Influence of Parasites on Behaviour

Sometimes we think that we have understood something, then scientists comes up with new insights, which force us to rethink about that understanding. For example, over the past decade, insights about the gut bacteria which constitute our microbiome and might shape different aspects of our lives, from obesity to depression, have opened a new areas of scientific enquiry. The discovery of a "new body organ", the interstitial space, is another emerging area of research and understanding, which might have surprises waiting for us. Kathleen McAuliffe's book about parasites and how they might affect human behaviour relates partly to the role of gut bacteria, but has a wider scope. It did manage to force me to reflect about issues that I had not thought before.

About 50 years ago, when I had joined medical college in India, I used to think that almost all the things that could have have been discovered about human body and diseases had already been discovered. I imagined that technology might help us improve some things, like diagnosing some difficult to diagnose conditions, but I had no idea that in these 50 years scientific knowledge about some aspects of human body, such as genetics, was going to change so drastically. That is why I love reading books which give an understanding about human body and its influence on the changing practice of medicine.

McAuliff's book has a strange title, "This is Your Brain On Parasites", which does not sound very interesting, but its subtitle explains it better - "How tiny creatures manipulate our behaviour and shape society". This post is about this book, which I would divide into 2 parts - the first part is about different parasites which infest worms and insects and, change their behaviour; the second part is about humans. The latter is more speculative, it wonders how parasites and fear of illness might be influencing our sense of disgust and our behaviour towards "outsiders".

Parasites in Other Life Forms

In the first part of the book, McAuliff talks about researchers who have spent all their lives following the life cycle of a parasite and the surprising things they have discovered. McAuliff explains that searching for these stories was what led her to writing this book:The impetus for this book was a discovery on the Internet. I’m a science journalist and one day while foraging for interesting topics to write about I stumbled across information about a single-celled parasite that targets the brains of rats. By tinkering with the rodent’s neural circuits—exactly how is still a matter of fervid study — the invader transforms the animal’s deep innate fear of cats into an attraction, thus luring it straight into the jaws of its chief predator. This is a felicitous outcome not only for the cat but also, I was stunned to learn, for the parasite. It turns out the feline gut is exactly where the organism needs to be to complete the next stage of its reproductive cycle ... As I continued reading, more surprising news greeted me: The microscopic organism is a common inhabitant of the human brain because cats can transmit it to us when we come in contact with their feces. Perhaps the parasite was meddling with our brains too, speculated a Stanford neuroscientist associated with the research.
The stories of parasites entering the bodies of their hosts and changing their behaviour to suit their own desires, are like the stories of ghouls and spirits taking over and turning living beings into zombies - fascinating and frightening. At the same time, this part of the book explains the different obstacles these scientists had to overcome in their single-minded passion about one worm or one insect, over periods lasting decades. It is a pity that most of their names remain in obscurity.

For example, there is the story of the scientist Janice Moore who got interested in the life-cycle of a tapeworm and studied how it passes part of its beginning life in the ants and then it makes the ants go crazy, so that they climb on the the tip of grass and wriggled in such a way to attract the sheep to come and eat those grass-blades. Thus the worm reaches the brain of the sheep, needed for the next phase of its life-cycle.

From crazy fishes flipping on their belly on the surface of water so that they were eaten by some cranes to cockroaches meekly following the wasps to their nests so that wasp could deposit its eggs on its tummy and when wasp-babies come out they could have fresh cockroach meat, the stories are incredibly interesting and morbid.

They also made me think about some flamboyant persons with attention-seeking behaviours and wonder if they might have some worms in their brains? We do have some popular ways of sayings in Hindi in India, such as "Iske dimaag mein keeda laga hai" (His/her brain has got a worm), which sounds very similar to these stories.

Parasites and Human Behaviour

In this part of the book, McAuliff focuses on human psycho-pathology. These are more of hypothesis rather than scientific studies, about how the bacteria living in our bodies might be influencing our behaviour (though these bacteria are not really parasites, rather these are symbiotic organisms, as they get nutrition from us but they also provide benefits to us such as vitamins).

Cruickshank, in her review of McAuliff's book in New Scientist has critiqued this part:

Oblivious, McAuliffe skips into attention-grabbing territory armed with only the flimsiest of evidence. She claims, for example, that infection makes us more sociable and sexually voracious as the parasite seeks to infect others. This is based on a study that followed people given a flu shot (it being unethical to give people actual influenza). The subjects’ increased sociability might have been due to viral manipulation, but for my money it’s more likely they were simply feeling confident about being protected from infection.

McAuliff may not have evidence for most of the things she writes in this part of the book, but in terms of human psycho-pathology, they do raise some interesting hypothesis.

Conclusions

Studying the influence of bacteria and parasites on human behaviour is a field in expansion and new discoveries are already being made, which have many practical implications. For example, understanding how the malaria parasite influences mosquito behaviour and how it changes human physiology, can help us in diagnosing it and fighting against an infection which kills hundreds of thousands of persons each year. Some months ago, I had seen a TED video by James Logan about how dogs may be able to identify persons with malaria parasite, because the parasite makes our bodies secrete a chemical in our sweat, which attracts uninfected mosquitoes to come and bite us, and dogs can be trained to identify the persons with this chemical in their sweat.

I found this book hugely interesting and read it in a span of a few days, almost like a thriller. It is true that in terms of influence of micro-organisms and parasites on human behaviour, this book is speculative. However, it might influence young researchers to study these areas and see if such infections/infestations can be implicated in the causation of conditions which are yet not properly understood, like schizophrenia and Alzheimer disease.

*****

The City of 47 Ronin

The tiny town of Ako in south-west Japan is known for the story of 47 Ronin. The city has a beautiful Shinto shrine with the statues of those 47 warriors who had chosen to become outlaws to avenge the death of their lord.

I had watched the film "47 Ronin" starring Keanu Reaves, which was based on this story. A couple of years ago when I was in Okayama for a meeting organised by Sasakawa Health Foundation, I had discovered that it was not very far from Ako. Thus, I took that opportunity to go and visit this city and to become familiar with its famous legend. This post is about my visit.

Samurai and Ronin Traditions in Japan

The Samurai (Bushi) warriors became an important group in Japan in the 12th century when they worked for feudal lords. Those lords along with their samurai were the real rulers of Japan.

The samurai followed a code of conduct called Bushido. According to the Bushido, when a Samurai became master-less, for example by the death of his master, he was expected lay down his arms and to commit suicide by Seppaku (by plunging a knife in the stomach). Any samurai who did not kill himself was known as ronin, a warrior without honour.

The ronin were looked down upon by their fellow samurai and by the society. They were ridiculed and faced public humiliation.

In 1868, with the Meiji reforms, the military control of country was replaced by a centralised bureaucratic governance. This ended the role of samurai.

I feel that the idea of warriors without a lord committing suicide according to an ethical code sounds similar to the ideas in medieval India about widows letting themselves be immolated along with their husbands' bodies under the "Sati" rituals. Such ideas may seem acceptable while one is wrapped inside and isolated in those ritualistic beliefs. Perhaps some can argue that the suicide bombs by radicalised Islamists are similar rituals, though those are fundamentally different since they also involve additional killing of unsuspecting persons. However, an unwrapping of self and a contact with wider world makes such ideas of ritualised suicides seem like aberrations and a kind of mental illness (though the traditionalists won't agree with this view).

Looking at the figures of Ronin through modern eyes, I feel that seeking revenge for their lord's death was a better option for the warriors, than killing themselves through ritual suicide, though in the Ako story, they did kill themselves after taking their revenge.

The Ronin of Ako - Historical Background

"Ako vendetta", was a historical event in which a group of ronin avenged the death of their master Lord Naganori Asano.

In 1701, Lord Asano, the Daimyo of Ako, was forced to commit ritual suicide by Kira Yoshinaka, a scheming official of the imperial court. However, Asano's samurai did not commit seppaku as foreseen by the Bushido and instead became ronin. Their initial attempts to avenge the death of Lord Asano were unsuccessful. Finally, those 47 ronin managed to kill Kira at Sangakuji in Edo (now known as Tokyo).

Even though by taking up the arms after the death of their lord, they had violated the samurai code of conduct, their honourable action in avenging Lord Asano was recognized. Thus after their revenge, those 47 ronin were allowed an honourable death by committing seppuku.

During the Meijo era (1868-1912), the story of 47 ronin became very popular all over Japan through songs and traditional plays such as kabuki. It was a tale of persistence, honour and sacrifice. The Hollywood film "47 Ronin" (2013) was inspired from this story.

The City of Ako

Ako is located in the Hyogo prefecture in south-west Japan, between Osaka and Okayama. Its railway station is called Banshu-Ako. It is a small coastal town facing the inland sea. It has a population of around 50,000.

Ako is located on the banks of Chikusa river and has a good network of canals. On 14 December each year, Ako celebrates the Gishisai festival to remember the 47 ronin, with a parade of the warriors dressed in old costumes and illuminations with lanterns.

Reaching Ako

When I told my Japanese friends that I wanted to visit Ako, they were a little surprised. The city's name was not so familiar to them. I had to explain the story of 47 Ronin to them. Even at the tourist office in Okayama where I went to ask for information, they were surprised that I wanted to go to Ako. They were not sure if there was much to see in Ako. However, as you can see from the images, it is a beautiful city and is worth visiting.

To reach Banshu-Ako, I took the Ako line local train from Okayama. The journey took around an hour. Passing through small towns and villages (including Bizen and Osafune, two famous small towns in this region) along with verdant mountains, it was a beautiful journey.

The local train network also connects Banshu-Ako station to Himeji and Kobe on the east.

Places to visit in Ako

The city centre is small. The places to visit include the ruins of the castle of Ako and some shrines and temples. Among the shrines, the most important is the Shinto shrine linked with the 47 ronin located near the castle.

Among the temples, the most important is Kagaku temple. The Kagaku temple, the Ako castle and the Shinto shrine of the 47 ronin, are all at a walking distance from the railway station. The main street in front of the railway station leads to the castle. A map of the city in the square facing the railway station will show you all these landmarks. The city, including the railway station, is full of banners, posters and tiles with images of the different Ronin warriors.

In Kagaku temple, I met a group of Japanese artists, who were visiting the city and making drawings of its different buildings. They were curious about me but we had to communicate with gestures as they could not understand English.

The Kagakuji (or Sengakuji) was the family temple of the Asano family. It is a beautiful Buddhist temple with a giant bell and with different shrines. I was told that Kagaku temple has the tombs of the 47 Ronin, each marked by the number "7" to denote death by seppuku. However, I had also read that the tombs of the 47 ronin are in the cemetery of the Sengakuji temple in Tokyo, so I am not sure if the tombs in the Kagaku temple of Ako were real or not. I tried asking about them but was unable to make myself understand and thus, did not see them. In the temple, there were no sign boards indicating the tombs.

Ako Castle and Oisho Shrine of the 47 Ronin

When I reached the castle, some of the persons from the group of Japanese artists had also reached there and they smiled at me. There was no ticket to enter the castle, which does not have many things to see. Imposing walls surrounded the castle ruins. This castle was destroyed by the bombings during the second World War, and its walls have been recently rebuilt to recreate the old ambiance.

Inside the walls, most of the ruins were just empty spaces marked on the floor explaining the different building of the old castle. The castle was built by Naganao Asano Ako, the third lord of Ako domain and the grandfather of Naganori Asano. It had taken them 13 years to built this castle. I was told that the rooms of the Lord and his wife were marked on the floor, but since it was only in Japanese, I could not identify them.

On one side inside the castle, there is a short and squat tower (Tenshudai), where you can go up and have a panoramic view of the area.

A winding path passing near the Ako Museum of History and the Gardens of Ako castle took me to the shrine behind the castle. It is marked by a row of statues of the 47 ronin on both the sides of the path. This shrine is also called Oisho shrine to remember Oisho, the leader of those Ronin.

Each statue of the ronin was different - showing men of different age groups, each with his favourite weapon, some of them standing while others were sitting. Against the background of the castle ruins, the two rows of statues lining the path leading to the shrine made a powerful visual impact.

Inside the shrine gate (Torii), on the two sides were two giant wooden statues of pot-bellied old men. The one on the left was Daikoku Sama, symbolising luck and matrimonial happiness. The one on the right was Ebisu Sama, symbolising success in business and trade.

Inside the shrine, there were different memorials for persons to express their admiration for the warriors - for example, through the streamers of paper-cranes usually placed in cemeteries. The courtyard also has a statue of Oishi Kuranosuke, the leader of the Ronin.

One of the shrine buildings was Homotsu-Kan or the treasure hall, entry to which has a ticket. Inside you can see the Oishi "Glass of Rules" for the Ako samurai. The rules included the following - do not fight, do not spill drink from your mouth and do not force a non-drinker to drink.

A path from the Shinto shrine led to castle garden - a beautiful garden just outside the castle ruins. When I visited it in April 2017, it was not yet completely done and some parts were closed. Still it seemed to be landscaped beautifully with a canal, some gently bubbling fountains and a quaint bridge.

The garden ruins also include two ponds, both beautifully designed to evoke feelings of peace and harmony.

Conclusions

I could visit Ako only for a few hours. It was a rainy day. I knew that there would not be enough time to visit the historical museum or to go to the sea coast in Ako. On the other hand, I had thought that I will be able to visit Chikusa river and a couple of other shrines near the railway station. However, the visit to the castle and the Oisho shrine took most of my time and I could not do more, I had to rush back to catch the train to Okayama.

I think that Ako merits a visit. If you are visiting south-west Japan, such as Okayama or Kobe, it would be worthwhile keeping a morning to visit it.

*****

#banshi-ako #japan #samurai #bushido #legends #47ronin 

4th Schio Biennale of Papermade Art 2019-20

The 4th edition of the Schio Biennale focusing on Papermade exhibition is going on at Fogazzaro Palace in Schio. It is a biannual art exhibition on paper art.

This post is about my favourite 15 art works from the 2019-20 Papermade exhibition. 

The Theme of Papermade 2019-20

The theme of 4th edition of Papermade curated by Valeria Bertesina is "Beauty in the non-essential". Art and beauty may be seen as unnecessary, even superfluous, but I feel that art and beauty add life to our lives. Prehistoric humans understood it, when they made cave art, necklaces out of colourful beads and painted figures on earthenware.

This exhibition started in October 2019 and will finish on 9 February 2020 (Note: it has been extended till 13 April 2020). It includes two special events - (1) a series of "sculptures" by Joseph Rossi which re-interpret some iconic & provocative works of the well-known Italian artist Maurizio Cattelan, and (2) a mini- exhibition of 15 artists from Finland. The image above presents "Him" by Joseph Rossi, which was a re-interpretation of the Maurizio Cattelan sculpture (2001) of a school boy with the face of Hitler kneeling in prayer.

Re-Interpreting Maurizio Cattelan

Joseph Rossi is a graphic artist based in the nearby Thiene. This edition of Papermade is hosting few of his installations, including some which are a homage to the iconic works of Maurizio Cattelan.

Cattelan, a famous artist based in Padova (Padua), has been in the news recently because of his provocative work of "art" which had a banana fixed to the wall with a duct-tape in the "Art Basel" exhibition in Miami Beach USA, which was sold to an unnamed French art collector for 120,000 dollars and eaten by the Georgian performance artist David Datuna. I think that such works are an example of performance art, which may even be seen as a criticism of the way "conceptual art" is dominating the various recent biennales.

The image above presents another of Joseph Rossi's re-interpretation of Cattelan's provocative works - of the 1999 wax sculpture called "Ninth Hour" which showed Pope John Paul II lying dead crushed by a meteorite.

Finnish Artists in Papermade

There are works of 15 well-known artists from Finland in this Papermade exhibition. They range from art-works with pastel and ink on different kinds of paper, to etching, mezzotint and digital prints. They also include 2 installations - (1) Trio Schio, a paper-meche work by Arja Jappinen; and (2) Beauty, an assemblage including cut paper and origami by Jouni Boucht (in the image below).

Among all the other Finnish artists, my favourite were the 'charcoal on paper' art works by Paula Suominen, presented in the image below.

Another work which I liked very much was called "Land of the Free", made with ink and spray paint by Egs, a well-known graffiti artist from Finland. The image below shows part of this work.

Other Art-works at Papermade

An important presence at Papermade was of the Australian artist Giuseppe Romeo. His cockroach-like origami "sculptures" with a metallic finish, greeted visitors on the stairs and spread over the exhibition, on the floors and the walls, looking like an infestation.

I liked the colours and vivacity of the collages by the Italian artist Elsa Pietrelli.

I was touched by the digital print of a woman's face by the Vietnamese artist Quang Pham Khac, who explained that it was an image of his wife, which he has been making in different forms over the recent period to cope up with her death.

I loved the colours and feelings evoked by the series of paintings/collages by Silvio Cattani inspired by the poetry of the famous Russian poet Sergej Yesenin.

The tropical foliage (below) and the human figures created by Canadian artist Zachari Logan in his "Eunuch Tapestrieses", with pastel art-work on black paper, were visually very striking because of their vivid colours and details.

I am not a fan of the "conceptual art". Even in this exhibition, there were a couple of such installations, which I felt were unexciting and a kind of lazy art. However, I liked the idea behind Iginio Iurilli's simple installation called "Exploding tomato sauce can" (below).

I liked the prints from etchings/woodcut/Relief by Tribhuvan Kumar Dev from India, Haladaj Wieslaw from Poland, Linda Whitney from USA (presented in the image below), Marco Trentin & Leonardo Marenghi from Italy and Yuji Hiratsuka from Japan.

Finally, I liked the tiny and exquisite water-colours of birds by Michela Moretto (below).

For this post I have presented pictures of 15 art-works which I had liked. However, I am very much aware of my own fickle subjectivity - on another day, I would have chosen other art-works. If I ask you to choose your favourite art-works from this exhibition, surely your choice would be different from these 15 works!

Conclusions

I think that this edition of Papermade has a lot to see, admire and think. Generally speaking, in an exhibition on paper art, I would like to see works which use paper in innovative ways and not just as a background to make prints or to paint with ink, pastels or water-colours. In that sense, there were not many new ideas in the exhibition. However, if you visit it with an expectation of seeing art which stimulates you and makes you reflect, you won't be disappointed.

Let me conclude this post with two cut-paper origami inspired works - the delicate "Between you and I" by Susanna Doccioli (above), and the gossamer "Suspended Labyrinth" by Susy Manzo (below).

The exhibition is open till 9 February 2020 (Note: it has been extended till 13 April 2020), so if you are visiting Schio, do not miss it. It is a 5 minutes walk from the railway station. 

*****

Highlights from My Journeys in 2019

2019 was full of journeys for me, from Philippines in the east to Brazil in the west. This post is to remember the most significant moments of my travels. The first picture (below) is from a wonderful journey across Kerala and Karnataka in India - from the Chennakeshava temple in Belur.

There was a time, when I did a lot of international travel. Then over the past decade, my travelling had gradually decreased, though I still continued to visit 3-4 countries every year. However, in 2019, a number of events came together, creating greater opportunities for my travel.

Travels in India

I started 2019 by travelling to Delhi in January. During this visit, I decided to explore the expanded network of the Delhi metro. For example, one day I went to search for the Dalit Pride Park in NOIDA. On my way back, I stopped in Jamia Milia and went to visit the tomb of Dr Zakir Hussain (in the image below), who was the President of India during 1967-69.

As a child, I had met Dr. Hussain and the well-known artist M.F. Hussain at Triveni Kala Sangam in Delhi and had vivid memories of that meeting. I was curious to visit his tomb.

In January, I also went to Kerala, where in Fort Kochi I visited the Kochi Art Biennale 2018-19. The image below presents an installation by Venu V. from the biennale.

I travelled in trains and buses along the Kerala coast, going from Kochi to Mangalore and then to the town of Hassan in Karnataka. From Hassan, I visited the amazing temples of Halebidu and Belur. The first image at the top presents one of the amazing women sculptures from the Chennakeshava temple in Belur.

Back in Delhi in February, I visited the recently rennovated Sundar Gardens near Hamayun tomb. The image below shows Sundar burj from these beautiful gardens.

February was also an opportunity to visit the street art in Lodhi colony, about which I had heard a lot. It was the time when some artists were visiting the city to make new murals, so during my next visit to Delhi, I am planning to visit this area once more to see the new additions.

In March, we had a family visit to the Kumbh mela in Prayagraj (Allahabad). My cousin sister had passed away suddenly and our visit included a ceremony for dispersing her ashes at Sangam, where river Ganges meets Yamuna. This visit was also an opportunity to visit and meet persons from our extended family and our old family home, before coming back to Delhi and concluding my India visit.

Milan, Italy

Back in Italy, in early April, I was part of a conference in Milan. This was an opportunity to explore the Naviglio canal. I had been there many years ago and remembered it as an old and decaying area. With the cleaning of Naviglio, the whole place has changed completely. Now it is full of tourists visiting crowded restaurants and new glittering shops.

Liberia

In the last week of April, I was back in Monrovia, the capital of Liberia. There is not much to see in Monrovia and security concerns make it difficult to go out. I also had to run a training course, so there was not much free time. However, one early morning, before the starting of the training, I did manage a walk along the seaside.

I also travelled for a day to Ganta in Nimba county to meet some old friends. They are trying to build up a wild life sanctuary in Liberia. May be in future, one day there will be places to visit here.

Mongolia

I visited Mongolia twice in 2019. The first time at the end of June when I stayed in Ulaanbaatar and did not travel to other places. However, I did go out for different walks to discover the city, such as a walk to look at the sculptures of a camel caravan.

During the second visit, in October, we visited some provinces around Ulaanbaatar. One of the visits was to Arkhangai and on the way, we stopped to see the Buddhist monastery at Korakorum, the old capital of Mongolia during the times of Gengiz Khan (in the image below). It was a place that I had dreamt of visiting one day and the visit was really great.

Brazil - Campo Grande and Niteroi

In August I was in Brazil for a couple of weeks, first in Campo Grande and then in Niteroi, near Rio de Janeiro. In between my work commitments, I had plenty of time to go around for walks in Brazil. In Rio de Janeiro, a short ferry ride away from Nietroi, I went to different museums but my most precious experience was visiting an Ai Wei Wei art exhibition.

Niteroi is a wonderful place to stay with some of the most beautiful views of the Bay of Guanabara and the amazing skyline of Rio de Janeiro (in the image below).

Manila, Philippines

Back from Brazil and with a short break of a few days, I had to go Manila for a conference. The 12 hours time difference from Brazil, made this visit very difficult for me. I tried everyday to walk and discover parts of Manila that I had not seen earlier. Thus, I joined the visit organized by our conference hosts to visit Intramuros, the Spanish part of Manila (Fort Santiago in the image below).

Istanbul, Turkey

In October, on my way back from Mongolia, I stayed overnight in Istanbul. I have passed through Istanbul airport many times, but had never stopped there and was hoping to visit the city. However, during my one day of stay, it was raining most of the time and thus, I was forced to stay in my hotel room. The image below was clicked from the bus going back to the airport. I hope to have another opportunity to visit Turkey in the new year.

Geneva, Switzerland

Between August to October, I had travelled so much that I became unwell and had to cancel a visit to Spain. I had also made plans for a family gathering in the USA, but I was so tired of travelling that I cancelled it.

The only journey outside Italy I made was to Geneva for a meeting at the World Health Organisation in mid-November. Even during the brief stay, I found some time to go for a walk along the left bank of the Leman lake, which I like very much (image below). Unfortunately, there was not enough free time to visit the botanical gardens, another of my favourite places in Geneva.

Italy - Padova, Treviso & Venice

Veneto region of Italy, where I live, is full of beautiful little medieval towns. This year, I visited some of them such as Castelfranco Veneto, Padova, Treviso, Thiene and Vicenza (below an image from the Padova Pride parade).

In November, I also managed to visit the Venice Art Biennale before it ended. It had a couple of installations that I had seen in Kochi art biennale in the beginning of the year. The image below shows the visually striking giant installation by Lorenzo Quinn from this Biennale.

Conclusions

I am glad that I could visit so many countries during 2019, though I overdid it! My new year resolution is to have fewer work commitments in other countries in 2020, so that I can enjoy my travels more.

Already my bags are packed and I am preparing to go back to India. I want to conclude this post with an image from the street theatre perforamnce by students of Aurobindo college in Delhi, which I had seen during my last visit to Delhi - the play was about the vanishing languages of India and was called "Zubaan sambhal ke". I like street theatre plays very much and am hoping to catch some of them during my visit.

One new development in 2019 was my increasing use of phone-cameras, instead of my usual Canon DSLR. This explains the different sizes and qualities of the pictures used for this post. Carrying a mobile to click pictures is so convenient and I think that in 2020, I will use it even more.

*****

Fighting Superbugs

65 years ago when I was born, dying due to a simple infection such as diarrhoea or pneumonia was common. Our family history had numerous stories of persons dying young. At that time, average life expectancy in India was less than 38 years. While I was growing up, during 1960s and 70s, slowly we had become familiar with names of antibiotics like Tetracycline and Chloramphenicol. By the time I finished my medical college in late 1970s, average life expectancy had increased to 53 years, while the list of available antibiotics had become much longer with drugs like ampicillin, amoxicillin, erythromycin and gentamycin. Every year, new medicines were coming out. Occasionally we had infections which were resistant to some of these medicines, so we had started doing cultures to check which antibiotics could be more effective in a patient who was not responding to treatment.

In the last 50 years, the situation has changed drastically. Every now and then we hear of infections which do not respond to any medicine. Matt McCarthy's 2019 book "Superbugs: The Race to Stop an Epidemic" is about this subject.

Use of Antibiotics in Livestock

The first use of antibiotics in the livestock was approved by the Federal Drug Agency (FDA) of USA in 1951. They started to be used in small amounts in concentrated animal-feeds for growth promotion and prevention of diseases among the farm animals, especially in the poultry and cattle destined for meat production. They helped chickens, pigs and livestock to grow faster and put on weight. Since then, the use of antibiotics in the industrial production of meat has become routine.

Eating this meat introduces those antibiotics in our bodies and in the environment, promoting drug resistance in the bacteria. Already in 1969, a British committee of experts had concluded that the use of antibiotics in animals was contributing to antibiotic resistance in humans. Thus we are aware of this problem for a long time. However, its importance was under-estimated.

Apart from the use of antibiotics in the livestock, another problem has been indiscriminate use of antibiotics. Many doctors prescribe antibiotics for viral infections, even when they know that these are not useful. There is no control on the sale of antibiotics in many countries, so that people can buy them without prescription.

Antibiotic resistance and resistant bacteria both travel around the world, passing from one country to another. Thus, it is global problem affecting everyone and no one is safe from it.

Over the past decade, numerous cases of infections non responding to any medicine and leading to death of persons have brought this subject to the attention of general public. Extremely resistant cases of diseases like tuberculosis have appeared and are widely feared. The World Health Organisation has already issued some catastrophic warnings and asked for urgent search for solutions.

Matt McCarthy's Book

McCarthy's book on the subject of superbugs is written in an extremely engaging style. He works at the Presbyterian Hospital in New York, where they try to identify new antibiotics which can treat resistant infections. He explains the difficulties of treating superbugs through stories of individuals who turn up in the emergency department of his hospital. Reading the theories of antibiotic resistance is very different from reading about someone who has this infection.

For example, the story of a person, whose diagnosis of cancer has devastated his family. When it seems that chemotherapy might save him, a minor infection suddenly takes him close to death, unless the doctors can find some new treatment to treat it, but it is not responding to any medicine. McCarthy's book has a series of these real-life inspired stories, which start as a character sketch of the persons and their families and then reach a sudden turn of random events which turn their lives upside down, showing the fragility of our lives.

Once I started this book, I didn't stop reading it till 4 days later when I finished it. While I have known about superbugs and the problems of antibiotic resistance for a long time, the book explained the different challenges associated with it. Mixing of scientific information with human stories makes it very interesting. The book mainly moves around the human trials of a new antibiotic called "Dalbavancin" or Dalba. It also mentions some other new medicines and the persons involved in their research but most of its stories are of persons on whom Dalba is being tried.

Over the decades, doctors engaged in research for new medicines have not always behaved in an ethical manner. Recently, I was reading about an unethical research done by Armeur Hansen, who is known as the person who had discovered the leprosy bacillus in 1873. McCarthy shares the details of inhuman and unethical research done in the Nazi camps. Then he tells about another research carried out in Tuskegee, Alabama (USA), where hundreds of black men and women were recruited in a research, given false information and denied treatment which could have easily cured them, so that the doctors could study the natural evolution of the sexually transmitted infection syphilis. This had happened in 1950s-60s, years after the Nazi experiments.

The book also touches on the world of Big Pharma. For many years, I was part of a group fighting for people's right to health. In these groups, multinationals and especially the Big Pharma, is seen as villain, as they look only at their profit margins and are uncaring of the poor persons' need of medicines. McCarthy's book avoids painting the drug companies in black and white.

For example, McCarthy's explanation about insufficient research on new antibiotics and the role of the big Pharma is in the following terms:

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, is the man responsible for establishing federal funding priorities for research on antibiotic resistance, and he told me that developing new drugs is, in fact, one of his top priorities. But the situation is complicated. “You don’t want the federal government to be a pharmaceutical company,” he said, “because you’d have to build an entire industry, and that would divert away from what the government does well, which is scientific discovery and concept validation. We need a partner.”And that partner, for better or worse, is Big Pharma. “If the federal government tried to re-create Merck,” Fauci said, “it would cost billions of dollars. The expertise of production, filling, packaging, and lot consistency. People take that for granted, but that’s an art form that has been perfected by these companies, not the government.”The problem, ultimately, is that many antibiotics are not very profitable. When a new drug emerges from an idea, there’s a step-by-step process that costs upward of a billion dollars to bring it to market. If that leads to Viagra, the expense is justified because you’ve just made a multibillion-dollar drug. With an antibiotic, however, the profit margins are narrow because of three characteristics: they’re usually given in short courses, they’re prescribed only when someone is sick, and sooner or later even that terrific new antibiotic is going to develop drug resistance. The latter is not a matter of if but when. “The incentive to make major investments in antibiotics,” Fauci told me, “is not something that attracts the pharmaceutical industry, so how do you get around that?”

The book is also an ode to McCarthy's senior colleague and mentor, Tom Walsh , director of the Transplantation-Oncology Infectious Diseases Program, who seems to live only for his work and does it with great empathy. It is difficult not to share McCarthy's admiration of such a wonderful human being and professional, and wish that if one day we would find ourselves in a hospital, we shall have a doctor like him.

Apart from his skills as a clinician and researcher, McCarthy also has a way with the words. For example, he introduces Tom Walsh with the following words:Walsh is a wisp of a man, pale and thin like a potato chip, with deep-set eyes, a warm smile, and a surprisingly firm handshake. His modest features are a notable contrast with my own: I have a high forehead, broad shoulders, and a nose that’s slightly too large for my face. We make for an odd pair.

Conclusions

I love reading books about health and medicine. These give an overview of the issues in a way which is impossible in the medicine textbooks, which limit themselves to dry facts - symptoms, diagnosis and treatments. On the other hand, a good book on medicine aimed at general public, provides a glimpse into its history and how our understanding about the disease condition changed over a period of years or decades.

For example, I have been really impressed by a couple of books on psychiatry and autism, which I had read recently - they had opened the doors to a largely unknown world to me. "Superbugs" by Matt McCarthy didn't have the same impact, because I was already familiar with some the ideas and questions it discusses. However, I loved reading it and will recommend it to everyone for gaining a deeper understanding about an important subject, in an engaging way.

Note: In 2019, after writing this post I had contacts with Dr Abdul Gafoor who told me about the WHO initiative on antibiotics resistence and that spread of resistant strains through lack of sanitation was a much bigger contributing factor compared to the irrational use of antibiotics. He referred me to his article in The Hindu, from which the following excerpts are presented below:

"... back in 2010, people like me sincerely believed that AMR was caused primarily by the misuse of antibiotics by the medical community. We all wrote a few lines about infection control, but 90% of our articles, research papers was about irrational antibiotics usage. I did not write about environmental sanitation. I did not write about most of the things that I know today, because that the concept has changed over the last 10 years. At that time, we thought that antibiotic stewardship was the most important component in tackling AMR, along with infection control, and then made a mention of the importance of sanitation. Now if you ask me, what is the most important component of tackling AMR, I will say in a developing country such as India – it is sanitation. I will put sanitation right on top, then I will put in infection control, and then, antimicrobial stewardship, rational antibiotics usage - whether at the hospital or over the counter.

Why? Thanks to scientific evidence that has emerged, since, and changed our perspective. A commentary published in Antibiotics, an open access journal, recently showed that AMR rates were found ‘positively correlated with higher temperature climates, poorer administrative governance, and the ratio of private to public health expenditure.’ When a more complex analysis was done, then better infrastructure (e.g., improved sanitation and potable water) as well as better administrative governance (e.g., less corruption) were strongly and statistically significantly associated with lower AMR indices. And this is significant: the comment stated that ‘Surprising, and contrary to most current beliefs, antibiotic consumption was not strongly associated with AMR levels. This empirical evidence implies that contagion, rather than antibiotic usage volumes, is the major factor contributing to the variations in antibiotic resistant levels across countries.’"

*****

#bookreview #antibioticresistance #mattmccarthy

Ai Wei Wei - Later Works in Brazil

The first part of this post was about the earlier works of celebrated Chinese artist Ai Wei Wei presented in an exhibition called Raiz (Roots) held in Rio de Janeiro (Brazil) in 2019. This second part of the post focuses on his works created between 2015 and 2018, and presented in this exhibition.

The works of the artist from this period show a transformation - from his criticisms of the regime in China in his earlier works, he moved on to other themes afflicting humanity, from wars and refugee crisis to climate change. His latest works from his period in Brazil are even more personal, looking at sexuality and cultures.

Expressing Dissidence

The first works of Wei Wei after his release from the house-arrest in Beijing were understandably about the period of that arrest, though they continued to be ironic and symbolic, like the installation called Forever Bicycles presented in the image above. This installation was made from one thousand stainless steel bicycles. These represented personal freedom and its title, "Forever", referred to a brand of bicycles common in China when Wei Wei was growing up with his father in the exile.

His next work from 2015 was Blossom, a carpet made from hundreds of porcelain flowers made by joining 16 panels. This installation also referred to the period of his house arrest, when as a way of protest, he had decided to put every morning some flowers in the basket of a bicycle parked in front of his home. Thus, Blossom represents the flowers of his protest.

War and Refugees

After his release from house arrest in China, in 2015 Wei Wei had relocated to Berlin in Germany. That brought him in contact with the refugees who were pouring into Europe from the war-torn middle-east and whom the European countries were refusing to accept. Wei Wei felt the cries for help of the refugees, probably because he was also a refugee, though a fortunate one, since he had been accepted in Europe because of his celebrity status and because of being a known Chinese dissident.

In 2015 itself, Wei Wei visited the island of Lesbos in Greece and saw the shoreline littered with life-jackets and buoys of Syrian refugees trying to enter Europe. His 2016 marble sculpture Tyre is a "monument to the lost" remembering those who risked everything to seek a better life for themselves and their loved ones.

During 2016-17, Wei Wei travelled to 23 countries and 40 refugee camps. Out of these visits came his film "The Human Flow". In the same period, he also produced different other art works on this theme.

His next work on the theme of refugees is titled Odyssey and is a wallpaper which traces the stories of human migrations from the time of the Old Testament, through the pictorial techniques of antique Greek and Egyptian carvings and panels. The image below presents a detail from it.

There was another work on the theme of refugees in this exhibition titled "Refugee motif pillar of vases". It has 6 Qinghua blue and white vases, crafted in Jiangxi province of China in the antique Ming style. Like the wallpaper, the vases touch on 6 themes - war, ruins, journey, crossing the sea, refugee camps and demonstrations.

Brazilian Works

In 2017, Wei Wei visited South America many times to plan some of his exhibitions. In Brazil, he became interested in forests and specifically in a tree species called Pequi. He decided to make a mould of a 1200 years old, 31 metres high Pequi tree in a forest reserve in Bahia state. From his stay in Brazil and the enormous work related to the Pequi tree, a series of other art works have been produced, starting with the works called Raiz (Roots) which had given the title of this Brazilian exhibition and were presented in part one of this post.

The next image shows the roots part of another art work on Pequi tree, with a human figure, which gives an idea of the height of this tree.

The next image shows traditional votive wood sculptures (2018) made by artisans of Juazeiro do Norte in Brazil inspired by Wei Wei's art work.

The next image has Taifeng, a mythical creature from the old Chinese tales of Shanhaijing (the Classic of Mountains and Seas). It is made from Bamboo and silk and is inspired by the traditional Chinese kite-making traditions.

The next installation has Two Figures (2018) in white plaster - the male figure is moulded on Wei Wei himself, while the female figure is moulded on a model. Close to the head of male figure, there is a heap of Armosia seeds, which reminded Wei Wei of seeds he had seen in Gobi desert as a child. Through this sculpture, Wei Wei touched on the ostensible sexuality in Brazilian culture and to his own intense dreams during his stay in Brazil.

Conclusions

The Raiz (Roots) exhibition in Rio de Janeiro was a great opportunity to see different art works of Ai Wei Wei and thus get a more holistic idea of his art-world and artistic journey. Reading about his provocative exploits (for example, about the breaking ancient urn or covering antique vases with paint), gives a certain idea about the person. His constant rebellion against the Chinese government, but at the same time, finding a gentle and ironic way of rebelling, shows a maturing of the person. His works on climate-change and refugees, shows a widening of views where his personal journey is placed in the context of similar journeys of millions of other human beings. Finally, over the past couple of years, his exploration of his sexuality adds a personal dimension to his artistic journey.

To conclude this post, I want to present another of his personal art - a poster called Mutuophagia or the reciprocal eating, which has strong elements of the sensory and sexual world through the blood red water melons, the strategically placed bananas and the female figure on the extreme left. He is also talking about the importance of inter-mixing of cultures and learning from different cultures, which is his criticism of the current politically correct mode of looking down at "cultural appropriations".

For me, coming across the Wei Wei exhibition in Rio de Janeiro was a case of serendipity. I had no idea that it was there and I saw it just by chance. I would count it among my most wonderful art-experiences.

If you haven't already seen the first part of this post, you can check it now.

*****

#artinstallations #aiweiwei #brazilianexhibition #artofaiweiwei