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.’"

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#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.

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#artinstallations #aiweiwei #brazilianexhibition #artofaiweiwei

Dissident Art of Ai Wei Wei

Ai Wei Wei from China is one of the most famous contemporary artists. His name had become known because of a couple of controversial art installations. Through his art he has brought the spot-light on the absurdities of unequal power balances in the modern world, pointing fingers at both the totalitarian regimes as well as, the so-called civilized countries. I love the art of Ai Wei Wei.

The image above shows the entrance to the Wei Wei exhibition in the CCBB atrium in Rio de Janeiro, with a couple of "Roots" sculptures which gave the title Raiz (Roots) to this exhibition. During 2017-18, Wei Wei visited Brazil, where he came across these roots of the massive Pequi Vinegreiro trees, which were once common here and which now risk extinction - this art installation of Wei Wei referred to that experience.

In August, while in Rio de Janeiro (Brazil), by chance I came across this exhibition. Visiting this exhibition of Ai Wei Wei's works was one of the highlights of my Brazil visit.

It was organized in 2 locations. However, due to my work commitments, I was only able to visit one of the locations, the Cultural Centre of the Banco do Brasil (CCBB), which had his works from the period 2009 to 2018. This is the first part of a post describing those works, covering the period 2009 to a part of 2015. The second part of this post covers his works from 2015 to 2018, including some art installations he has created in Brazil.

Ai Wei Wei's Background

Wei Wei was born in Beijing in 1957. His father Ai Qing (Jiang Haicheng) was a well known poet who was a communist party member and who had been in jail during 1930s for opposing Kuomintang. When Chairman Mao's cultural revolution started, there was a deep distrust of poets, intellectuals and thinkers and thus Ai Qing was forced to shift to a small rural comune, where his job was to clean the toilets. Wei Wei accompanied his father during 5 years of their stay in this comune.

There is a story about Ai Qing, afraid of being labelled "elite", one night burned his poetry and other books, with his son's help. This left a deep impression on Wei Wei's psyche, who was around 9 years old at that time.

Ai Qing was finally rehabilitated in the communist party in 1979. In 1981, Wei Wei went to live in New York, where he lived for 12 years and became an artist. Back in China in 1993, two years later he sparked wide outrage and became famous for his artwork called "Dropping a Hun Dynasty Urn". For making this art installation, Wei Wei dropped and broke into pieces a 2000 years old urn and the whole scene was documented in a series of 3 photographs. Through this installation, Wei Wei denounced the destruction of hundreds of old Chinese temples and buildings along with their ancient treasures during the years of Mao's communist revolution.

In 2006, another art installation of Wei Wei called "Coloured Vases" made news all over the world, when he took 39 Neolithic vases and covered them in industrial paint. With this installation, he wanted to denounce the destruction of world's habitat along with old cultures due to non-stop onslaught of humanity and commercial interests.

Even when not making international news, Wei Wei was continuously challenging the Chinese Government by criticising it through his art. In 2009 he was placed under house arrest and in 2010-11, his new art studio was bull-dozed. Some of his most subversive and dissident art came during these years. Finally in 2015, his first solo exhibition was held at Galleria Continua & Tang Art Centre in Beijing and in July 2015, his passport was given back to him. After his release, he relocated to Berlin (Germany).

Wei Wei's Works from 2009

The Raiz exhibition had two of his works from 2009, before he was placed under the house arrest.

The first one is called Porcelain Cube. It has a cube outline made from 1 metre long porcelain cylindrical tubes made according to the traditional Qinghua technique, known for their blue coloured designs. Thus, the cube itself is a negative space.

The second one is called "The Hanging Man", which has the profile of the American artist Duchamp made from a porcelain hanger. During his years in New York, Wei Wei had been greately influenced by Duchamp's works. It is a small work and you can see it below on the wall-paper art from 2015 called "The animal that looks like a Llama but is really an Alpaca" (Last image at the bottom).

Wei Wei's Art Works from 2010-2015

These are his works from the years when he was under house arrest and immediately after it.

The first one is called the "Sun Flower Seeds" & is from 2010. For this installation, Wei Wei had made millions of porcelain sunflower seeds. Each seed was crafted individually in northern Jiangxi province, an area known for its kilns where they made imperial porcelains. Initially authorities could not understand the meaning of this installation. It was recalling the hero-worship cult of Chairman Mao, who was called the Sun and people were supposed to follow their leader like sunflowers.

The sun-flower seeds also reminded about the days of political rallies called by the supreme leader (Mao), where people went with sunflower seeds in their pockets so that they could eat something when they became hungry. This kind of subtle irony and hidden criticism of the communist regime became Wie Wie's approach, which was difficult to control by the authorities.

The second one is called He Xie or the river crabs and is also from 2010. These represent the destruction of his art studio in Shanghai. When Wie Wie was told that bull-dozers will raze his studio to ground, he organized a He Xie party for his friends for an ironical celebration. The authorities were confused that he was celebrating the imminent destruction. Finally, they decided to place him under house arrest.

The installation is composed of 1000 river crabs in porcelain, each made individually. Ai explained, "In different dynasties, people used to make these crabs from jade, bamboo or onyx. In 1976, when the gang of 4 was arrested, to celebrate it many artists had made the sculptures of these river crabs." There was another subtle message in the crabs - its Chinese name, He Xie, sounds like the Chinese word for harmony. Thus, it alludes to the struggle between the authorities and the society in the name of maintaining "a harmonious society".

The third one is called "The hanger" (2011) and has cloth-hangers in different materials - steel, wood and crystal. During the house arrest he was allowed to keep only a few things, which included some hangers. These sculptures are a reference to his house arrest and thus represent an oppressive regime. These also recall similar works by some American artists like Marcel Duchamp on concept art.

The 4th is called the Mask and is from 2013. It has a mask in marble, placed on a tomb stone. Carved from a single piece of marble, this mask represented the smog covering Bejing, due to unregulated industrialization which did not respect the environment. It can also be seen as a symbol of un-breathable air across different cities of the world due to pollution, as is affecting Delhi during these

days.

The fifth art installation is called "Grapes" and is made of 32 antique Chinese wooden stools from the Qing dynasty and is from 2014. The stools have been joined together, using the traditional wood-working techniques. Like the more controversial destruction of the antique urn mentioned earlier, this was a criticism of the destruction of ancient art, culture, heritage and religion during the cultural revolution.

Conclusions

To the see the pictures of Wei Wei's controversial installations "Destroying a Hun dynasty urn" and "Coloured vases" is a deeply disturbing experience. Try searching for these 2 installations on internet. The destruction of antique vases which go back to thousands of years is like a wound in the soul, because that loss can never be repaired.

Through these installations, Wei Wei hits us with a killer punch forcing us to think not only of the years of destruction during the cultural revolution in China. It also forces us to think of millions of persons killed in the Holocaust by the Nazi regime or by ideologues running totalitarian regimes in China and Cambodia. It is a reminder of the destruction done by radical Islamists and by the so-called "forces of Liberty" - the Bamayan Buddha statue, and ancient ruins in cities like Mosul, Nimrud and Palmyra in Afghanistan, Iraq, Syria and Libya.

I am concluding this post with an art work of Wei Wei from 2015 - it is a wallpaper called "The animal that looks like a Llama but is really an Alpaca". The title of this artwork refers to the optical illusion. On a first glance, the wallpaper looks composed of geometric designs. A closer look shows you that it is made of elements like surveillance cameras, handcuffs, twitter birds and alpacas, each a representation of his struggles with the Chinese authorities and symbols of the Chinese society. Hanging on the wall, you can also see this 2009 work called the Hanging Man.

The second part of this post will focus on his remaining works from 2015 and later, that were presented in the Raiz exhibition.

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#aiweiwei #artofaiweiwei #artinstallations