gravitational mass are identical, there will be no difference between these two scenarios. This has been verified to ~1 part in one trillion for matter, and was the thought (Einstein called it “his happiest thought”) that led Einstein to develop his general theory of relativity.
Einstein was no stranger to having strongly held convictions about both life and physical reality, but each of his opinions, even those he was most certain of, were no more sacred to him than a mundane hypothesis. When one has a hypothesis, or idea, the goal isn’t simply to find out whether that hypothesis is right or wrong; in some sense, that’s the least interesting part of the endeavor. The search for the answers, including figuring out how to perform the critical test and interrogate the Universe itself in an effective manner, was what truly got Einstein excited.
His thought-experiments were among the most creative approaches ever taken by physicists, and that line of thought has been adopted by a great many scientists ever since who wish to avoid what’s known as cognitive entrenchment. What would a light-wave look like if you could follow it by traveling at the same speed it traveled at? How would the light from a distant star be deflected by the Sun’s gravity during a total solar eclipse? What experiments could one perform to determine whether our quantum reality is pre-determined by variables we cannot observe directly? Unlike a preacher who claims to be infallible, a prosecutor who wants to convince you of their perspective, or a politician who just wants to win your approval, having a puzzle mindset — i.e., the mind of a scientist — is the only one that can lead you to novel discoveries, including quite unexpected ones.
Rule #4: Think deeply, both long and hard, about things that truly fascinate you.
Over the course of his long life, Einstein received many letters: from those who knew him well to perfect strangers. When one such letter arrived on Einstein’s desk in 1946, asking the genius what they should do with their life, the response was as astute as it was compassionate. “The main thing is this. If you have come across a question that interests you deeply, stick to it for years and do never try to content yourself with the solution of superficial problems promising relatively easy success.”
And if you fail to arrive at the solution you’ve been chasing, don’t despair. As Einstein wrote to his friend David Bohm, “You should not be depressed by the enormity of the problem. If God has created the world, his primary worry was certainly not to make its understanding easy for us.” Although Einstein was most famous for the problems he did solve, there were plenty whose solutions eluded him all his life: from finding a deterministic explanation for the observed quantum behavior to the attempt to unify all of physics (including gravity and the other forces) into one overarching framework.
Although many have tried-and-failed (and continue to try-and-fail) to solve these and other puzzles, the greatest joy and fulfillment is often to be found in the struggle itself.
This political cartoon, published in 1933, shows Einstein shedding his pacifist wings to roll up his sleeves and take up a sword labeled “preparedness.” Einstein would at this point call upon the friends of civilization all across the world to unite against Nazi militarism. (Credit: Charles R. Macauley, 1933)
Rule #5: Don’t let politics fill you with either rage or despair.
Einstein kept up with many friends and members of the public, but also with his extended family. In correspondence with his cousin Lina Einstein, he offered a lesson that many of us would do well to heed. “About politics to be sure, I still get dutifully angry, but I do not bat my wings anymore, I only ruffle my feathers.”
How many of us have seen a friend, acquaintance, or even total stranger make a statement that filled us with outrage, and flew off the handle, filled with righteous indignation, and launched into a tirade as a result? While that might fulfill some primitive need in us to speak our mind and challenge what we see as an unacceptable narrative, how often was such a response actually effective in achieving any of our goals?
Sometimes, it truly is important to intervene and go all-out: what Einstein refers to as “batting our wings.” But at other times, in a lesson that King Bumi from Avatar: The Last Airbender would heartily approve of, sometimes the best response is to sit back, observe, think, and wait for the opportune, strategic moment to take action down the road: “ruffling our feathers” for the time being. The Lina he gave the advice to, his cousin Carolina, left Europe in the 1930s and emigrated to Uruguay, where she lived out the rest of her days.
Albert Einstein (right) is shown with physicists Robert Millikan (left) and Georges Lemaître (center) several years after admitting his biggest blunder. If you think that modern critics are harsh, one can only imagine how Lemaître must have felt to receive a letter from Einstein calling his physics abominable! Fortunately, just as Einstein was not dissuaded by the prevailing authorities of his time, Lemaître and others were not deterred by Einstein’s declarations of unsoundness. (Credit: Bettmann / Getty Images)
Rule #6: Blind obedience to authority is the greatest enemy of the truth.
Many of us, upon hearing something that we are certain is either absurd, flawed, or hopelessly corrupt, immediately and vociferously make up our minds to oppose them, regardless of what the full suite of evidence actually indicates. Once we abandon our critical thinking faculties because we are certain we know the answer, we tend to simply go along with those who agree with us and oppose those who espouse anything different. To Einstein, this represented the death of the rational mind, which he called “collective insanity” or a “herd mind.” Today, we would likely call it groupthink, and Einstein noted that it was often driven by a prominent figure spouting propaganda.
Scientists, including formerly reputable ones like Johannes Stark (Nobel Laureate and founder of the Stark effect), formed an anti-relativity society that discredited Einstein and his theory. Fueled by nationalism and anti-semitism, Einstein and his ideas became a target, with one line of attack claiming relativity was wrong and dangerous, and another line claiming it was brilliant but that Einstein stole the idea from “real” (non-Jewish) scientists. It was this course of action that eventually led to Einstein having a bounty placed on his head, leading to him fleeing Germany for the United States. While Einstein initially thought these machinations were silly, ridiculous, and harmless, he later concluded that “Blind obedience to authority is the greatest enemy of the truth.” In the era of fake news, this lesson is more important to assimilate than ever.
During the 1940s, Einstein himself gave a number of lectures to students who would have, in the past, never have had access to a speaker such as himself. Einstein made it a point to be generous with his time and with affording others access to him, and was a prominent supporter of civil rights for all. (Credit: Lincoln University of PA/Langston Hughes Memorial Library)
Rule #7: Science, truth, and education are for everyone, not just the privileged few.
Einstein was often very critical of the United States Government, even after emigrating in the 1930s and gaining his citizenship in 1940. The history of slavery and ongoing segregation and racism, in particular, resonated with him the same way that anti-Semitism did: as fundamentally dehumanizing as it was baseless. The FBI began a file on Einstein in 1932, and it had burgeoned to more than 1400 pages by the time Einstein died in 1955, and Einstein’s anti-racist actions were deemed fundamentally un-American by many (including Senator Joseph McCarthy), but Einstein would not be deterred.
In 1937, Einstein invited black opera star Marion Anderson to stay at his house when she was refused lodging at the local (segregated) hotel in Princeton. In 1946, Einstein took the revolutionary action of simply visiting Lincoln University — the first degree-granting black college in the United States — and lectured, speaking with students and answering questions. Delivering an address to the student body, Einstein said:
“My trip to this institution was on behalf of a worthwhile cause. There is a separation of colored people from white people in the United States. That separation is not a disease of colored people. It’s a disease of white people.”
In 1953, Einstein defended the academic freedom of William Frauenglass, a teacher who taught about easing interracial tensions, in a letter published by TheNew York Times. The following year, he further pushed for “the right to search for truth and to publish and teach what one holds to be true.” In this day and age, we can be certain that Einstein would have pushed for science, truth, and education to be available to everyone. While certain physical properties may be relative, like space and time, the joys, knowledge, and truths uncovered by science belong to no one race, nation, or faction, but rather to all of humanity.
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