The Silent Epidemic by UMiami Scientifica Magazine

Issue 16

May 2020

THE

SILENT EPIDEMIC

Contents The Silent Epidemic Introduction

Miami's OpioId initiative

6 8

The Idea Clinic

Chetwyn "Arrow" Archer

Blood Money

Psychic Chains

Exploring the Controversy Surrounding the Baker Act

Influencer Mania Pandemic for the ages

AustraliaN Bushfires THE Anthropoceneâ&#x20AC;&#x2122;s Furnace

Inferno: A dance etErNal

Into The Apathetic Inferno

The Fires of Denial and Indifference Plaguing Australia

2 | The Silent Epidemic

Health

Ethics

News

The Rise and Impact of YouTube

Failure to report

COffee

your lipstick is a cute sHade of bug

The shadow Plague

Everything to know about your cup of Joe

Cover art by Leena Yumeen

Research a Hot Mess

Glowing plants to loudspeakers

Imagine This

Profiles Patient turned researcher

From Caribbean Crop To your Cup

Research Profile on Antonio Fontanella

The Diverse Applications of Carbon Nanotubes

The Impact of Imagery

It's me again, the flu vaccine!

The silent

Epidemic p. 6

In this issueâ&#x20AC;&#x2122;s feature section, The Silent Epidemic (p. 6), Leena Yumeen and Marissa Maddalon delve into the opioid epidemic in the U.S., a crisis that is making its presence known in large cities and small communities alike.

Research Profile on Ezra Remer

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l e t t e r f r o m t h e e d i to r I hope you all are staying healthy in these uncertain times. Now more than ever, we must remind ourselves of our responsibility to find factual information, dispel myths, and remember our obligation to the those around us. It’s important to recognize that individual health is public health, and vice versa. Hiding in the shadows of the pandemic, another equally deadly but far more silent epidemic is tearing through communities across the U.S., including ours here in Miami. Though the tragic deaths may not be as conspicuous, we hope our coverage of the opioid epidemic in the U.S. will inform you about the issue’s severity and urgency. With the COVID-19 pandemic, opioid epidemic, Australian bushfires, or any other crisis, it’s time to ask ourselves what is stopping us from providing resources— whether it be virus tests, treatment, or emotional support—to those in need. Now is the time to take action and make sure this first modern pandemic is the last of its kind. Stay safe, ‘Canes! Anuj Shah Microbiology and Immunology Class of 2021 Editor-in-Chief, UMiami Scientifica

letter from the e d i to r i a l A dv i s o r I speak for everyone at UMiami Scientifica when I say that I hope you are staying safe and following the guidance of our public health officials and scientific community. We are all used to seeing controversy in our daily lives, but our lives change significantly when deception infiltrates the information that we rely on for our survival. The theme of this issue, deception and controversy, is even more relevant in our current situation, as we ask ourselves “how do we really know who and what to trust?” Scientific studies and discoveries showing what can appear to be promising advances often do not pan out, and as scientists or laypeople, we must be diligent to evaluate the sources of our knowledge and question those in positions of power. Prior to COVID-19, the opioid epidemic was at center stage, displaying the dangers of corporate greed and misinformation toward creating impactful policy. Please enjoy this issue, and appreciate that even though our world is usually filled with factual advice, there still exists those who are set on pushing forward regardless of the cost.

Roger I. Williams Jr., M.S. Ed. Director, Student Activities Advisor, Microbiology & Immunology Editorial Advisor, UMiami Scientifica

s c i e n t i f i c a C o r e s ta f f Anuj Shah Shravya Jasti Carolina Mallar Aaron Dykxhoorn Leila Thompson Sneh Amin Mac Clifton Amirah Rashed Corey Fehlberg Trevor Birenbaum Wil Harris Kyle Alford Austin Berger Sofia Mohammad Victoria Pinilla Roger Williams, M.S. Ed

4 | The Silent Epidemic

Editor-in-Chief Magaging Editor Copy Chief Design Director Art Director Director of Photography Webmaster Secretary Director of Finance Distribution Manager Director of Creative Writing Business Manager Director of Public Relations Director of Community Outreach Board of Advisors Liason Editorial Advisor

S c i e n t i f i c a s ta f f 2020 Board of Advisors Barbara Colonna Ph.D. Senior Lecturer Organic Chemistry Department of Chemistry Richard J. Cote, M.D., FRCPath, FCAP Professor & Joseph R. Coutler Jr. Chair Department of Pathology Professor, Dept. of Biochemistry & Molecular Biology Chief of Pathology, Jackson Memorial Hospital Director, Dr. Jonn T. Macdonald Foundation Biochemical Nanotechnology Institute University of Miami Miller School of Medicine Michael S. Gaines, Ph.D. Assistant Provost Undergraduate Research and Community Outreach Professor of Biology Mathias G. Lichtenheld, M.D. Associate Professor of Microbiology & Immunology FBS 3 Coordinator University of Miami Miller School of Medicine Charles Mallery, Ph.D. Associate Professor Biology & Cellular and Molecular Biology Associate Dean April Mann Director of the Writing Center Catherine Newell, Ph.D. Associate Professor of Religion Leticia Oropesa, D.A. Coordinator Department of Mathematics *Eckhard R. Podack, M.D., Ph.D. Professor & Chair Department of Microbiology & Immunology University of Miami Miller School of Medicine Adina Sanchez-Garcia Associate Director of English Composition Senior Lecturer Geoff Sutcliffe, Ph.D. Chair Department of Computer Science Associate Professor of Computer Science Yunqiu (Daniel) Wang, Ph.D. Senior Lecturer Department of Biology * Deceased

SECTION EDITORS ETHICS NEWS RESEARCH HEALTH PROFILES

Trevor Birenbaum Siena Vadakal Alexandria Hawkins Abigail Adera Carolene Kurien

COPY EDITORS Gaurav Gupta Siena Vadakal Avi Botwinick Nikhil Rajulapati Giovanna Harrell Sean Walson Greg Zaroogian Abigail Adera Yashmitha Sadasivuni Leena Yumeen Sneh Amin Avery Boals Kylea Henseler Jeffrey Caldwell

DESIGNERS Megan Buras Rachel Murray Leila Thompson Varsha Udayakumar Anam Ahmed Leena Yumeen Aaron Dykxhoorn Sandy Taboada

WRITERS Leena Yumeen Marissa Maddalon Snigdha Sama Sofia Mohammad Sanjoy Kundu Wil Harris Kimberley Rose Amirah Rashed Isik Surdum Anam Ahmed Geethika Kataru Saraith Aviles Alexia Vignau Robert DiCaprio III Trevor Birenbaum Ellie Martin Sandy Taboada Samantha Tano Setareh Gooshvar Anastasiya Plotnikova

PhotograpHers Dhara Patel Avery Boals Joseph Hughes Raghuram Reddy Alexis Paul

Artists Leila Thompson Sandy Taboada Anam Ahmed Megan Buras Varsha Udayakumar Sofia Mohammad Kylea Henseler

THE SILENT

EPIDEMIC BY LEENA YUMEEN

hile controversy erupts over the legalization of marijuana, a far more lethal—and, ironically, far more legal—class of drug has swept America off its feet in the past decades. Indeed, we are in an era dubbed the “national opioid epidemic.” In the 17-year span from 1999 to 2016 alone, overdose-related deaths claimed the lives of 630,000 Americans, the majority of which resulted from prescribed opioids. Although the United States is one of the most developed nations in the world, our opioid overdose rate is more than twice that of any other country. With over 10.3 million patients misusing prescription opioids and 2 million diagnosed with opioid use disorder, citizens across the nation demand answers: How has our public health infrastructure contributed to a substanceabuse epidemic? The tale is one of rampant capitalism, hidden corporate agendas, and a disinterested government. Tracking back to the 20th century, physicians advocated for pain to be recognized as an ailment requiring treatment. Unfortunately, with this new public sentiment came an increase in the use of opioids for treatment. Physicians initially limited opioid prescriptions to cancer pain, but soon many began to argue that non-cancer chronic pain had been left grossly unmanaged by medical professionals. Physicians like Ronald Melzack, harboring sincere concerns, published articles laden with misconceptions regarding the addictive strength of opioids and argued for pain management expansion. As opioid use grew more common, the American Pain Society called for pain to be treated as a “fifth vital sign.” Herein swooped big pharma, seizing the opportunity to profit in our privatized system of healthcare. The main culprit, Purdue Pharma, introduced OxyContin to the market in 1996. The primary ingredient of the drug is oxycodone, a chemical derived from thebaine, a constituent of opium. Hiding under the guise of benevolence, the company claimed that it had formulated the drug to prevent addiction—that it was the safest, most effective and

6 | The Silent Epidemic

humane option for pain treatment. This claim convinced both the public and medical professionals. The drug was approved by the Food and Drug Administration (FDA) in 1995, allowing Purdue to launch an aggressive advertising campaign promoting the narcotic. Efforts were of both macro and microscale: some employees lobbied lawmakers in order to protect the right to sell, while others visited individual doctors to convince them to give OxyContin prescriptions. As Purdue and other pharmaceutical companies weaved their way into hospital infrastructures, the nation became ever more reliant on the painkiller. It was this internal operation—not foreign drug cartels or the immigrants that we so frequently label—that caused our national opioid epidemic. In fact, pharmaceutical corporations transformed the American commons into the new drug cartels. There was no need for a black market for opioids. Rather, users legally obtained medical prescriptions to sell in their communities. The government, accepting Purdue’s copious gifts, remained complicit as the nation suffered. To this day, Purdue Pharma continues to invest millions into members of Congress to uphold the company’s power to distribute opioids. Just this year, US Congressman Tom Marino stepped down after the public learned of his critical role in creating legislation that interfered with the ability of the Drug Enforcement Administration (DEA) to stop pharmacies from haphazardly selling the drugs. Our government, however well-intentioned it may have originally been, actively contributed to this new opioid rush. Regulations initially created by The Joint Commission (TJC), a U.S.-based non-profit responsible for accrediting and certifying health care organizations, mandated that hospitals and physicians administer pain medication. Subsequently, the medical community continued to heavily rely on opioids. If physicians failed to prescribe such pain relievers, hospitals would suffer from poor patient satisfaction rates and lose federal funding in failing to meet TJC regulations. Decades later, physicians remain pressured

to administer opioids to maintain satisfaction rates for their hospital administrations. This crisis has expanded far beyond OxyContin. Physicians are currently allowed to prescribe morphine, fentanyl, and codeine, to name a few. Such drugs work by binding to opioid receptors on neurons throughout the nervous system, reducing their relay of pain signals to the brain. Typical short-term physiological effects include feelings of calm and sleepiness, yet chronic usage leads to fatigue, increased sensitivity to pain, depression, and nausea. Patients prescribed methadone for chronic pain can develop cardiac arrhythmias (irregular beating of the heart). Excessive use of buprenorphine—another opioid used for pain management and treatment for opioid addiction—can lead to acute hepatitis. While opioids are effective for short-term pain management, chronic use quickly deteriorates general health. In recognition of such side effects and the growing addiction crisis, federal and state governments have been rolling out new legislation to combat opioid overprescription. In 2016, the Centers for Disease Control and Prevention released guidelines for physicians on prescribing opioids, and Massachusetts became the first state to limit the use of opioids for treatment to seven days for patients who are first time users. Florida quickly followed suit in July of 2018, passing a law preventing doctors from prescribing opioids past three days for short-term pain management. Today, over 15 states have laws limiting

GRIM STATISTICS

I II III

130 AMERICANS DIE EVERYDAY OF OPIOID OVERDOSE 10.3 MILLION PEOPLE MISUSED PRESCRIPTION OPIOIDS IN 2018 2.0 MILLION PEOPLE HAD OPIOID MISUSE DISORDER IN 2018

Pharmaceutical corporations transformed the American commons into the new drug cartels. opioid prescription. However, the new regulation certainly has its pitfalls. Some state laws limit opioids prescription so much that patients with severe pain disorders have no access to the only treatment that works. Nervous system disorders, like Complex Regional Pain Syndrome and Central Pain Syndrome, cause pain so severe that patients report “burning” or “pins and needles” sensations. Yet, opioid restrictions make it increasingly difficult for youth and adults suffering from such ailments to gain relief. While cases are rare, the lack of treatment available for such severe pain can be just as tragic as opioid mishandling. So despite recent progress, it will take much more to create fair regulations and reverse the ramifications of two decades of opioid mishandling. Now that hospitals have reduced opioid prescriptions, those already suffering from addiction find other means to attain the drugs and practice unsafe habits in using them. This has led to a spike in infectious diseases: cases of hepatitis C more than tripled between 2010 and 2016, and most were linked to unsanitary needles used while injecting drugs like opioids. Other consequences stretch far beyond the current generation: From 2004 to 2014, five times more children were born with NOWS, or neonatal opioid withdrawal syndrome. NOWS occurs when mothers use opioids during pregnancy, and it can only be treated by prescribing drugs such as morphine or methadone to affected infants. Perhaps even more devastatingly, many children are now forced to mature in households where drug addiction is a given. As the FDA acknowledges, “the toll of addiction, in lost lives and broken families, touches every community in America.”

IV V VI

808,000 PEOPLE USED HEROIN IN 2018 81,000 OF THOSE WERE FIRST TIME USERS 46,000 PEOPLE IN TOTAL DIED FROM OPIOID OVERDOSE IN 2018 News | 7

MIAMI’S OPIOID INITIATIVE: BY LEENA YUMEEN

THE IDEA CLINIC

8 | The Silent Epidemic

few blocks down from the Miller School of Medicine, medical students operate the IDEA clinic syringe exchange program. The setup is humble. A few shipping containers sit on gravel, and students buzz in and out. Yet the program is responsible for bolstering the health of some of Miami-Dade’s most vulnerable populations. Volunteers working at the front desk accept used syringes from incomers—often opioid users—and provide new ones, along with any other materials needed to inject safely: cotton pads to filter what’s in the syringe, alcohol wipes, and a sharps container. Another shipping container serves as a clinic on Thursday afternoons, complete with a physical check-up chair and medical supplies in case any patient requires wound care. The program was established just three years ago following the passage of the Infectious Disease Elimination Act (IDEA), dedicated to “reducing the spread of HIV and hepatitis C” through a harms reduction model by providing clean needles to those who use them. It was an initiative that was championed by Dr. Tookes, a physician and assistant professor at the University of Miami Miller School of Medicine who began to campaign for the passage of the act when he was just a student in medical school. It took 5 years of lobbying the Florida Legislature, but the act was approved and the clinic established in 2016 on World AIDS Day. Its creation came at a critical point in Miami’s public health crisis. In June of that year, the Florida Department of Health reported that over 36,000 Miami-Dade residents presented with AIDS, 29,456 were diagnosed with chronic Hepatitis C, and over 300 had succumbed to opioid overdose. Indeed, as was dismally stated by John N. Katopodis of the Florida Medical Association that year, “a deadly opioid epidemic has engulfed our state and the country as a whole.” Yet, the clinic has been working diligently to reverse the health implications of the current crisis. Not only does the syringe exchange operate to provide sanitary needles to prevent infection, but it hits the road to travel to areas like Overtown and North Miami to educate Miami’s citizens on how to use cleanly and offer syringe exchanges to those who may not be able to travel to the main location. Perhaps most importantly, the clinic has been credited for distributing Narcan widely among the city. Narcan, the brand name for the compound naloxone, functions to reverse opioid overdoses as they occur. IDEA workers have given out more than 2,000 doses since the opening of the clinic, reversing as many as 1,000 possible deaths.

However, as services for opioid users expand, drugs circulating within the supply become increasingly deadly. Overtown has become an infamous hotspot for cheap packets of heroin, known locally as “boys,” fentanyl, and even carfentanil, a stronger compound than fentanyl and a key component of elephant tranquilizer. In extreme cases, many patients may not even know what they have used. A large portion of overdoses in Miami are induced by injecting heroin laced with fentanyl, a far stronger combination than pure heroin. Indeed, the rate of overdose had become so overwhelming for emergency responders that during the peak of the epidemic in 2016, The Miami Herald reported, “Toward the end of a frenetic summer, Miami paramedics would often save one person from an overdose in the morning—then again in the afternoon after the user walked out of a hospital.” Such stories prove the need for the IDEA needle exchange service and the attention it provides to Miami’s most neglected subgroups. A large portion of exchange participants are homeless and lack access to basic healthcare. Other groups disproportionately affected by the opioid crisis, and, in turn, the HIV epidemic include gay men, Black men, and Hispanic men. But no matter the life circumstances of those who come in, the medical students are quick to provide non-judgemental care. “I think one thing that we always stress is that it’s not because they’re gay or because they’re black that they’re at risk but because of all the structural factors and historical factors that come into it,” says Maggie Ginoza, a medical student who served as project manager for the clinic during the last academic semester. Beyond providing individual preventative care for patients, the clinic also investigates community-wide trends in HIV infections and opioid overdoses. In fact, just last year, the clinic researched a spike in HIV cases in the region by attempting to identify cases of “zero conversion”—a term denoting those who test positive for HIV but had previously tested negative at the clinic—and mapping connections between those who tested positive. While many of the cases proved to be coincidental rather than correlated, the clinic intervened successfully before the trend accumulated into a much larger outbreak. It’s work like this that makes the clinic so trusted within the community. And while patients are turned away or frightened of general hospital settings due to the stigma surrounding drug usage, many appreciate the clinic as a reliable source for critical healthcare because of its long-standing history.

INTERVIEWING MIAMI’S HEROES Our staff interviewed Marcus Castillo and Maggie Chiseko, two students at the Miller School of Medicine who volunteer at the IDEA clinic, for the creation of this article. Maggie answered the following questions regarding the severity of Miami’s opioid epidemic.

Why do you feel that the opioid crisis and high rates of HIV infection hit the Miami community so hard? “There’s a lot of factors that come together, especially in Miami and in the Jackson Hospital healthcare system. Some of it has to do with education—whether that’s an understanding of addiction, HIV, or sexual health practices. There are also cultural factors. Even if people want to get information about this kind of stuff, a lot of cultural factors seem to tie in to people just not talking about it, so people don’t know where to get the information that they want. It also has to do with structural factors—when you’re living in poverty, or you’re homeless, or you’re faced with racism, it makes it a lot harder to access the medical care and the services that you need to keep yourself safe and keep yourself healthy. People often cope with those difficulties in many ways, including opioid use.” What kind of stigma do drug users face and how do you believe that impacts how they seek treatment? “Commonly, people who use drugs face lots of stigma in medical settings. They’re seen as “drug seekers,” or that their pain isn’t real. People don’t want to give them medications that would help with withdrawal because they think they deserve to be suffering or they’re not worthy of care. So people who use drugs often receive poor care and face a lot of discrimination in medical settings. It’s just little things like people calling them “addicts” or “junkies” or using lots of these derogatory terms to refer to patients. [But] even if the patient can’t hear [physicians] using those kinds of terms, using that kind of stigma towards your patients has been shown to lead to poor healthcare outcomes, whether it be not getting the pain control that they need or just in general not getting the care for what their medical problems are at the level that they should be because of the stigma surrounding their drug use.” Do you feel that this stigma that people face prevents them from going into the hospital as much as they should? "There’s a lot of people who might be afraid that [they] have abscesses or other medical problems that would be best if they could get it treated early, but they don’t feel comfortable or they get scared about going into the hospital. And whether that’s because of stigma, or because they know they are going to have to wait a long time and they’re going to get sick while they wait and they don’t want that to happen, or whether they’re afraid of potentially encountering law enforcement and running into issues with them—there a lot of reasons that people might be afraid to go to the hospitals and go to the ER, and it’s definitely very common among our patient population. People would love to get medical care and see a doctor but for all these reasons it’s really challenging or scary for them." What do you think that we should be doing to prevent overdoses from drugs like heroin or other opioids? “One of the things that the IDEA Exchange does that has been a really valuable tool in preventing overdoses is distributing the drug naloxone by the brand named Narcan. This drug is really useful because it can reverse an overdose that’s in process—it’s an antagonist of the opioid receptors. The drugs that the exchange distributes is in [the form of] a nasal spray so you don’t need to know anything about how to use it other than to stick it up someone’s nose. It’s important to make this drug available and get it into people’s hands, especially those who are using drugs."

News | 9

“I was dead; I was purple. She resuscitated me.”

fter over 40 years of heroin use, Chetwyn “Arrow” Archer had made a decision—his road ended here. He laid on the ground, taking his last few fluttering breaths. Overcome with hopelessness after the loss of his partner, Arrow had just shot seven bags of heroin with the intent to overdose. On a hunch, Emmy Martinez, a volunteer from the IDEA Exchange needle exchange clinic, stopped by the place where Arrow was staying to check in on him and make sure everything was okay. Instead, she found him unconscious. Knowing she was the only thing standing between her friend and death due to overdose, she injected him with Narcan and was able to successfully resuscitate him.

CHETWYN “ARROW” ARCHER BY MARISSA MADDALON

10 | The Silent Epidemic

“I got shot.”

Arrow described his descent into addiction as fitting a pattern seen far too often today—through the use of painkillers. Years ago, when he lived in the Bronx, Arrow was shot and prescribed Placidyl, a common sedative at the time. Upon finding it was less and less effective over time in treating his pain, Arrow turned to an old friend from his time in the military, who offered something a bit stronger. His friend helped him shoot heroin for the first time, and as Arrow put it, “it was a love affair after that.”

“You’re living for the next high.”

At one point, Arrow was living under a bridge in Miami, weighing only 115 pounds. Arrow details his day-to-day experiences during this time as bleak, with one main purpose—to get high. As he put it, heroin causes people to cycle between blissful highs and devastating lows, but it is always the sweet sensation of the high that would call you back. Arrow recounts, “you go out, get high, and then you produce whatever it is that you need—whether it’s stealing stuff from a store, selling dope, selling your body—whatever it is you have to do to make the money to get high.” As the city began to crack down on the homeless in particular areas, such as underneath bridges, Arrow—homeless and in need of a place to stay—was offered a spot at the Camillus House by Dr. Hansel Tookes III, the founder of the IDEA Exchange. Shortly after, Dr. Tookes introduced Arrow to a rehabilitation program.

“I was done.”

After being resuscitated after his near-overdose and having gone through detoxification, Arrow spent 45 days on the streets surrounded by the temptations he knew all too well. But, as he put it, he was simply “tired”—tired of sleepless nights, tired of the “fake respect” of friends who would betray and rob him for that next high, and tired of losing those most important to him, including his partner, whose ashes he still carries with him. Describing his disillusionment with the life he had become accustomed to, he states that although “the high is the best thing ever, I wouldn’t wish it on anyone.” Arrow recognized that he was

ready to move on and felt a desire to change his future, and acknowledges that others should go through a similar process. Arrow personally gives credit to Dr. Tookes and the team at the IDEA Exchange as his main saviors.

“They relate to me. If I can recover, so can they.”

Arrow's first visit to the IDEA Exchange was when it was in its infancy; the clinic used to give out money to sign up and partake in the needle exchange, which is how Arrow first discovered the clinic. However, since entering recovery, Arrow has found a new mission in recent months through working with the IDEA Exchange’s other programs and partnerships, which are focused on education and rehabilitation. Through the constant interactions he had with the volunteers and staff since the clinic’s founding, Arrow was able to form trusting relationships with them and was eventually able to enter rehab. Now, his goal is to do the same, to help others who are in the situation he was once in. Arrow’s path to recovery serves as an inspiration for people he meets through his work at the clinic, many of whom he had “shot dope with or sold dope to” in the past. Despite using for over 40 years, Arrow was able to make a 180-degree change in his life, and knows that others around him who are suffering from addiction can “see the change.” With this mentality, he maintains confidence in his ability to both support those making a transition into rehab and save lives if the need arises. As a reminder of the power and responsibility he now possesses, Arrow keeps count of every life he’s saved. Since his personal recovery, he has resuscitated 158 people.

“We stop a lot of things from happening.”

HIV and Hepatitis C are bloodborne diseases that can be spread through needle sharing during intravenous drug use, as there are always trace amounts of blood left in the needle. As Arrow highlights, in addition to the needle exchange services, the IDEA Exchange also offers testing and treatment for HIV and Hepatitis C, giving individuals who have tested positive for these diseases the opportunity to start on antiretroviral treatment. This is crucial to preventing the spread of the diseases, as once a person’s viral load is undetectable as a result of treatment, the virus is untransmittable to others. In addition, Arrow stresses the importance of the clinic’s education campaigns, especially those regarding new synthetic opioids such as fentanyl and carfentanil, which are even stronger and easier to overdose on than heroin. As the clinic continues to expand its reach and address the infectious diseases here in Miami, its outreach programs serve as a further testament to the good the clinic does for the population it aids.

“Relapse is a part of recovery.”

Arrow believes recovery is less about leaving something behind you entirely, and more about finding the resources that empower you to fight another day. Arrow chooses not to use the word “quit,” as he’s seen others dragged back into substance abuse. Instead, he prefers to view every day as a new opportunity because he understands the gripping power of addiction, something he believes should never be underestimated. As for Arrow’s goal, it’s simple—to “keep having more todays.” To this day, he has had nearly a year and a half of them.

Detoxification is a difficult process. Relapse rate after initial detox ranges from 72% to 88% after 12-36 months.

News | 11

PAN DEM IC by Snigdha Sama

For the Ages

Design: Anuj Shah

In a matter of months, the novel coronavirus has swept through cities, countries, and continents. The staggering loss of life has left us wondering how something so small could be the cause of such immense destruction. Like it or not, the COVID-19 pandemic has changed life as we know it.

f you’re one of the millions of students graduating from Zoom University or someone instructed to work from home and you find yourself going stir-crazy, you can thank COVID-19. Albeit tiny in size—so much so that it takes about 800 of these particles stacked to make up the thickness of a sheet of paper—the magnitude of this virus’ impact is undeniably huge. What exactly is the virus? The coronavirus is not actually a single virus; it is a large family of viruses that includes minor illnesses such as the common cold, as well as major ones such as Severe Acute Respiratory Syndrome (SARS) and the novel Coronavirus Disease 2019 (COVID-19), which was first detected in late 2019 in Wuhan, China. The name coronavirus is derived from the Latin word corona, meaning “crown,” referring to the crown-like appearance of the halo that exists around the virus particles when they are viewed under a microscope. A coronavirus is usually found in animals; rarely, it can be transmitted from animals to humans and then spread from person to person. Based on an analysis of the virus’ transmission, researchers suspect it originated in bats or pangolins and was first transmitted to humans in a market in Wuhan. If you’ve heard one of those conspiracy theories out there that it was deliberately genetically engineered by humans to cause disease, worry not. A study in Nature Medicine that analyzed the spike proteins around COVID-19 found that the evolution of the virus was so specific and effective that it could have only been the result of natural selection and not of genetic engineering. The symptoms of COVID-19 tend to appear 2-14 days after contraction of the virus and can include fever, a dry cough, shortness of breath, aches, and fatigue. In more severe cases, it can lead to pneumonia and multiple organ failure. The main mode of transmission is person to person, in which the respiratory droplets of an infected individual are transmitted into the air from an infected individual and then ingested by others via their nose, mouth, or eyes. A secondary and more minor mode of transmission is through surface contact, as COVID-19 is believed to be stable for up to two days on hard surfaces, though the exact duration is still being determined. After transmission of the virus into the body, viral proteins hook

onto cell membranes and allow the virus’ genetic material to enter the cell. It then takes over the cell’s machinery and alters it to help the virus multiply and infect nearby cells. When the virus reaches the lungs, the lungs become inflamed, impairing the flow of oxygen and making it much more difficult for an individual to breathe. While this virus appears to zero in on the lungs, it can spread through mucous membranes and cause widespread inflammation. Our body’s immune response to the virus actually serves as an additional stressor, and when combined with the effects of the virus itself, can cause organ dysfunction. However, the majority of patients with the virus either have no symptoms or mild illness. It is important to note that if you suspect that you have COVID-19, do NOT rush to the emergency room; avoid public areas, and if you are concerned, call your doctor or a treatment facility for advice. On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, indicating that the illness was globally prevalent. As of mid-April, there are over 1.5 million cases and counting, resulting in around 90,000 deaths. While symptoms tend to range from nonexistent to mild in the young and healthy, people of old age and those with chronic illnesses are at risk of exhibiting serious symptoms; scientists suspect that this is due to impaired immune function. As of late March in Wuhan, while the overall fatality was 1.4%, it was 2.7% for those over 64 and a mere 0.5% for those aged 1544. As we age or experience chronic illness, the number of white blood cells that find and eliminate infection in our body declines, and those that remain become less adept at identifying new pathogens. The virus can overwhelm the immune system and leave the body vulnerable to other illnesses. These statistics indicate that this virus will not bode well for the U.S. population: as baby boomers are hitting retirement age and natural births are decreasing, the average American is getting older, and 60% of Americans have at least one chronic condition. As of late March, there are concerns that the U.S. has not done enough to enforce social distancing measures. While strict isolation methods that included sealing off apartment buildings and scanning millions for rising body temperature and signs of the virus were effective in China, these restrictions are much harder to enforce in western nations such as the U.S. and E.U. countries. The White House has instituted social distancing guidelines for Americans, advising the avoidance of travel and encouraging schools and nonessential businesses to close. As we enter the summer months, there is concern that these measures are too lax, as the rate of infection continues to grow and shows no signs of abating. As microscopic as it may be, COVID-19 has made inadequacies

of the U.S. healthcare system glaringly visible. Already, our hospitals are feeling the brunt of the virus with occupancy at its maximum and medical staff having to reuse prevention personal protective equipment (PPE). A large part of this problem is programs is impractical and that America has a relatively weak foundation for primary healthcare. results in the preventable loss of life. The economic Due to a mixture of a shortage of primary care physicians and consequences of an outbreak far outweigh U.S. spending on efforts people delaying doctor visits to avoid massive healthcare premiums, to control it, and while the mistakes in allocating our budget have Americans lack access to doctors they know and trust, and instead already been made, our government needs to act swiftly in order to flood emergency rooms even curtail any further spread. if their symptoms don’t As the number of cases has warrant that level of care. Many skyrocketed, there has been a Americans rely on emergency massive shortage of COVID-19 departments for acute, chronic, test kits. More rapid tests Four reasons why the new coronavirus and even preventive care. have already been developed, During a healthcare crisis, but regulatory and logistical disease is not “just the flu” this is a huge problem. When hurdles have prevented these individuals with only mild tests from being disseminated 1 cases of the COVID-19 go to the effectively. In addition, action COVID-19 is more readily emergency room they not only needs to be taken to rapidly transmitted than the flu delay care to the truly ill, but produce masks, gloves, and they also pose a risk of passing other PPE. If our healthcare Both types of virus particles are 2 on the virus to other patients workers cannot be protected spread similarly, but... COVID-19 takes a longer and healthcare professionals. from the virus, our first line of COVID-19 Flu time to cause symptoms Not only are too many defense collapses. Normally, people rushing to the hospital we depend on international at once, but the reserve supply chains to produce our 2.0 - 2.5 1.0 - 1.5 new capacity of hospitals in the medical supplies, but as they new cases cases U.S. is almost nonexistent. are primarily based in China, vs COVID-19 has a higher 5-9 days 1-2 days Despite our increasing supply is rapidly dwindling. reproductive number, meaning population, the number of More aggressive steps must be more new cases are generated beds in hospitals per 100 taken to direct factories inside from an infected individual COVID-19 Flu people in the U.S. has decreased the U.S. to divert production to from 1990 to today. This PPE to adequately supply our COVID-19 has a much longer 3 incubation time, meaning it can be hospitals. situation has been aggravated We don’t have a vaccine passed on before a person is by the massive budget cuts to These measures, while able or herd immunity to fight aware they are sick disease prevention in recent to slow the spread of the virus, COVID-19 years. In 2018, the Trump will take time to implement. administration cut ObamaIn the meantime, we must While a seasonal flu 4 vaccine exists, a era disease security programs, do our part to avoid further COVID-19 is far deadlier COVID-19 vaccine will forcing the Centers for Disease spread by socially distancing than the flu take at least a year to COVID-19 is easier to Control and Prevention ourselves. The fewer people be ready for use transmit (CDC) to scale back efforts to that get infected at this critical prevent global outbreaks in moment, the better chance Herd immunity several areas, including China. our doctors, hospitals, leaders, usually protects vs vulnerable members Around the same time, the schools, and researchers have Flu of the population, COVID-19 Complex Crises Fund, started to prepare for the worst of but this will not by former Secretary of State the virus. Avoiding large occur with COVID-19 is estimated to be Hillary Clinton to deploy gatherings and maintaining at COVID-19 at least 10 times as deadly disease experts and others in least a 6-foot distance between as the seasonal flu, and is particularly dangerous for the event of a crisis, was also cut. yourself and others will ‘flatten elderly and The effects of these cuts are the curve’ of infection and push immunocompromised still being felt today. Plans to back the peak of the outbreak conduct widespread testing for so our healthcare system can COVID-19 have been delayed and regulatory problems are preventing further mobilize. Maybe now is the time to learn that elusive hobby many CDC labs from being able to test at full capacity. and catch up on that special TV show. Treat this time like a ‘staycation’ The only way to solve this problem is to target its route—to fix and please, stay at home. the underlying problems in our healthcare system so that when Disclaimer: If you have the symptoms listed on this page or suspect nature inevitably throws its weapons, sharpened by natural selection, you have COVID-19 for any reason, stay home and avoid public areas for at us, we are prepared. Our administration needs to be aware that at least 14 days. If your illness worsens and you need medical care, call ahead simply throwing money at a problem after decades of budget cuts to before visiting a treatment facility.

COVID-19 ≠ FLU

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The

Anthropoceneâ&#x20AC;&#x2122;s Anthropoceneâ&#x20AC;&#x2122;s

Furnace The fires of denial and indifference plaguing Australia By Sofia Mohammad Photography: Avery Boals Design: Aaron Dykxhoorn

14 | The Silent Epidemic

aybe it’s the ominous red sky swirling above a blazing continent full of fire. Maybe it’s the billions of decaying corpses of scorched kangaroos and koalas dotting the terrain. Maybe it’s the raging inferno racing across the continent, obliterating everything in its path. Maybe it’s the complacency of people in power, refusing to implement post-catastrophe policy changes. Regardless, the dreary, seemingly dystopian images evoked by the Australian wildfires shed light on the fact that the climate catastrophe occurring in Australia and our world is undoubtedly a real threat that demands real change—unless we would like to see our world descend into our own rendition of Dante’s Inferno, that is. The most pressing tragedy afflicting Australia’s natural ecosystem is the recent series of fires destroying Southeastern Australia’s natural landscape and infrastructure. A culmination of factors, including the onset of record breaking temperatures, extended periods of drought, and strong winds have synergistically created the perfect storm, with conditions conducive to spurring and fueling bushfires across the nation. The fires have burned over 45 million acres and killed over 1.25 billion native animals, with a particular threat being posed to animals that were already threatened and endangered before the crisis. For instance, over one-third of Kangaroo Island on the Southern Coast of Australia has fallen victim to the fires, and thousands of kangaroos and koalas have been killed. More worrying, however, is the loss of an endangered subspecies of black cockatoos, of which there were only about 300 to 370 before the crisis. Endemic species of velvet worms and trapdoor spiders, among many others, can be lost due to ecological changes in Australia’s climate, and we may not even be able to discover the features and contributions of these rare animal species before they too fall victim to climate disasters. Beyond the effects of the blazes on wildlife, the destruction of the fires has also pushed Australians out of their homes and forced them to seek refuge from the fire on the beaches, indicating that climate refugees are a reality that we may see in the very near future if we continue to neglect the environment. This has the potential to threaten the global economy, incite political upheaval, and also place a strain on resources as the world’s population struggles to adjust to a changed world. Over the past 20 years, we have seen tremendous changes in Australia’s ecosystem. Though the Australia wildfires of 2020 constitute the most recent tragedy affecting the continent, the

damage began several years ago, starting with the destruction of Australia’s iconic giant kelp forests at Shelly Point in Tasmania. According to research conducted by the University of Tasmania’s Institute for Marine and Antarctic Studies, the extension of the East Australian Current into Tasmanian waters warmed the ocean climate in Eastern Tasmania, subjecting the giant kelp forests to elevated sea temperatures and nutrient poor waters. What was once a thriving, dense kelp ecosystem has now been reduced to sparse patches of kelp. Though this in itself is an environmental tragedy, it also has threatening implications for biodiversity, food security, and economic stability, given that the depletion of the kelp and the subsequent deterioration of complex marine communities supported key species who held immense conservational and commercial value, such as weedy sea dragons and rock lobsters. For instance, indigenous populations of Tasmania have relied on the kelp forests for natural materials to utilize in traditional jewelry making and basket weaving, thus contributing to the cultural traditions of Tasmania as well as art forms that have been used for economic support for indigenous groups for centuries. Though kelp restoration projects are now underway in a desperate attempt to revive the giant kelp forests and restore environmental, social, economic, and cultural balance, prevention would have been undeniably easier and more effective than searching for a cure. Another key climate issue plaguing Australia is the onset of ocean acidification—a phenomenon that has spread like an epidemic, killing millions of vulnerable coral populations that once dotted the coast of Australia as part of the Great Barrier Reef. The Great Barrier Reef constitutes one of the world’s most precious natural habitats, spanning over 133,000 square miles off the coast of Australia, so large it can be seen from outer space. Since 2016, however, half of all of the coral in the Great Barrier Reef has died, devastating what was arguably the greatest colossus nature had to offer our world. Ocean acidification is cited as the root cause of the depletion of the coral in the Great Barrier Reef, as it prompts the onset of phenomenon such as coral bleaching, a mark of coral stress. Since 1998, the Great Barrier Reef has seen four main bleaching

News | 15

events, and two of them have taken place post-2015, thus stripping corals of their diverse and vibrant colors and subjecting them to an increasingly vulnerable state. To put this in perspective, one coral bleaching event in 2005 in the Caribbean caused the U.S. to lose half of its coral reefs. Coral bleaching is a phenomenon that afflicts stressed coral, and is characterized by the loss of protective algal symbionts from the coral surface due to elevated ocean temperature, overexposure to sunlight, extreme low tides, or pollution, depriving coral of their primary food source and rendering them bleached and vulnerable to disease and decay. Researchers speculate that if our carbon emissions continue at current rates, the speed of coral bleaching will double every decade starting in 2035, thus gradually depleting what is left of the natural ecosystem of the Great Barrier Reef. Though Australia’s Great Barrier Reef is undoubtedly one of the most complex and biodiverse ecosystems on the planet, it is also a reservoir of economic power for Australia’s economy, generating over $4.5 billion dollars annually and supporting thousands of

jobs. With the decline of new organisms inhabiting and sustaining the reef due to the widespread deterioration it is experiencing, researchers postulate that we are currently on track to collapse the entire reef unless we begin serious efforts to conserve our climate. Today, the inaction of politicians such as Australia’s own Prime

16 | The Silent Epidemic

Minister, Scott Morrison, amidst crisis is undeniably adding fuel to the fire. Climate change is undoubtedly a real phenomenon that is spurring observable changes in our world, especially in Morrison’s own nation. His inaction, like that of many other politicians in power, is the root of policies and political discourse that propagate a lack of environmental consciousness and regulations to lessen our ecological footprints. Thousands of Australians have taken to news outlets and social media calling him to action, labelling him as “missing” and informing him that “[his] country is on fire.” Unfortunately, powerful institutions such as coal industries that employ lobbying efforts and financial incentives have dominated Australia’s political discourse on the topic of coal mining. Though the process should be discontinued for the sake of reducing its harmful environmental effects, the competing interests of economics and environmentalism have placed the politicians and the nation at a bitter stalemate. Despite the glaring inaction of politicians such as Australia’s own prime minister, there lies immense potential for change in Australia’s most powerful resource: its people. Amid the crisis, massive strain has been placed on firefighters who are overwhelmed in a fight against the so-called “forever fires.” However, people and institutions from across the world have mobilized to send extra firefighters as support to Australia, volunteers have taken to stitching blankets and cotton “Koala Mittens” to promote healing for wildlife, and donation drives have been initiated to help rebuild the nation post-disaster. Victims continue to contribute to wildlife preservation in their own unique ways. One such victim, Katharine Catelotti, who places food out for injured or displaced animals, states, “[though our] efforts [don’t] bring back properties, for some it can give a sense of not giving up the fight.” The power for

in Australia, are imminent. Like the blazes ravaging Australia, we cannot afford to let the fires of complacency and denial spread to people who have the potential to unite and affect change in both their local communities and our world, especially when it comes to kickstarting the reversal of our harmful impacts on the global climate. We need environmental consciousness. We need change. And we need it before it is too late.

change lies in people who care, and that is especially true given the overwhelming support and positive responses from the people of both Australia and the world in response to this crisis. In essence, Australia is a paradigmatic example of what modern scholars have dubbed â&#x20AC;&#x153;the Anthropocene,â&#x20AC;? an emerging geological age characterized by the adverse climate and environmental impacts of human ambitions for development. For centuries, natural ecosystems have been able to resist the pressures posed by human demands for urbanization, development, and migration, and have reliably achieved a balanced equilibrium between natural preservation and human development. However, with recordbreaking high levels of deforestation, greenhouse gas emissions, ocean acidification, and global warming, among many other factors, the natural world is now unable to compensate for our shortcomings, and climate catastrophes, such as the one transpiring

The power for change

lies in people who care...

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Inferno: A Dance Eternal By Wil Harris & KimberlEy Rose A lone scintilla, falling like a star Emerging as the sole munition from a paper canon Hits the parched earth and mummified grass Unnoticed save for the scent of acrid sulfur and tar Who knew a lone cigarette would later leave such a scar

An innocent life, just begun Learning the ways of the earth Its faithful mother at its side Neither knowing of what is to come With nowhere to hide and nowhere to run

Like the meteors and comets of yore Its burning lips presaged cataclysm A continent subdued by the emissaries of Vulcan’s wrath A threat man never should have ignored As fire was never known for taking prisoners in war From the vermillion egg hatched a Hydra of flame One spark begot the next Until the world became awash in a sea of cerise The trees and shrubs now battlefields where it lay its claim A chthonic beast, incapable of being tamed

The mother worked with tireless patience and care In the endless job to raise her young The gentle soul for which she was it’s only hope Both still blissfully unaware Of the incendious monster which would soon be there

Crimson bodies born of the flames and ash start to dance Ethereal malicious nymphs of destruction Form coruscating lights, an aurora of exquisite terror Their mendacious beauty putting all in a trance A gorgon ablaze, they could kill with a glance As if born from a God’s ire Legions of trees fell to the Charybdis’ voracious maw Caring not for life nor death It burned with the intensity of Hadean hellfire An unfeeling idol to gluttony’s desire

The smoke and flames charred their home Mother and child were pushed to the edge Their once lush paradise now scorched and barren Forced away from the land they used to roam Helpless to change the forces destroying their biome

Living treasures hidden beneath the curtain of hazy gloom Lay nameless in sepulchers never to be witnessed by man As the roiling conflagration Leaves only obsidian spires in the wake of its doom Serving as the inhabitant’s haunting tombs Iridescent plumes on birds born in aeons untold Now only reflect shades of maroon and sanguine Absconding from their former Eden Crying out in melancholy at the fate of the forests, old Their voices like sonorous funerary bells tolled

18 | The Silent Epidemic

All around were fallen friends If not taken by the voracious crimson tendrils Then by the depletion of their water sources from the searing heat But the mother had no time to truly mourn their untimely ends For in her own search for sustenance, her child’s life depends.

Yet, this god’s days were woven in the fate’s threads As Gaia’s grief smote the beast with a body of flame Cutting it’s string with an aqueous sword Fallen from the alabaster clouds as tears shed Foretelling the land’s rebirth ahead Ash, like charred maleficent snow Choking the blackened ground Washes away with the delicate touch of the rains As Persephone’s tears for her lost children flow One day soon the autumn flowers will again paint the earth indigo

At last she rested, exhausted and spent She could do no more for herself or her youngling But accept defeat unto her parched and singed body Yet miraculously came a spectacular event A helping hand who on seeing the pair could not help but lament

As with the Phoenix, arcane Or the rose at the terminus of winter Life can never truly perish After all the pain Even in ashen earth sylvan blooms will come again Just as with the twin dragons in their dance of eternal strife, Life cannot conquer death and death cannot conquer life.

INTO THE APATHETIC INFERNO

By Sanjoy Kundu

ne late winter evening, the crackling sound of treacherous flames broke me from my sleep. My mother had been silently weeping and her ghastly expression frightened me. She mustered the courage to pierce me with heart-breaking words, “... your father passed away in the line of duty.” My body became numb as I tried to process this, but nothing could placate me and a deluge of tears inundated my eyes. After a few minutes, I hesitantly turned on the television, and every news station ubiquitously featured the terrible bushfires that had spread throughout Australia. As I viewed graphic images of the once verdant landscape being destroyed, I became engulfed with sheer despondency and my thoughts converged to my father. He was a fire-fighter who always swore to protect the environment and save as many lives as possible. The finality of knowing he would never return overwhelmed me, as I slowly faded and fell asleep once more. One morning, I decided to pay a visit to the now charcoaled forest that had consumed the life of my father. While cycling through the dense forest trail, I realized that I could truly appreciate my surroundings and become unified with nature. However, the ashes from the devastation surrounded me and I tried to quickly pass through the thick smog that seemed to follow me endlessly. Suddenly, I heard a fading scream of anguish. This sound reminded me of my inner voice; the reaction had been one and the same when my mother cast those cruel words upon me. As I cautiously walked

over, my eyes wandered toward the ground and I noticed a small creature gasping for breath, barely clinging on to its dear life. I quickly realized it was an infant koala, but as its somber gaze met mine, I fell into a completely submissive trance. Both the koala and I shared hazel eyes, marked by the depths of our grief and despair. At that moment, the young koala let out another faint scream and I immediately grabbed my water bottle and began feeding it. Indeed, the koala was severely dehydrated, as my nearly full bottle was empty in a matter of seconds. Upon holding the koala, I noticed several second-degree burns near its paws. My mind instantaneously thought of the wretched bushfire that had not only burned down over half the forest and the surrounding Eucalyptus trees, but cruelly cast permanent havoc and condemned whatever family the koala had to a most horrendous fate. Seeing as the injured koala had nowhere else to go, I decided to take it to the nearest animal hospital to get it treated. While waiting, I came to terms with perhaps the harshest reality caused by this bushfire - there was no distinction between man and animal; it only strived to induce the commonality of loss. The profound amount of physical devastation inflicted to the landscape would eventually heal, but the emotional trauma inflicted a permanent scar on all. Indeed, the upcoming weeks would be extremely challenging, but with new resolve in mind, I set out my journey into the apathetic inferno.

News | 19

BLOOD

MONEY

by Snigdha Sama Illustration & Design: Varsha Udayakumar

n 2015, Elizabeth Holmes, founder of the revolutionary biomedical technology startup Theranos, was on the top of the world, worth nearly $9 billion and in possession of an idea destined to change the future of medicine. Today, she awaits trial in 2020 on multiple counts of wire fraud and faces up to 20 years in prison.

Elizabeth Holmes was born in 1984 to a congressional committee staffer mother and a well-connected, federal agency executive father in Washington D.C. She attended an expensive private high school in Houston, Texas until she graduated in 2001 and went on to attend Stanford University. There, she studied chemical engineering and worked as a student researcher and lab assistant in the School of Engineering. In 2004, she dropped out of Stanford and used her tuition money to fund her consumer healthcare start-up, a company she called Real-Time Cures. Inspired by her fear of needles, Holmes sought to develop a technique to perform blood tests using only a small amount of blood, just from a simple finger prick. Her pitch to the world was that for her tests, you would need only “one drop of blood,” a revolutionary paradigm shift when compared to the tubes of blood that are normally required to conduct laboratory tests. She renamed her company Theranos (a mixture of the words “therapy” and “diagnosis”) in April of 2004 and recruited the dean at Stanford’s School of Engineering, Channing Roberts, to back her idea. Holmes’ vision relied on an invention she titled the “Edison,” after the famed inventor of the lightbulb. No one is entirely sure how the machine works; Holmes avoided questions about its functionality and instead labeled it as a magical machine that simply returns astoundingly accurate results for thousands of lab tests from blood from only a finger prick. For almost a decade, Holmes operated her company in a stealthy mode, with employees ordered to stay silent about company operations. In the meantime, she slowly gathered more than $100 million in funding from investors, under the condition that they would not ask anything about her technology. Theranos finally announced its partnership with Walgreens in 2015, and soon added collaborations with

20 | The Silent Epidemic

Cleveland Clinic, Capital BlueCross and other widely influential companies. However, Holmes failed to reveal that the Edison had a fatal problem: it just didn’t work. The reason blood from the finger isn’t used for blood tests is that with a finger prick, the sample taken contains both tissue and blood. Testing this sample simply wouldn’t be as accurate as one from venous blood. Her idea of needing only a finger stick was destined to fail. Moreover, only one of the hundreds of clearances Theranos submitted to the FDA was approved using the Edison: the test for Herpes simplex virus, arguably one of the easiest tests to conduct. For the rest of tests, Theranos diluted the drop of blood from the patient with saline solution and ran this mixture in traditional commercial lab machines. The more a sample is diluted, the more errors the results are prone to contain. As a result, the values Theranos returned tended to fluctuate widely from hospital results. In early 2015, John Carreyou from the Wall Street Journal, suspicious about the lack of any peer-reviewed data about the technology and Holmes’ general vagueness, decided to investigate the company and talked to a former laboratory director at Theranos, Alan Beam. Beam told Carreyou everything he knew about the company and revealed the truth behind Theranos: less than 10% of tests were performed on the Edison and the ones that were returned erroneous data to the patients. He published a breakthrough article that resulted in lost partnerships and FDA scrutiny. Eventually, the Centers for Medicare and Medicaid Services suspended Holmes and her business partner, Sunny Balwani, from owning or operating a lab for two years. By this time, the public was well aware of Theranos’ fraud due to Carreyou’s article, and unsurprisingly, no one wanted to buy the company. It was formally dissolved in September 2018, and Holmes and

Balwani were charged with “massive fraud” by the Securities and Exchange Commission for their part in attempting to defraud investors with false promises. Holmes will undergo trial in August this year for wire fraud and jury selection for the trial will begin this July. While revolutionary and novel ideas are a dime a dozen in Silicon Valley, in the biomedical world, the process is far slower; a concept needs to be developed, careful testing must be conducted, clinical trials must be completed, and only then can a product be released. Though rapid and unrelenting success is always desired, it simply doesn’t happen in the medical world—any errors can result in the loss of human life. Holmes started with only a vision: an idea that if rapid blood-testing with only a drop of blood were possible, it would help the world immensely. However, one thing she was missing was exactly how she would make this possible; Holmes had no medical training at all when she started Theranos. When asked why she started the company, Holmes simply repeated that she wanted to “spend [her] life changing our healthcare system” and avoided questions about the technology behind her idea. In Silicon Valley, an idea might be enough; the programming can always come later, with whip-smart and experienced programmers doing the busy work behind the project. A few bumps or bruises in the process would at worst be a mild inconvenience for customers and a slight dip in business. In the world of biomedical technology, however, any errors can be fatal, and with Theranos technology, there were many errors. One woman was inaccurately diagnosed with a thyroid condition called Hashimoto’s disease and changed her lifestyle, taking medication she didn’t need. A man who had heart surgery visited a Theranos clinic to monitor the results of a drug and was switched to a different drug. He blames the inaccurate lab values from the Theranos clinic for the second heart surgery he

had to have. Unfortunately, this rush for rapid results is a concept rapidly encroaching into the research world in the present day, much to the detriment of good scientific practice. A 2011 report looked at the retraction indices, meaning the likelihood that a paper in a given journal will eventually be pulled, of papers published from 2001 to 2010 in 17 journals and plotted the papers’ retraction indices against their impact factor. They found a clear indication that the higher the impact factor, the higher the retraction index. Common reasons for those retractions include not being able to confirm original results and errors found in the procedures and analysis. As a whole, the number of retracted articles has risen approximately ten-fold over the past decade. While the higher retraction rate could be partially due to higher replication rates of high-impact papers and generally more peer reviewing overall, a more probable reason is that in the interest of getting out more high impact, “publication-worthy” work, researchers may spend less time ensuring their scientific practices are sound. No matter the legality of Holmes’ actions nor the morality of them, the result of this scandal on consumer trust is resounding and it doesn’t seem to be receding anytime soon. At its height, Theranos operated about 40 centers in Walgreens stores in Arizona and a single center in California and sold more than 1.5 million blood tests. Almost all of the results run on its machines were voided, and the ones that weren’t are still tainted by an air of hesitation associated with the brand of ‘Theranos’. Thousands of patients were alarmed by fluctuations from normal lab values and were left worried, thinking something was wrong with their health. Trust is crucial in the healthcare industry, and this scandal led to a serious breach of trust in the minds of patients. The story of Theranos points to a clear need for increased oversight of emerging technologies, research funding, and the veracity of groundbreaking results. When something sounds too good to be true, it just might be.

Ethics | 21

one tiny drop changes everything. 1984 Born in an affluent family in Washington, D.C., Holmes develops a fear of needles.

2015 Theranos is at its peak with 40 centers in Walgreens and 1.5 million blood tests sold.

2001

2018

Holmes enrolls in Stanford University to study chemical engineering.

Carreyou publishes breakthrough article on erroneous data and fraudulent practices.

2004

2020

Holmes drops out of college and funds a healthcare startup called Real-Time Cures, later renamed Theranos.

22 | The Silent Epidemic

Holmes will undergo trial for wire fraud and face up to 20 years in prison.

Theranos is formerly dissolved with Holmes and her partner Balwani facing charges of fraud.

P s y c h i c C h a i n s Exploring the Controversy Surrounding the Baker Act By Amirah Rashed Photography: Sneh Amin Design: Aaron Dykxhoorn

Ethics | 23

he Florida Mental Health Act, more commonly known as the Baker Act, was enacted in 1971 and named after Maxine Baker, a former Democratic state representative who took a special interest in mental health issues. The Baker Act outlines criteria for both voluntary and involuntary admission of patients with mental illness. The Baker Act brought about major changes to Florida’s archaic laws that governed treatment of mental illness. However, the effectiveness of the act has recently been called into question, and calls for further reform are widespread. Although the Baker Act encourages voluntary admission for mental health patients, it is notoriously known for its involuntary provisions. Under the involuntary provisions, all three of the following criteria must be met in order to take a person to a receiving facility for examination: there is reason to believe that he or she is mentally ill, the person has refused voluntary examination due to his or her mental illness, and without care, the person is likely to suffer from neglect and will cause harm to others or self. The Baker Act is meant to provide a temporary intervention in crisis situations, but its overuse on some of the most vulnerable populations, such as children and teens, has drawn criticism. Children are often “Baker Acted” by school staff or parents who are unable or unwilling to care for difficult children. Recently, Nadia Falk, a 6-year-old girl, was Baker Acted at Love Grove Elementary School in Jacksonville. School officials stated that they followed protocol by calling Child Guidance, a crisis care provider. A mental health counselor from Child Guidance who responded to Nadia’s tantrum said she was a "threat to herself and others," "destroying school property," and "attacking staff," and made the decision to Baker Act Nadia. Her mother, Martina Falk, stated that she had no say in whether her own child should be Baker Acted and was only notified after the Baker Act was invoked. Nadia was removed from school by law enforcement officers and committed to Riverpoint Behavioral Center for psychiatric evaluation where she remained for two days, separated from her mother. At the facility, Nadia was sedated. The facility which Nadia was admitted to offers specialized care for children and encourages family participation during treatment, yet her mother had to wait for several hours at the facility before she had a chance to see her. According to her mother, the Baker Act was not in the slightest the right decision for her daughter, who school staff knew had ADHD and global developmental disorder. This kind of experience would traumatize any child, especially one with pre-existing mental disabilities. If Baker Acting a 6-year-old seems excessive, that’s because it is, but this isn’t the first time it has happened. On the other end of the age spectrum are the elderly, many of whom suffer from dementia and Alzheimer’s. These cognitive diseases often cause the elderly to lash out at family and caregivers. However, studies have shown that Baker Acting them only serves to put them at risk for depression, anxiety, and similar behavior disturbances as they are moved around from their homes to a hospital or nursing home. In December of 2014, a 57-year old woman with dementia and Alzheimer’s was Baker Acted and committed by court order to Northeast Florida State Hospital, where she was attacked by other patients and fell multiple times according to her sister. She also underwent surgery not recommended for dementia patients. Her primary care physician attempted to move her to the medical ward and discontinue a psychotropic drug she

24 | The Silent Epidemic

administered, but she was abruptly removed from caring for the patient after disputing this matter with the patient’s psychiatrist. Over time, the patient reverted to her native language, and her sister requested to move the patient to a facility which could provide more appropriate care, but these requests were denied. After nearly two years of this inadequate care by the facility, the patient died. Although the holding period for the Baker Act only lasts up to 72 hours, its consequences last forever. Many people who are Baker Acted return to their jobs only to find out that they’ve been terminated. The Americans with Disabilities Act (ADA) is the only measure that employees have to fight back, as it prohibits discrimination by an employer against employees on account of a disability, but it is difficult to prove that an employer truly did violate the ADA. Among the elderly, patients who are Baker Acted are relocated from assisted living facilities to nursing homes or hospitals, where care may not be as specialized. Between the 2001-18 Florida state fiscal years, Baker Act examinations of children increased nearly 141 percent. The sharpest increase in committals, 84 percent, was among children between the ages of 14 to 17, but even the committals of children between the ages of 5 and 10 grew 76 percent. Some kids are Baker Acted multiple times in a single year, leading some to coin the Baker Act as mental health’s ‘revolving door.’ Instead of providing a means to a long-term mental health intervention, the Baker Act simply displaces children from their daily lives in a manner that criminalizes mental health problems. Students are removed from their schools in handcuffs for situations that could easily be resolved by school staff working with parents and recommendations for external mental health services. Stopping overuse of the Baker Act among children and teens must be a joint effort between parents and schools, in which schools need to search for longstanding interventions. With a lack of child psychiatrists and funding for in-school interventions in the state, amending the Baker Act may be a more far-reaching option. Falk is currently working with her attorney to encourage Florida school districts to implement better protocols to ensure parents are notified before the Baker Act is invoked, and that children under 10 years old are only subject to the act under extreme circumstances. Along with identifying steps to reduce overuse of the Baker Act, changes to the Baker Act should include a path to long-term mental rehabilitation. The reason many patients are Baker Acted multiple times is that the 72 hours mandated by the act only gives mental health specialists enough time to identify the problem, not to find a solution to a patient’s problem or create a long-term treatment plan. If the Baker Act were expanded to include a long-term mental health plan for patients, it would allow for patients to receive treatment in a manner that will allow them to make sustainable changes in their lives. For any vulnerable group, whether it be the elderly, teens, or any suicidal patients, moving individuals to a general psychiatric center and placing them among a diverse population may only exacerbate a difficult situation and cause further trauma. Having personnel at the psychiatric centers trained in caregiving for specific types of patients such as those who are suicidal or those suffering from dementia will undoubtedly help to avoid further trauma, physical harm, and suffering among vulnerable members of our population.

Student Opinions “I wouldn’t want anyone to be sent to one of those mental health facilities. This might sound bad, but I’ve known others who have refused to tell the school about a friend going through mental health issues because they didn’t want them to be Baker Acted…out of fear of what they might experience in a facility.”

“After being Baker acted, I spent three days at the mental health facility. There, I was stuck in a room with a guy who randomly shouted, and it felt sort of like a free-for-all, a mix of adults all going through their own issues…It’s pretty jarring. “Many of the staff spoke only Spanish and not English, which made it tough to communicate. There was a form someone was asking me to sign, and I wanted to read it first because that’s what the form instructed. When I stopped to read it, they took it away and said ‘you just have to sign it. You don’t need to read it’. In general, it didn’t feel that they were set up to take care of a college student who’s suicidal or depressed. [The process] helped as an immediate intervention to prevent something tragic, but it was also a traumatic experience on its own.”

“If I wasn’t Baker Acted, I don’t think I’d still be at the university. It wasn’t comfortable, but it’s what kept me here in the long-term.”

“It seems like [the Baker Act] is supposed to be a one-size fits all solution, but that’s not how mental health issues work. They can’t really be generalized. I get that if someone might be a harm to others they definitely need to talk with counselors or police. But I don’t know if taking young kids out of school in handcuffs is right.”

Ethics | 25

Influencer Mania The Rise and Impact of YouTube by Isik Surdum Design: Sandy Taboada

HE AGE-OLD QUESTION, “What do you want to be when you grow up?” seems to have been turned on its head due to the modern reign of social media. Prior to the explosion of online careers, there seemed to be a few commonly selected answers: teacher, fireman, doctor, football player, and so on. However, millennials may be the last generation to desire a traditional career at such a young age. In a recent study, 75% of children aged 6 to 17 chose being a YouTuber as their most desired career. Within the last decade, social media has skyrocketed in popularity, transforming regular people into celebrities seemingly overnight. Unsurprisingly, YouTube is known for taking this trend to the extreme. YouTube, a video sharing platform created in 2005, allows anybody with a computer to upload videos containing any content to the site. More often than not, this ranges from cute animal videos to study materials, and even includes “vlogs,” video blogs that people create and share to document their everyday lives. Vlogs are often popular amongst the younger demographic. One could say it’s a revolution of the role of the typical movie actor: the YouTuber has become the main character of his or her own TV show, with their family and friends as the side characters and their day-to-day conflicts as the plot. However, the glaring difference between these YouTubers and traditional celebrities

26 | The Silent Epidemic

is that we can never truly tell whether these YouTubers are acting or not—they may or may not be putting on a façade, but we don’t know either way, which can be scary. They use the relatability of their private lives as a source of content, but the extent to which this “relatability” is genuine is always under question. Nonetheless, it’s as demanding as any Hollywood career: vloggers invest time and effort in exchange for the chance to be launched into superstardom. For today’s youth, most of whose lives aren’t as glamorous as the Kardashians, the life of a YouTuber holds immense appeal because of its accessibility. Most vloggers’ origins are indeed humble: when starting out, a YouTuber is just someone filming their life without much intention of going viral or becoming famous. When compared to the highly polished and saturated celebrity culture in which stars strut a full hairdo and face of makeup around the clock, it is easy to see how much more relatable a YouTuber starting out can seem. However, many don’t realize that their favorite online creators reap the same monetary profits as our Hollywood stars. YouTube has become an extremely lucrative business, with the top YouTube creators making between 15 and 20 million dollars a year—without even considering the additional revenue they collect from merchandise and paid appearances.

Eventually, the life that made these creators seem so relatable and likable to their audience fades away as they become millionaires and lose their grasp on what made them popular in the first place. There are indeed some online creators who reach this high level of success and are not seen as out of touch with reality, such as Jenna Marbles and Shane Dawson, both of whom have been on YouTube for over 10 years and each have over 20 million subscribers. Others aren’t so fortunate—far too many other creators are ripped apart for “changing” with the fame that comes along with their careers. Take Emma Chamberlain, for example, an 18-year-old girl with over 8.5 million subscribers. Chamberlain started her channel 2 years ago with extremely relatable content, documenting her outfits for school, taking her driving exam, and making iced coffee. She instantly gained popularity for her self-deprecating humor and incredibly relatable life. However, as quickly as she was launched to fame by her fans, people began tearing her down for the transformation of her content. When her videos switched from showing what she bought at the Dollar Tree to vlogging her attendance at a Louis Vuitton show at Paris Fashion Week, hundreds of thousands of people flooded her videos with hate comments, saying how the fame had “changed her.” While objectively this may be true and almost unaviodable when normal people blow up online and become extremely successful in a short period of time, this doesn’t stop the hate from coming in. But knowledge of the common fate of such YouTubers has yet to stop children from desiring the YouTuber lifestyle and career. In fact, more and more studies report that anywhere between 1 in 5 and 1 in 3 children want to be either a YouTuber or some other variation of an online creator. Despite the majority of watchers disliking how the creators change when reaching massive success, they themselves also desire to reach this level of impact. This creates an interesting dichotomy between the creator and the viewer, and jealousy tends to play a large role in the hate creators receive. Especially when compared to traditional celebrities, it is much easier to envy an online creator, as viewers can feel like they “watched” the change from normal life to superstardom. But the life of a YouTuber carries burdens beyond the unwanted attention that comes with fame. For one, there is no option to “step back” from work. In a typical field, many leave their work at the office and are able to come back home and enjoy their lives once the workday is done. With the lifestyle YouTubers have, however, this is simply impossible, as their job is directly interconnected with their everyday life, creating a muddled sense of self. Yet when creators attempt to speak about these hardships, they face even more hatred—often, they’re met only with a harsh reminder that however hard their jobs may seem, they are receiving higher salaries than most surgeons for simply showcasing their everyday activities. This field of work did not exist a decade ago, which is what makes it so innovative, yet elusive and confusing. A typical adult does not even know what the word “YouTuber” means, let alone know that these creators can make millions of dollars off the platform. This creates a sharp discordance, as parents often perceive the world far differently compared to their children, who will now be growing up watching YouTubers more than standard television. The rise and popularity of YouTube and its online

creators is only at its beginning stage, and it is no doubt going to be an incredible and exciting journey to watch the way that this new job settles into the job market, and how the creators will find a balance between their own desires and those of their everchanging audience.

Ethics | 27

FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT BY ANAM AHMED FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT

E R U L I FA TO REPORT

linical trials provide critical insights on preventing, detecting, and treating diseases, so when their results go unreported, patients are the ones who suffer. Disregarding the law with minor to no consequences, clinical trials neglect to report their findings on time or at all, exemplifying a new level of procrastination that may actually be a matter of life or death. ClinicalTrials.gov was established in 1997 to create a clinical trial registry for research that tests the effectiveness of new drugs and devices targeting serious diseases and conditions. Through the National Institutes of Health (NIH), the U.S Department of Health and Human Services specifies which trials must register and submit results to the database. Both privately and federally funded trials are required to submit this information, which includes demographics of study participants, outcomes, and a summary of any adverse effects that the participants experienced. Even after a law in 2007 that made reporting mandatory for registered clinical trials, compliance on the part of those running many trials was severely inadequate. In 2017, the Food and Drug Administration (FDA) and NIH released a “Final Rule” to clarify and delineate the posting requirements, yet again. The document even specifies monetary penalties to those sponsors who don’t post their trials or post them late. However, an investigation by journalist Charles Piller from Science Magazine finds that the officials are inadequate at enforcing the law, as many clinical trials fail to report their results.

28 | The Silent Epidemic

In a time where evidence-based medicine is critical, this widespread noncompliance is indicative of a faulty system. After the “Final Rule,” trial sponsors are required to submit results and data within one year of a trial’s completion. Pharmaceutical companies and some universities had actually improved their reporting rate, but other sponsors, including the NIH itself, were considerably below the mark. More than 50% of the 4,700 clinical trials investigated by Science Magazine had submitted their results late or not at all. In late September of 2019, 184 institutions had at least five results for trials due, but 30 of them never submitted a single one. Many of these violators are those receiving the largest NIH grants of last year—including Baylor College of Medicine, Yale University, and Boston Children’s Hospital (affiliated with Harvard University). One would assume that penalties would be issued, but nothing has been done so far. The FDA promise of fines up to $12,103 for each day a trial’s results are left unreported has not been upheld.

The trials fall under a wide range of medical fields and there appears to be no trend with the type of clinical test, which in turn also affects a larger scope of patients. Science Magazine gives an example of a two year late trial comparing immunotherapy with conventional chemotherapy in 600 patients with late-stage lung cancer. Healthcare providers and patients rely on this public site, which is viewed an average of 215 million times a month, for vital information that affects current clinical decisions. It isn’t as if the data are unavailable; any results that the trial produces simply have to be uploaded to the website. Many sponsors see this process as a burden—unnecessary administrative paperwork—and argue that published trials in peerreviewed journals are a more important resource. But this “annoying legal burden” has been justified as a critical resource for many people. There is no doubt that articles published in journals hold an immense role in advancing science and sharing knowledge; however, scientists choose which data they want to submit for publication. If an article is accepted for publication, the public still won’t be able to view it for months or years, given that they are able to access it without paying a journal subscription. Trials deemed “insignificant” for publishing may not reveal breakthrough innovations, but hold immense importance as the basis for ruling out treatment options. Clinicaltrials.gov was created to overcome these obstacles and allow patients, doctors, and possible trial participants to make informed, vital decisions. Additionally, this “paperwork” is a large part of science communication—sharing new scientific knowledge with the world. Without this, results and discoveries would be lost or hidden among a select group of people who would not be able to apply their findings to real life. Communication must be a priority in science and medicine. These failures to report aren’t small administrative delays; they are significant violations that impact people’s health and ability to choose from treatment options.

Average Days Reported Late Academic/ Nonprofit

Government

Industry

97 143

FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO FAILURE TO Academic/Nonprofit REPORT Government Industry REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT Data obtained from clinicaltrials.gov via FAILURE TO REPORT FAILURE TO REPORT FAILURE TO REPORT

Clinical Trials Reported 2017-Present

TrialsTracker from sponsors with > 15 trials due

Ethics | 29

COFFEE

Everything to know about your cup of joe by Geethika Kataru 30 | The Silent Epidemic

Illustration: Megan Buras

Design: Anuj Shah

affeine is by far the world’s most common and widely used psychoactive drug. It is second only to oil as the most valuable legally traded commodity in the world. Coffee, in particular, is a worldwide phenomenon. Nearly every culture has its own traditional way of preparing coffee, and most countries now contain large coffee brands. Coffee’s early beginnings are shrouded in lore. An Ethiopian legend describes how coffee was discovered by a goat herder who noticed his goats were unable to sleep at night after eating a particular type of berry. The use of the “coffee berries” spread quickly via merchants and travelers to the Arabian Peninsula. There, it became integral to social settings at coffee houses, where people gathered to listen to music, play chess, and exchange news. By the 1600s, trade had brought coffee to Europe, where it was so well-loved that it received official papal approval. Coffee houses all over Europe were dubbed “penny universities” because anyone could grab a cup of coffee for a penny and engage in stimulating conversation. In the New World, coffee didn’t fully take hold until the Boston Tea Party. Disgruntled colonists viewed taking tea out of their daily diet and replacing it with coffee as their patriotic duty, part of a momentous rejection of all things British. Later in American history, the drink was used to raise morale in the Civil War, providing soldiers with an energy boost battle and the strength to carry on afterward. By the late 1800s, large companies were capitalizing off coffee’s popularity and selling the product to western cowboys and Californian gold diggers alike. Now, this drink is used by the majority of Americans to wake up and go to their nine to five jobs. Caffeine works well inside the body because it is both water- and fat-soluble,

which also contributes to its unique ability to penetrate the blood-brain barrier. Contrary to popular belief, caffeine itself works differently than what we normally consider a stimulant. Rather, it disables the brain’s natural brake system. Structurally, the molecule is similar to a naturally occurring molecule called adenosine. But whereas adenosine is produced throughout the day and locks into adenosine receptors in the brain to trigger feelings of tiredness, caffeine works by blocking the adenosine receptors, speeding up nerve activity, and keeping the drinker alert for a few hours. Surplus adenosine begins to build up in the brain, serving as a signal to the adrenal glands to produce adrenaline, another stimulant. In addition to this, the brain’s natural stimulants like dopamine work more effectively when the adenosine receptors are blocked, boosting the feeling of alertness. This concoction of chemicals in the brain effectively keeps a person awake and alert, sometimes to the point of anxiety. With consistent use, caffeine can negatively affect one’s cardiovascular system. These caffeinated consequences include increasing blood pressure and heart rate, as well as occasional arrhythmias. A constant and regular intake of coffee leads to an increase of adenosine receptors and a decrease of receptors for various stimulants in the brain, as the body seeks more inhibitory signals to return to equilibrium. The telltale signs of withdrawal—that “don’t speak to me until I’ve had my coffee” mood we may experience—are made worse by the fact that the brain can quickly build up a tolerance to the high caffeine levels in coffee. After a coffee habit has been built, it is similar to other addictions in that it is likely that symptoms of withdrawal can be seen when it is stopped abruptly. Headaches, abnormal blood pressure, extreme fatigue, and a decrease in sociability are the most common signs of withdrawal. Depending on the individual, withdrawal symptoms can also include stomachaches, joint pain, and decreased motor activity. These symptoms are wide ranging and vary amongst individuals, because each brain tries to adjust to the lack of caffeine differently. While building a tolerance to caffeine, receptor levels within the brain increase or decrease to adjust for the constant consumption of coffee. When that caffeine is no longer present, the precarious equilibrium the brain worked so hard to

build is once again thrown off. Excessive adenosine receptors are not being blocked by caffeine molecules, and so the naturally occurring adenosine within the brain fills that spot. This increases fatigue and prompts the other symptoms of withdrawal to kick in, such as excessive feelings of drowsiness. The receptors of various stimulants whose levels were adjusted are now not being used as frequently or as effectively. This chain of events causes chemical chaos within the brain. Of course, the regular cup of coffee in the morning can serve as a “band aid” solution to the problem, but will not fully subdue the chaos. Only completely breaking a caffeine addiction can do that. Just like any other addiction or dependence, it’s difficult to quit cold turkey. A gradual decrease in consumption over the course of a few days or weeks will allow the brain to remove and replace the necessary receptors. So what do scientists recommend to people looking to quit altogether? Some estimates say that going one to two weeks without caffeine is needed to adjust back to the normal balance

Health | 31

Coffee Certifications

32 | The Silent Epidemic

of receptors and return to a caffeine-free morning. While the human brain takes only a few days to adjust to coffee, the environment hardly shares the same flexibility. The global love affair with coffee has led to far-reaching environmental consequences. From the very beginning, certain techniques of bean growing have been detrimental to the surrounding ecosystem. For example, monocropping is a technique where a certain plot of land has the same crop grown on it throughout the seasons. Without any diversity, the nutrients in the soil are quickly depleted, leading to more erosion and increasing the need for organic and inorganic fertilizers. Though runoff of fertilizers can contaminate the surrounding soil or water, however harmful this technique may be, the large quantity of coffee that the world demands leaves monocropping as the most cost-effective way to meet demand. The large amounts of land and sunlight that coffee growing requires results in the clearing out of forests, which also decreases biodiversity and increases erosion and soil degradation. Helpful plants, insects, and other animal species are driven out by these techniques, and consequently the need for pesticides increases. Furthermore, added on to the environmental effects of the crops is the large carbon footprint associated with the processing and transportation of the coffee itself. Once the coffee has made it on the grocery store and into your home, there are still countless more consequences. Whether it be the coffee grounds or plastic cups and packaging, the waste associated with making coffee that ends up in landfills takes a long time to break down. At every step, the environmental consequences of a mere cup of coffee are immense. Unfortunately, aside from the environmental effects, human rights abuses are rampant within the coffee industry as well. Both the farmers that must plant and harvest the crops and the workers who process the beans and transport them

tend to be treated poorly and paid meagerly. Many cases have been seen of coffee giants such as Nestlé and Jacobs Douwe Egberts either turning a blind eye to the struggles of farmers and mistreatment of workers or only acknowledging their plight when the companies are pressured. The coffee industry is notorious for using child labor and increasing farmers’ debt—both scenarios are extremely prevalent, as up to three quarters of coffee is grown by smallholder farmers spread out over about seventy countries. In light of these issues, being an informed consumer is an important aspect of modern living, in making sure that purchases are not lining the wrong pockets. This is obviously more easily said than done, as many catchy phrases are not regulated, leaving the consumer in the dark on how reliable the claims really are. In relation to coffee, phrases such as “green” and “direct trade” are not enforced on packaging and advertising, and are likely more about marketing than actually improving the coffee industry. However, there are some specific phrases and certifications we can look out for. “Fair Trade Certified” means that the farmers behind the coffee are getting a minimum, livable wage for the coffee that they are growing. “Rainforest Alliance Certified” means that the product has been checked to make sure the growing techniques are sustainable, with some shade and clean water, and it also provides protection from child labor. A lesser known but very thorough certification is the “Bird-Friendly Certification” which ensures that the crops are grown in majority shade, and are grown organically. All in all, there is an intricate background to every cup of coffee, from the cultural events that gave it global importance to the chemical components that allow it to modulate our lives. Despite its simultaneously rich and bitter past, we can take action to make sure that the coffee we drink today is on the right side of history.

Coffee at the Exploring the Health Benefits of Coffee for College Students by Saraith Aviles ¡Bienvenidos a Miami! ¿Cafecito o cortadito? Here at the University of Miami, a melting pot for many different ethnicities, students swarm for steamy espressos at all hours. Whether someone is Colombian, Venezuelan, Argentinean, Cuban, Caribbean, Middle Eastern, European or more, many of us have developed one thing in common—a love for local coffee. For many students, coffee has become more than just a process of warming up and energizing themselves, and is now also a social custom with its own unique value. This widespread cultural phenomenon has caught the attention of many scientists, inspiring studies to find the positive and negative effects of coffee on our health and leading us to the important question: “Is coffee harming or helping us?” Turns out coffee can be more of a friend than a foe after all. In particular, coffee contributes to college students’ surplus of antioxidants. Antioxidants are vital to keeping our cells healthy from stress and disease, and they do this by combatting free radicals. Free radicals are unstable molecules produced as a byproduct during daily chemical processes happening in our body such as exercise, generating energy from food, medication, and stress. Free radicals or reactive oxygen species are the major cause of pathological changes in our body, and they can cause oxidative stress due to excessive accumulation of oxygen from metabolic pathways. These molecular villains can break bonds in other molecules and oxidize protein molecules, DNA, and lipids in structures such as

blood vessels. Most types of coffee are not only highly pleasant to the taste, but are also a rich source for antioxidants. The antioxidant effect of coffee is related to its content of chlorogenic, caffeic, and n-coumaric acids. Green coffee bean is the processed, non-viable seed of the coffee cherry, which contains the highest level of antioxidants. Some coffee beans, however, are compromised during the roasting method. Commercial beans are often roasted at air temperatures from 180 °C to 230 °C for around 10 to 20 minutes. Furthermore, a research study from the University of Udine in Italy under Dr. Maria Cristina Nicoli reported that different coffee brewing and storage methods can affect the antioxidant effects. Most importantly, she found that “ready-to-drink” coffee brews suffer a partial loss of antioxidants due to the inevitable alteration of chlorogenic acids. In general, medium roast coffees (which tend to have higher levels of antioxidants to start) were seen to lose around 15% of their antioxidant concentration, while darker roasts lost even more. No matter what type of coffee you enjoy— whether it be a flat white, cold brew, or caramel macchiato—know you’re amongst fellow coffee lovers here in Miami. In addition to its health benefits, drinking a steaming cup of freshly brewed coffee is certainly a great way to connect with friends and start your day. ¡Salud!

“Turns out coffee can be more of a friend than a foe.” Health | 33

34 | The Silent Epidemic

ESPRESSO

Milk

ICE

Iced Coffee

Cold

Water

Hot or cold?

Milk

Taste! I want this to be an experience

Vienna

ESPRESSO

Whipped cream

Of course!

Espresso

ESPRESSO

Double Espresso

ESPRESSO

Looks like coffee isn’t your cup of tea...try some tea instead!

Need. More. Caffeine.

Nope, just need a quick pick-me-up!

Still want it to be a little sweet?

Time! Gotta run to class!

Are you more worried about taste or time?

Yes

Thinking about having coffee today?

Water or Milk?

Hot

Whether you’re just entering the wide world of coffee or you’re a self-proclaimed coffee expert looking to switch things up, the vast number of possible coffee types can be pretty scary. But fear not! Most coffee drinks actually draw from a limited list of components, and simply involve different types of beans, combinations of ingredients, or methods of preparation. Here are a few of the most common types—now is the time to start exploring!

by Anuj Shah

Choose Your Coffee

| 35

Want a bit of extra flavor?

Try these for a new twist.

Need some extra Flavor?

Mocha

ESPRESSO

Chocolate

Steamed milk

Milk Foam

Americano

ESPRESSO

Hot water

ESPRESSO

Steamed milk

Milk Foam

Less

Almond and soy milk are great alternatives to normal milk, especially for those with dietary restrictions.

Almond or Soy Milk

Pumpkin spice is a popular flavor addition to coffee, especially in the fall and winter, and contains cinnamon high in antioxidants.

Pumpkin Spice

Latte Cappuccino

ESPRESSO

Steamed milk

Milk Foam

How much milk?

Strong

ESPRESSO

Milk Foam

Weak

Adding just a tinge of vanilla extract can give coffee a more creamy and rich taste.

Vanilla Extract

Macchiato

Strong or weak coffee flavor?

Adding melted chocolate can be a sweet addition to the normal bitter taste of coffee.

Chocolate

Try a local favorite with less texture and a more silky feeling!

Honey is a healthier alternative to artificial sweeteners, and contains some vitamins and antioxidants as well.

Honey

Cortado

ESPRESSO

Steamed milk

K C I T Your LIPS is A

Cute Shade OF

Bug by Alexia Vignau

36 | The Silent Epidemic

Design: Anuj Shah

“Girl, your lipstick is such a cute shade of parasite!” This may not be a phrase you hear everyday, but it is certainly grounded in truth. Red 4 Carmine, derived from South America’s cochineal insect, is one of the most widely used pigments in America, seen in everything from raspberry yogurt to drugstore makeup products. The dye was even used in Starbucks’ pink Strawberry Frappuccino until consumer backlash due to animal rights called for revision. Despite the controversy, this dye has been used since the Aztec civilization and poses a natural alternative to chemically derived—and potentially dangerous—synthetic food-grade dyes. The process used to derive the coloration is nothing less than eerie, considering the pigment adorns lips and is ingested along with our favorite beverages. Red Carmine’s constituent insect, the parasitic beetle Dactylopius coccus costa, commonly known as the cochineal beetle, is harvested from different varieties of cactus grown on plantations primarily in Peru, Bolivia and Chile. The beetles are then killed by immersion in hot water before being sun-dried. The female beetles are the pigment source, and up to 25 percent of their dry weight can be attributed to the color. Extraction is then carried out using an alkaline solution containing either ammonia or bicarbonate, yielding something referred to in the pigment business as a “lake.” This so-called lake is Carminic Acid, a compound created by combining a water-soluble dye with salts to render an insoluble compound. The compound is then capable of tinting via dispersion in oil. The exact shade is dependent on the acidity of the application, meaning that a higher pH forms a more purple red. Lakes tend to be more stable than other forms of dyes and, in the case of carmine (red 4), able to withstand higher temperatures, making them ideal for lipstick and cosmetics. However, the amount of beetles required for a single batch is staggering: it has been reported that 5 million insects are required to make 32 lbs of extract. Moreover, as a biocolorant, the shade of the compound is sensitive to temperature changes. According to the book “Natural Food colouring: A healthier alternative to artificial food colouring,” by M. Kamatar, “natural food colours are also not guaranteed to retain their original colour when subjected to high temperatures.” This sensitivity drives up the cost of natural colorants, and is economically pertinent because products with a longer shelf life are easier to store and can be sold for longer time periods (extended expiration dates). Despite this, Kamatar holds that the increase in processed food paired with the increased awareness of negative effects of synthesized colorants explains why “naturally derived colours [have a] predicted annual growth rate of 5 to 10 percent. Synthetic colours are still forecast to grow but a lower rate of between 3 and 5 percent.” The synthetic colors make a huge appearance in both our drivethrus and dinner plates. There is a correlation between increased food colorant usage and processed food. Therefore, it should come as no surprise that fast food goliaths utilize such coloring to make their processed products appear more similar to the natural foods they are derived from or inspired by. There is a reason why we don’t have pink butter and green ketchup, even though these were both short-lived, unsuccessful fads. The history of food dying dates back to the European Bronze Age, where coloration was used to enhance the appearance of cuisine. In the modern day, correlation between food color and consumer appeal is being extensively studied. The modern increased demand for colorants which would allow food and cosmetics to retain their appealing hue for an extended shelf life has become

imperative. However, since the rise in usage of petroleum-derived synthetic dyes in the 19th century, they have been subject to scrutiny and controversy. Since their advent, most have proven toxic enough to be banned by the FDA, which has reduced the list of approved artificial food colors from around 700 to seven. However, these dyes still pose frightening dangers to our health. According to a 2015 journal article, “Azo dyes and human health: A review” by the Journal of Environmental Science and Health, certain artificial dyes called azo-dyes have carcinogenic forms. Also, a 2018 article from the journal Nutrition claimed, “not only did azo-dyes exhibit a correlation to aggravated asthmatic responses,” but also that “11.54 percent of processed food items contained at least one azo dye.” Suddenly, beetle pigment doesn’t seem so bad anymore. There are strides being made to find alternatives that would avoid negative synthetic side effects of artificial colorants and increase production efficiency as well as ameliorate ethical concerns. Frontier research is exploring methods of utilizing fermentation products from molds like Monascus ruber to produce pigmentation and ultimately void the need for cochineal or Red 40 (its synthetic equivalent) entirely. This method of production is not only natural, since it is microbe derived, but also presents the advantage that it can be mass produced in a lab. Until these findings become mainstream, however, we can all keep rocking “bug red.”

Health | 37

The Shadow Plague By Robert DiCaprio III

ILLUSTRATION & Design: Anam Ahmed

lthough you might have heard of hepatitis, you may not have a complete understanding of what the disease is or what causes it. Hepatitis is defined as inflammation of the liver caused by a viral infection, drug, alcohol abuse, or in rare cases, an autoimmune disease. The liver provides over 500 essential functions in the body including filtering impurities from the blood, producing bile for digestion, and making proteins for blood clotting. Hepatitis inhibits the liver from performing its normal functions, which may cause fatigue, yellowing of the eyes and skin (jaundice), abdominal pain, fever, nausea, and vomiting. Furthermore, virus-induced hepatitis has been shown to be specifically associated with the development of liver cancer, or hepatocellular carcinoma (HCC), one of the deadliest forms of cancer due to its resistance to chemotherapy. Hepatitis A, B, C, D, E, and G are the names given to the various forms of virus that can cause this condition. Although all of these variations can be detrimental to one’s health, types A and B are easily preventable due to the availability of specific vaccines, and D, E, and G are rare. The odd man out is the deadliest of them all: hepatitis C.

History of Hepatitis Before advanced knowledge in the field of medicine was known, hepatitis victims were identified by the characteristic yellowing of the eyes and skin. In 400 B.C. Hippocrates coined the name “epidemic jaundice” to describe the diseases. Several hundred years later in the 9th century, Pope Zacharias quarantined men and horses with jaundice. More than 40,000 cases of jaundice were reported in the Union army during the Civil War, and approximately 180,000 soldiers were hospitalized with HCV in World War II. Hepatitis C was not identified as a unique strain until 1989, more than a decade after Hepatitis A and B had been identified. There have been positive developments in HCV treatment throughout the 1990s, of note being the combination treatment of the antiviral drug ribavirin and natural proteins called interferons, Since then, many other drugs have been developed and found to be effective in treating and even curing HCV infection; however, the HCV epidemic is still rampant in many communities around the world and scientists are still actively searching for a more concrete solution.

Current State of Hepatitis Epidemic Despite the development of successful treatment methods, there

38 | The Silent Epidemic

are more than 70 million people infected with hepatitis C around the world. Other pathogenic diseases such as HIV/AIDS, TB, and malaria have had drastic decreases in the number of fatalities in recent years, but HCV fatality numbers are still on the rise. Although current treatment has around a 98% success rate, the hepatitis C epidemic is worsening due to lack of awareness of infection, linkage to care, and effective access to therapeutic drugs and treatments. After HCV infects an individual, it takes one to three months before symptoms overtake the body. It is estimated that about half of the people infected with HCV in the United States are unaware of their status due to the symptoms remaining silent. Not only are silent symptoms harmful for the individual, but also they increase the chance of unknowingly transmitting disease. This most commonly occurs in shared needles between illicit drug users, from mother to fetus during birth, in unsterile healthcare settings, and during sexual intercourse. The vicious cycle of HCV transmission by an asymptomatic carrier causes a proficient cascade effect which is shown by the increasing number of infections per year. Upon diagnosis, there is still a major barrier preventing proper treatment: money. A majority of hepatitis C cases are drug users or people of low socioeconomic status facing high costs of treatment. Furthermore, chronic HCV infection greatly increases the risk of developing hepatocellular carcinoma, which along with being one of the deadliest forms of cancer, also makes it even more difficult to treat the HCV infection.

Hepatitis in Miami Hepatitis C is one of the leading causes of death in Florida. Research indicates that the number of cases of infections increased 133% between 2009 and 2013. The majority of these infections are located in the city of Miami, Florida. HCV and other viral infections are highly prevalent in Miami due to the high frequency of injection drug usage, nightlife behavior, and the large wave of immigration into the city. In fact, it has been found that more than half of injection drug users have also been found to be infected with HCV. Furthermore, Miami has the highest foreign-born population percentage in America and is a top destination spot, and a portion of these travelers come from countries with severe hepatitis epidemics. The combination of an increasing number of infected individuals from abroad and an increasing rate of transmission through injection drug use and risky

behavior synergize to make Miami a breeding ground for the hepatitis C epidemic to grow.

Active Hepatitis Eradication Strategies Currently, active measures are being taken to reduce the severity of the hepatitis C epidemic, and hopes are that one day it will be eradicated. The current aim is to provide the majority of the HCV infected population with knowledge of their status, treatment, and retention in healthcare in order to prevent liver disease and the transmission of the virus to healthy individuals. A physician and professor at the University of Miami, Dr. Hansel Tookes III, M.D., M.P.H, was the driving force in the passage of the Infectious Disease Elimination Act (IDEA). This act allows Florida county commissions to authorize sterile needle and syringe exchange programs for people who inject drugs. In 2016, this mandate allowed the IDEA Exchange to provide drug users in Miami communities with clean needles in order to reduce the transmission of HCV, HIV, and other bloodborne pathogens. Additionally, the IDEA Exchange offers free HIV and HCV rapid testing, linkage to rehabilitation, and Naloxone—a medication to reverse narcotic overdose—to individuals without financial stability. With only one active location, it is impossible to reach enough drug users to make a substantial effect on the global spread of both HCV and HIV; however, innovative strategies, including the IDEA Exchange, are what is needed to make a difference in the spread of the HCV epidemic.

Normal Liver

Current Hepatitis Research Dr. Emmanuel Thomas, M.D., Ph.D., a physician and researcher at the University of Miami, is investigating the science behind hepatitis C in a clinical setting and hopes his research can minimize the effects of the epidemic. In a recent interview discussing HCV’s link to liver cancer, Dr. Thomas states, “it is sad to see these patients come in that are healthy except for their decreasing liver function, and then to see them lose their life as the cancer strangles their liver.” Dr. Thomas has implemented a screening program at the University of Miami Hospital Emergency Department that tests 10,000 people each year for both HIV and HCV so they can be linked to effective care and treated immediately. However, he still encounters barriers that prevent him from giving proper care; for example, Dr. Thomas states, “the patients have to be clear from any use of drugs, and that is a hurdle because some of these patients are using drugs and can’t get hepatitis C medication paid for by insurance.” His long term goal is to reach the World Health Organization (WHO)’s requirements in achieving HCV elimination in Florida: “we are not talking about eradication which is getting rid of every HCV infection, our goal is to significantly impact and decrease new infections and also the morbidity and mortality of HCV infection.” Dr. Thomas’ research on the link between HCV and liver cancer is vital to further understand the profound effects of HCV on the community.

Chronic Hepatitis

Future of Hepatitis Through the work of visionaries like our very own Dr. Hansel Tookes III and Dr. Emmanuel Thomas, there is momentum for new improvements towards decreasing hepatitis infections worldwide. The World Health Organization (WHO) aims to reduce hepatitis incidences from 6-10 million cases to 0.9 million cases, and to reduce annual hepatitis deaths from 1.4 million to 0.5 million by 2030. The most important factor in eliminating hepatitis C is to get infected individuals diagnosed and on treatment. Unfortunately, without a vaccine, it is highly unlikely that HCV will be eradicated in the near future. Given the widespread nature of the HCV epidemic, it is unclear when the epidemic will subside. However, given more time and research, scientists and public health experts hope that hepatitis C will become a thing of the past.

Cirrhosis Health | 39

A Hot Mess by Trevor Birenbaum Design: Rachel Murray

he United Nations and the World Meteorological Organization consider the pre-industrial temperature baseline to be the average of the global temperatures between 1850 and 1900, a period with the most reliable temperature records and less than 3% of energy derived from fossil fuels. Rapid industrialization brought about mass consumption of the Earth’s fuel resources, particularly coal and other fossil fuels, which are derived from the remains of organisms that died millions of years ago. This rapidly accelerated in the middle of the twentieth century, when after World War II, consumerism, technological advances, and strong economies drove an ever-growing demand for goods and services. Oil and coal were burned in even greater quantities, so the rate of release of carbon dioxide and other greenhouse gases (GHGs) into the atmosphere rapidly increased. This caused global temperature to increase as well, compared to a preindustrial baseline. So how does an increased release of carbon dioxide into the atmosphere affect global temperature? Primarily through the trapping of the Sun’s infrared radiation inside the Earth’s atmosphere. Infrared radiation is invisible to human eyes but can be felt as heat. In the absence of a meaningful atmosphere (such as on Mars), infrared radiation from the Sun would bounce off a planet’s surface and be redirected back into space. Consequently, the surface of Mars is icy and cold. However, when certain gases are present in a planet’s atmosphere, this changes. Carbon dioxide and methane are climate change “forcers” that are able to absorb infrared radiation, trapping heat in the Earth’s atmosphere and warming the planet. Greater release of carbon dioxide and other GHGs into the atmosphere leads to more infrared radiation being trapped, resulting in climate change on the global scale we see today. An additional cause of climate change is the breakdown of the Earth’s ozone layer, which can absorb the most energetic wavelengths of ultraviolet light. Starting in the 1960s, compounds known as chlorofluorocarbons (CFCs) were used in refrigerants, aerosols, and industrial cleaning products. When released into the atmosphere, CFCs are broken apart by ultraviolet radiation and release chlorine atoms, which react with ozone (O3) molecules to break them down into oxygen molecules (O2) that cannot absorb ultraviolet radiation. This led to a massive thinning in the ozone layer over Antarctica that still exists today.

40 | The Silent Epidemic

“

The furnaces of the world are now burning about 2 billion tons of coal a year. When this is burned, uniting with oxygen, it adds about 7 billion tons of carbon dioxide to the atmosphere yearly. This tends to make the air a more effective blanket for the earth and raise its temperature.

The effect may be considerable in a few centuries.”

- Australian Braidwood Dispatch and Mining Journal, July 1912 It’s been well-established by NASA, the UN, and many other organizations that the current accelerating temperature increase is a direct result of human consumption of fossil fuels and mass release of carbon dioxide into the atmosphere as opposed to random solar activity. Satellites that measure the direct energy output of the Sun have shown a negligible change since they were first deployed in 1978, and proxy indicators such as the amount of carbon in tree rings show that “solar irradiance changes cannot plausibly account for more than 10 percent of the 20th century’s warming”, according to NASA. This crisis is more dire than ever, and it’s humans’ fault. The world has hosted two major conferences to address the ever-growing problem of climate change, resulting in the signing of the Paris Agreement in 2016 by almost all UN member states. Under the Agreement, each signing country would set targets to mitigate global warming by decreasing their consumption of fossil fuels and promoting energy efficiency. However, many countries have failed to meet the goals of the Agreement, and the United States has pulled out of the Agreement altogether. In October of 2018, a 91-author report from the UN Intergovernmental Panel on Climate Change (IPCC) said that the world only had only until 2030 to implement policies that would slow the warming of the Earth to a sustainable rate that would mitigate the dangers of climate catastrophe; the situation has only become more dire since the signing of the Paris Agreement. Anthropogenic carbon dioxide emissions, those related to human activity must be reduced from 2010 levels by half by 2030, and eliminated completely by 2050. A UN climate change summit in September 2019 entitled “A Race We Can Win” discussed ways to slow down the warming of the planet and encouraged worldwide action and protests, headlined by the Global Climate Strike and the emergence of young climate activists such as 16-year-old Greta Thunberg. In the United States, a coalition called for the passage of the Congressional Green New Deal to transition the US economy to 100% renewable energy sources by 2030, as well as environmental justice, protection of biodiversity, and promotion of sustainable agriculture. It would be nice if world leaders would stop dragging their heels and let our metaphorical race car (hopefully powered by renewable sources of energy!) have a fighting chance. Because there’s no second chance and no followup race. If we lose this race, the consequences will be catastrophic and irreversible.

Research | 41

GLOWING PLANTS TO LOUDSPEAKERS THE DIVERSE APPLICATIONS OF CARBON NANOTUBES BY ELLIE MARTIN

DESIGN: AARON DYKXHOORN

arbon nanotubes are cylindrical sheets composed of single-layer carbon atoms (also known as graphene) that exhibit outstanding strength and low weight, high conduction of electrical and thermal energy, and a strange phenomenon in which inserted water turns solid when it should be boiling. Their unique properties, caused by strong sp2 bonds and van der Waals attractive forces, make them extraordinarily useful for a broad range of applications.

GLOWING PLANTS A research group at MIT has developed carbon nanotube-based nanoparticles that deliver luciferase, the enzyme that enables fireflies to glow, into watercress plants. By submerging the plants in a solution containing the particles and applying high pressure, the group was able to force the enzyme in through the plants’ pores. The emitted light is very weak and only lasts for close to four hours, but the group plans on improving intensity and durability and is currently developing a switch that could turn the plant on and off. Imagine driving down the road surrounded by an Avatar landscape of natural streetlamps!

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Oil Spill Remediation Researchers at Rice University and Penn State University were able to transform nanotubes into super-sponges by adding a touch of boron to introduce kinks into the carbon lattice structure. It works because the nanotubes are both superhydrophobic and oleophilic, meaning they hate water (read: float well) and love oil. The sponges are reusable, remaining elastic after about 10,000 compressions, and they can absorb more than 100 times their weight in oil. And since carbon nanotubes conduct electricity so well, the sponges can easily be manipulated with magnets.

Thermopower Wave Energy Generation If it hasn’t become apparent already, Michael Strano’s MIT lab is a pretty big fan of carbon nanotubes. Another project the group has spearheaded is the generation of thermopower waves, which utilizes the chemical energy of fuels (via exothermic reactions) and the high thermal conductivity of nanotubes to generate a self-propagating reaction wave along the length of the nanotubes. These waves move at velocities of about 2 m/s and can generate electrical outputs as high as 7 kW/kg (about the power-to-weight ratio of a BMW engine). Researchers hope to utilize the chemical-electrical energy conversion for fuel cells, since thermopower waves have a long shelf life and rapidly release energy.

Solar Cells Researchers at Rice University predict that carbon nanotubes should theoretically be able to bolster solar cell efficiency to about 80%—a huge uptick from the 20% efficiency current solar cells are capable of. The key here is that carbon nanotubes can absorb wasted heat energy radiating off the cells, whereupon they convert the heat energy into solar, and finally, electrical energy.

Electric Car Batteries Folks at the Advanced Materials and BioEngineering Research (AMBER) Center in Ireland have developed high-performance electrodes made of carbon nanotubes and lithium storage materials including silicon, graphite, and metal oxide particles, for added strength. The electrodes were used to make fuel cells with energy densities of 480 Wh/kg and 1,600 Wh/liter, twice as strong as current cells. The group says this will enable electric car batteries to operate at twice the current battery life. Next step: cost efficiency and integration!

Flexible Loudspeakers Tsinghua University, Beijing, has developed carbon nanotube loudspeakers that emit sound of the same caliber and quality as conventional loudspeakers. Instead of relying on magnets and moving parts for sound-pressure wave generation, these little guys operate on thermoacoustic effect. Essentially, alternating electrical current heats the surrounding air when it passes through the nanotube films, creating sound waves by expansion and contraction. The best part? These loudspeakers are transparent, flexible, and stretchable, and they can be made into any shape or size. Singing beer cans, here we come.

Tiny Radio Receivers Physicists at the Department of Energy’s Lawrence Berkeley National Laboratory have created a radio out of a single nanotube. The nanotube vibrates at radio frequencies to receive signals and requires only a battery and sensitive earphones to pick up AM or FM radio waves. It can act as both receiver and transmitter. The applications for this are ultra cool and CIA-esque—imagine befitting a tracking collar to a tiny bacterium!

EXPLOSIVES SENSORS Dr. Michael Strano’s MIT lab embedded carbon nanotubes into spinach leaves, enabling the plant to detect nitroaromatics (compounds commonly found in explosives). The leaves emit a fluorescent signal upon detection, which is picked up by an infrared camera attached to a very small computer, which then sends an email to the user alerting them of the signal. In case you missed it... plants are sending emails about potential explosives in the area.

Radios, loudspeakers, energy generators, explosives sensors, oil spill sponges and even glowing plants represent only a small fraction of the myriad uses for carbon nanotubes, and improvements in nanoparticles can be expected to continue the spreading across disciplines. Whether our future will resemble the illuminated, sustainable, arbitrary-singing-object sci-fi future current projects predict is simply a matter of time. Don’t forget to keep an eye out for these guys in the STEM headlines!

Research | 43

IMAGINE THIS THE IMPACT OF IMAGERY by Sandy Taboada

LASHCARDS, DRAWINGS, MENTAL MAPS. These are only a few of the ways we bring material to life when studying for a class or exam. We absorb knowledge through a visual means each and every day without consciously thinking of it. While we sit and watch TV, we’re greeted every ten minutes or so with a commercial for gum. The commercial shows pictures of the mint leaves, the ice cubes, and glaciers, just for the viewer to fully grasp just how fresh this gum feels while you chew. These subliminal messages are the basis of why visuals leave such a lasting impression on our brains, and they show how effective visual queues are in assisting words alone. Outside and inside of the classroom, visual information also holds weight on our interpretation of content. Studies have shown that visual learning not only improves student’s higher order thinking, but also their analytical thinking skills in problem-based learning. One study, performed

in the Al Qasemi Academic College for Education, found that students best learn from classrooms promoting “the presentation of information in visual formats such as images, diagrams, flowcharts and interactive simulations.” By placing students in a visual learning environment, with stimulation in the forms of video, images, and flowcharts, the students overall showed improvement in their scores than those in a traditional learning environment. In higher education, visuals hold just as much weight when it comes to learning the technical aspects of STEM courses. In a survey performed by Brown and McGrath, the visual approach to science allowed future scientists to “engage the higher cognitive parts of the brain by thinking and communicating visually.” The survey not only showed how visual learning engaged different parts of the brain, but also how this form of absorbing scientific knowledge improved their performance in scientific research.

During my time as a designer and Design Director of Scientifica Magazine, I’ve witnessed firsthand just how impactful visuals are to showcase scientific information. Bringing research, health, news, and ethics issues to the public in a way that anyone can understand is key to educating those who would not otherwise be exposed to this knowledge. Showcasing science through infographics, illustration, and design gets across a point that words cannot. It hooks the public to the information, and makes research easier to present than words ever could.

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Visual Learning Environment

Visual Learning Tools

Simulation

Video

Image

Flowchart

Visual Assessments

Average

Analysis and Evaluation

Selection

Ordering

Comparison Contrasting

Analysis

Evaluation

Skills Visual Learning

Traditional Learning Research | 45

It’s

by Samantha Tano Photography: Sneh Amin Design and Illustration: Megan Buras

Aga in, the Flu Vac ci

ne!

“Have you gotten your flu shot?”

It’s a question we often hear all around us. Whether it’s emails from the University, walking through CVS or simply getting groceries, the flu shot seems like it’s everywhere. While this might be the case, many college students seem to tune out these important announcements and skip getting the vaccine all together. In a recent national survey conducted by the National Foundation for Infectious Diseases (NFID), only about 46% of students get vaccinated although roughly 70% of students believe the vaccine is important. This leaves us with a rather interesting paradox. While people in the general public opt out of the flu vaccine because they claim that it doesn’t work or makes them sick, it seems that on college campuses the trend of students not getting their flu shot goes beyond just that. If more than half of the students attending college believe in the flu vaccine, then why do so few actually get it? While there are many possible answers to this question, recent studies indicate that time, or lack thereof, may provide a potential explanation. It’s a simple fact that college students have a lot on their plates. It can be chaotic and overwhelming to balance their time between taking care of their health, managing classes, maintaining a social life, and participating in extracurriculars. As the fall semester begins and class work piles up, it’s easy to move the flu vaccine to the bottom of one’s to-do list. However, the sad reality is that in this year’s flu season in the United States, at least 22 million people have developed illness from the flu and at least 12,000 people have died thus far. More students should be taking these statistics into consideration as the threat that

46 | The Silent Epidemic

the flu poses is becoming more imminent. Many college students share the common misconception that only young children and older adults suffer from the flu and that they themselves are healthy enough to fight the flu on their own. However, the combination of close quarter living, constant stress, and sleep deprivation is a perfect recipe to lower one’s immune system’s abilities, and makes one more susceptible to falling ill with the flu. Although college students believe they do not have enough time to get the flu shot, receiving it takes only a handful of minutes, whereas recovering from the flu could take several days and even weeks. Several researchers believe that early education will encourage more college students to get the flu vaccine. Instead of asking blindly whether or not someone has gotten the flu shot, providing them with facts surrounding the vaccine and disease may help them fully comprehend the importance of this vaccine. Maybe then these passive reminders to get the flu shot that students seem to overlook, will become more prominent and serve as a striking reminder to get the shot.

Patient Turned Researcher by Setareh Gooshvar Design: Aaron Dykxhoorn

Antonio Fontanella

ntonio Fontanella is a senior at the University of Miami, majoring in Biochemistry. His primary area of research is nephrology, the branch of medicine that examines the physiology and disease of the kidneys, with a particular interest in glomerular disease. Although the kidneys are small, relatively non-descript organs, they perform many vital functions that help maintain an individual’s overall health. Their primary function is to filter waste and excess fluids from your blood, keeping everything squeaky clean. The kidneys contain about one million nephrons, the structures that act as filter units, and each nephron contains a glomerulus. Glomeruli work similarly to strainers: as blood moves through them, they let waste and excess water pass through to become urine, while holding back all the good stuff like blood cells and proteins. Kidney pathogens often attack the glomeruli causing them to become damaged and inevitably unable to do their jobs. Without treatment, glomerular disease may stop the kidney’s function entirely. Glomeruli lose their ability to function properly and waste builds up in the blood, eventually leading to total kidney failure. Glomerular disease can be caused by a variety of things, such as an infection or a drug that is harmful to the kidneys. However, Antonio is most interested in lupus, an autoimmune disease that

48 | The Silent Epidemic

Research Profile on

affects the entire body and can cause glomerular disease in the kidneys. Antonio’s approach to this health problem is to examine an innate immune pathway called cGAS-STING to see if it is involved at all in the disease process. cGAS-STING is a type of DNA-sensing receptor which plays a role in detecting pathogens to bolster innate immunity. After cGAS-STING has detected a pathogen, it triggers the body’s system for defense by recognizing the DNA of the pathogen, triggering the inflammation response. Its propensity for DNA recognition is what implicates cGAS-STING in autoimmune diseases. The inspiration for this research came from the many studies that have implicated cGAS-STING in the contraction of cancer. Seeing a hole in the literature, Antonio and his mentors dove into the study of how cGAS-STING controls the development of lupus. They did this by taking different lupus disease models and seeing whether they express the cGAS-STING system at a baseline level. They then evaluate whether the expression levels in the mouse model systems are upregulated, downregulated, or affected at all. Once they find models that implicate the pathway, their future steps involve exploring whether turning down the cGAS-STING pathway improves the disease. This would be observed through mice with longer lifespans and more functional kidneys.

“[do] not be afraid to make mistakes, but also to be mindful and try your best and be informed so you can learn.”

Antonio himself has a very personal connection to the subject matter of his research. At the age of three, Antonio was diagnosed with nephrotic syndrome, a kidney disorder that causes your body to excrete too much protein. As his condition became worse and worse, it became evident that he would need a kidney transplant. Even after his transplant, he was still not doing very well. However, things changed when he was put on a clinical research trial in 2012. As Antonio progressed through the trial, his health recovered considerably, which has been a significant improvement in his life. Antonio’s passion for science came not only from this experience, but also as a subject of interest in school. Since he was always sick, school and academics became what he was good at, as well as his primary focus. As he learned more, he became more interested in science and research. When he got into the University of Miami, he reached out to the doctor who had treated him, asking for an opportunity to do research. He was placed in the very lab that was doing the trial on him, which ultimately saved his life. His passion was transformed into his driving force: since he was affected so strongly by the products of good research, he wants to continue biochemical research and help advance the field of nephrology through a future MD/PhD. Within the lab, Antonio is tasked almost exclusively with the in vitro work, while his supervisor takes care of the in vivo aspects of the research. Along with being critical to the lab, the techniques Antonio learned have also supplemented his understanding in his classes. When asked about any challenges he faced while doing research, Antonio’s first answer was how it felt to be a rookie. When he first started, he had to learn not to worry as much about results, and to ask questions when he was unsure or inexperienced. His advice to other budding researchers is to “not be afraid to make mistakes, but also to be mindful and try your best and be informed so you can learn.” In addition to his many contributions as a researcher, Antonio is also double majoring in Spanish. As a native speaker hailing from Cuba, he decided to take up the double major in order to achieve full mastery of the language. He is an avid consumer of Spanish theatre and literature and enjoys immersing himself in it regularly. He also added that it helps him stay well-balanced and well-rounded. He acknowledges that if he were to focus solely on science, he would burn out very quickly. By keeping things different, interesting, and a little fun, Antonio is able to fully utilize the many and diverse offerings of the University of Miami. As our time came to an end, Antonio left me with a very important piece of advice, especially for those interested in medicine. “As important as medicine and a career is, a career isn’t life.” After only a short time spent with him, it is evident that Antonio follows his own advice through the decisions he has made. We wish him all the best in his endeavors.

Profiles | 49

From Caribbean Crop to Your Cup Research Profile on Ezra Remer

By Anastasiya Plotnikova Photography: Dhara PATEL Design: Aaron Dykxhoorn

hat do hurricanes and coffee have in common? As it turns out, senior Ezra Remer has the

answer. Ezra is the founder of the Dominica Coffee Revitalization Initiative (DCRI), a non-profit organization founded in 2017 to economically remobilize a small Caribbean island named Dominica following the impact of Hurricane Maria. Naturally, I had to ask how Ezra knows about this lesser known island nation, let alone its potential for growing specialty coffee. “I have a background in coffee—I’ve been involved in the specialty coffee world since I was 14,” Ezra says. Back in his hometown of New Orleans, Ezra gained invaluable experience and insight into the coffee industry by working in specialty coffee shops, and it was this experience that made him manager of The Billy Goat coffee stand in the School of Architecture courtyard. However, this was just one piece of the puzzle. Ezra is also an avid traveler, and was first captivated by the natural beauty of the mysterious island when he read a travel book his step-grandmother, a former writer for the New York Times Travel Magazine, gave him. “I was always into islands,” he states. “I used to study these pages as a kid, but I’ve yet to find a place as stunning as Dominica.” Since then, Ezra has had the chance to step into the pages of his book and experience the island’s lush forests, massive waterfalls, towering mountains and “volcanoes that rise out of the ocean.” Amazingly, according to Ezra, the 36-mile-long island hosts nine potentially active volcanoes. Yet, as obscure as it may seem, Dominica’s history was a complicated tango of colonization and intrusion. Dominica’s nature has determined much of its history. While Dominica’s rugged topography never allowed the French and British colonizers to grow sugar or cotton or other “cash crops,” Dominica instead became the British Empire’s second largest producer of coffee around the 1870s. “Dominica is naturally suited for growing coffee because of its mountainous features,” Ezra explains. Coffee is not currently a staple crop, however, as a disease, coupled with the dissolution of coffee agriculture, resulted in a dramatic drop in the island’s coffee exports from 2 million tons

50 | The Silent Epidemic

to just 3,000 tons over the course of a few years. Since then, the island nation began cultivating bananas, and while they were considered “green gold,” their cultivation has the potential to not only dramatically reshape the land, but also pollute the clean waterways via application of herbicides and pesticides. Then, during Ezra’s sophomore year, Hurricane Maria hit Puerto Rico as a category 4 hurricane, devastating the island. Just before hitting Puerto Rico, Maria took on the island nation of Dominica as a category 5 with wind speeds up to 180 mph. “While the world responded to Puerto Rico’s crisis,” Ezra explains. “Dominica, which no one hears about, was left out of the equation.” There is a major reason why most people have probably never heard of Dominica, and that’s because the island is not a tourist destination. This means that its inhabitants heavily rely on agriculture. “Over 90% of houses were destroyed,” Ezra points out. “Their livelihoods rely on the land, but that’s the first thing to go when a hurricane hits.” Having been through Katrina when it decimated New Orleans in 2005, Ezra realized that the key to hurricane recovery is not just to provide short-term solutions like rebuilding houses, but to provide longterm solutions as well. So, determined to help Dominica find long-term success, Ezra did his research and discovered the powerful little island’s huge potential for growing coffee. As it turns out, coffee crops weren’t destroyed by Maria like the bananas were, because coffee is a low lying plant. Moreover, the coffee plants actually thrive when placed under the canopy of a “pwadu” tree native to the island. This tree hosts symbiont rhizobia, bacteria that act as natural nitrogen fixers and supply the nearby soil with essential and biologically accessible nitrogen. This observation by farmers has been culturally significant even before they knew why coffee grows where it does. As Ezra describes, “this is a prime example of [taking] a cultural legacy, [applying] modern science, and creating something that can benefit the forest and the coffee.” A few months after Maria, Ezra reached out to friend Michael Savarin, a Dominica native and Director of the Tantan Village Development Corporation. Within the next year, Ezra and his group had landed on Dominican land. While there, the DCRI

group filmed interviews and spoke to the people of Dominica about their needs. Filmmaker Alex Musca got involved with DCRI after incidently meeting Ezra at the Billy Goat. If there’s anything that Ezra, a communications student, knows more about than coffee and telling a great story, it’s people and how to talk to them. “The project, at its core, is an economic, cultural, and societal effort.” Ezra explains. While the Dominicans were friendly and open to talk, it can be hard to convince a native Dominican to put their faith in an abstract idea. According to Ezra, “‘why do I care about the forest if I can’t make a living for my family?’ is what the farmers would ask, but I would respond with ‘we can do both.’” Since the initial visit, Ezra has already visited Dominica two more times, and has just returned back from his most recent visit in January. During this trip, the group selected sites to test plots of land in coordination with two young DominicanAmerican and Canadian organic farmers. The goal is to show farmers that growing coffee is economically feasible, and doing so will encourage other farmers to try it out. “We’re not coming in and telling people what to do—it’s a locally led initiative,” Ezra says. In this way, the island nation will be able to engage in sustainable agriculture, strengthen their economy, and even enhance their resilience to climate change and decrease pollution by cooperating with their local ministry of forest and agriculture. “Agroforestry is a unique way to preserve the island’s natural beauty while also providing a source of income for the farmers, and this is something that can stand the test of time,” says Ezra, who is also working with the World Coffee Research organization, a non-profit organization dedicated to developing more vigorous hybrid coffee varietals to improve the quality and quantity of products in the face of a changing climate. With his sights set on Dominica, Ezra is fully committed to pursuing the project following graduation, and is currently a semi-finalist for the Fulbright Scholarship. Through his project, Remer also stresses the significance of sustainable agriculture on the global scale, which is something he keeps in mind every day as a key member of Student Government’s Eco Committee. “We will sink if we don’t adapt.”

“thi s i s a pri m e exam ple of [ tak i ng ] a c u lt u ral legacy, [apply i ng ] m od e rn sci e nce ,

a n d cr eat i n g s o me t h i ng t h at ca n b e n e f i t t h e fo r est a n d t he co f f e e .”

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