A History of Bugs and Resistance

A little over seventeen years ago around this time I started coming down with flu-like symptoms. My father already had similar symptoms, and my mother developed them shortly after. After a week our symptoms only got worse. So, we went to our doctor. He suspected a bacterial infection and prescribed an antibiotic: tetracyclin. This helped: within four days most of the infection cleared, and within two weeks all lingering symptoms disappeared.

The Ancient

Antibiotics may conjure up an image of people wearing white coats in a modern laboratory. However, traces of that same antibiotic we used, tetracyclin, were found in ancient mummies. How could this be?

We often think of medication as something made in a lab. However, antibiotics, stuff that either kills or slows the growth of bacteria, are all around us. Humans have been consuming antibiotics for a long time, though without knowing the actual mechanism behind their curing effects.

Antibiotics found in the soil are a natural byproduct of warfare at a tiny scale. As bacteria compete with other bacteria to survive, producing something that kills the competition is a highly effective survival strategy. The result of this small-scale chemical warfare can both help us and harm us.

The Great War

Anyone who went to Sam Mendes’s 1917, a film about the first World War, got at least an inkling of what it was like back then. However, while brilliantly shot, some of the trenches looked a bit too clean.

In reality the hygienic conditions in the trenches of World War I were abysmal. The spread of disease made worse by decaying corpses, poor sanitation and prolific bugs such as lice and flies. Combined with the soldiers’ own weakened immune systems and the transport of livestock near the front-lines, the environment formed the perfect breeding ground for existing diseases to flourish and new ones to emerge. While the macroscopic trench warfare was characterized by stand-offs, the microscopic germ warfare was continuous.

The Spanish Flu

Near the end of the war a new kind of flu emerged in northern France, one with an unusually high mortality rate. To maintain the morale of the troops, the news of this novel flu was mostly kept under wraps. However, as the infection spread to Spain, not subject to this censorship, reports of its devastating death toll started to spread more widely. This owed the disease its popular name: The Spanish flu.

The Spanish flu quickly spread to Ireland through returning soldiers. Saved from the brutal war, some of them would become the carriers of death for the home front. The disease spread throughout the United States and the rest of the world and killed about two people for every ten infected. In total it would go on to claim at least fifty million lives worldwide.

No antibiotic existed yet, but none would have helped directly against this flu either, since antibiotics combat bacterial infections not viral ones. Nevertheless, antibiotics could have saved the lives of many soldiers during World War I. Especially those with infected wounds and diseases like typhoid. However, it would take another decade for the first antibiotic to be found.

Fungi Fighters

In 1928 Alexander Fleming discovered this first antibiotic more or less by accident: penicillin. During the second World War, the availability of penicillin saved many lives. However, while useful for resolving and preventing bacterial infections, it was ineffective against fungal diseases which many came down with. Hence, focus shifted from bacteria to fungi. The race was on to find something that would kill those fungi.

Elizabeth Hazen, a bacteriologist, dedicated years of her life to the search for an antifungal producing microbe. She scouted soil samples and mailed them to Rachel Brown, a chemist, for purification. The pair searched for several years and during that time discovered many molecules that proved lethal to both fungi and animals. One day Elizabeth found a promising micro organism in a soil sample of a friend’s dairy farm.

Elizabeth Hazen and Rachel Brown (1955)

Fortunately, the organism produced a molecule that killed only fungi and not animals. Hazen and Brown marketed it as Nystatin, the world’s first antifungal drug. It saved countless lives since its introduction. The patent on the drug made them millionaires. Money which they donated to a nonprofit that went on to conduct similar research.

The Modern World

In recent years we have seen outbreaks of several high-profile influenza viruses with a higher than usual mortality rate. Think of SARS (2003), MERS (2012) and recently COVID-19 (2019). Like the Spanish flu, outbreaks like these have the potential to wreak havoc. However, while public awareness concerning the emergence of novel viruses is high, the risks of infections with mutated resistant bacteria, and fungi, are understated. After all, we already have antibiotics and antifungals to combat and defeat those, right?

Unfortunately, that has not been the case for many years. The best known example is MRSA: methicilin-resistant Staphylococcus aureus. Dairy cows serve as a reservoir for this family of mutated strains of the common and normally harmless Staphylococcus aureus bacterium.

The overuse and misuse of penicillin in the fifties contributed to the evolution of resistant strains of Staphylococcus aureus. Methicillin was then used instead to fight it, but over time resistant strains emerged: MRSA. Nowadays, the treatment for it is Vancomycin, but there are already mutations for which that treatment no longer seems to be as effective.

The circumstances that gave rise to widespread bacterial infections during World War I, still exist. There are plenty of overcrowded places with poor sanitation, proximity to animals treated with antibiotics which harbor resistant microbes, and lackluster medical facilities and dismal containment procedures. The ideal breeding ground for the next fatally resistant mutation. This risk is thus not restricted to viruses, but extends to bacteria and fungi alike.

These resistant microbes spread and thrive in places where people gather or pass through like hospitals. Their presence there can turn routine operations into risky procedures.

In conclusion

While the discovery of antibiotics is fairly recent, they have existed for many years in the soil. This continues to be a source for development of new drugs, so too for antifungals.

Poor hygienic condition provide a breeding ground for new bacteria, fungi, viruses and other pathogens to mutate into something more deadly. Finding an effective treatment can take many years, if one can be found at all.

While viral mutations are risky, so are mutations of bacteria and fungi. The treatments that we currently have for them can lull us into a false sense of security. This is why we should take care to protect our most potent antibiotics and antifungals. We should do this by using them judiciously, limiting their applications in agriculture, and incentivizing work on continuously finding new ones.

I conclude with the jarring realization that if there had not been antibiotics available, effective against the bacterial infection my family contracted, we might not have experienced the past seventeen years at all.

References

  1. McCarthy, M. (2019). Superbugs: The Race to Stop an Epidemic.
  2. Jackson, P. (2019). They shall not grow old.
  3. Jacobs, A. (2019). U.N. Issues Urgent Warning on the growing Peril of Drug-Resistant Infections.

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Compound Effects

Why do we have a poor intuition for processes that unfold non-linearly? How can we leverage compound effects in order to spiral ourselves upwards in terms of health, wealth and knowledge? Let’s explore.

Physical World

Many of our intuitions are rooted in the physical world. When we roll a ball gently across the floor, and it disappears behind a couch we know it will reappear on the other side. It may roll a bit slower and come to a halt eventually. However, we certainly don’t expect that ball to continue to accelerate and shoot through the outer wall, across the yard into the house of an adjacent neighbor.

It’s not that we never expect something to accelerate: if you jump out of a plane you expect to accelerate initially, falling faster and faster. However, that only last for a dozen seconds. After this you reach terminal velocity after which you keep hurtling towards the earth’s surface at a constant speed.

Miracles and Catastrophes

We don’t possess a good intuition for things that keep accelerating, for the simple reason that this does not happen in the physical world in a way we can easily observe or experience directly. When we do observe the outcomes of such accelerated processes, we often refer to its outcome as either a miracle or a catastrophe.

Consider our main building block: a single cell. It divides and after twenty generations of dividing gives rise to a million cells in total. Add to that another twenty generations and there are enough cells to make a human being like yourself. Although this process is, to an extent, scientifically explainable, many label this a miracle when they observe it.

In contrast: we can create nuclear energy by a controlled chain reaction of splitting the nuclei of atoms. When left uncontrolled this can lead to a nuclear explosion, which we label a catastrophe.

In both cases the outcome, a human being or an explosion, is an outcome that we observed and can reason about. Nevertheless, even knowing the facts, the outcome still feels surprising. It does not feel intuitive.

A Rational Example

To explore this a bit further, let’s look at a practical example to test your intuition. Let’s say that I gave you a choice between three options: (a) I give you ten euro’s now, which I guarantee will grow with five percent every day for the next four months, or (b) I give you ten euro’s now and ten euro for every day during the next four months, or (c) instead I give you a thousand euro’s and well: that’s it. Think about it for a moment: what would you do? Read back, reason and pick option a, b or c.

Now that you have picked, let’s take a look at what your best option really was. Starting with the last (c) option, the 1000 euro in your hand, that really is the best choice during a little more than the first three months of the time proposed. However, this is surpassed by the middle option (b) for getting ten euro for every day which tops out after about four months at 1200 euro. Spectacularly, the linear growth of (b) is passed even a couple of days earlier by option (a) with an exponential growth of five percent every day. In fact the first option literally explodes and balloons to nearly 3500 euro after the four months have passed! Was this in line with your expectations?

Interestingly the best option in the end performs quite poorly during the first three months. In fact: quite a bit worse than both other options. It is only after quite some time that the exponential approach starts to really pay off, and when it does: it pays off big time.

Seeing exponential effects plotted this way can help to foster a more intuitive grasp for them, which is much more difficult to infer from only a description. Let’s dive a bit deeper into applied implications of this exponential curve.

Money

The effect of making more money with some money is called compounding. The idea is that you start with some initial amount, called the principal, and then get some interest over this at the end of a time period, when you add that interest back to the principal it is called compound interest, as you can keep repeating this cycle like we did in the graph above.

Whether you know it or not, you are heavily relying on this effect if you take part in any sort of pension scheme, have money in a savings account or are holding onto investments. The idea is that if you have money you can lend it out to others. For this you get compensated: either by interest paid on the loan you provide, or with dividends or increased stock value in case of investments. Either way: you are making money with money.

It is important to realize that the flip side also holds: if you borrow money, you pay interest to whomever is providing you with it. In turn that means you can spend less. Thus, the exponential curve can bend upwards, but it can similarly bend downwards. This also explains the fact that people that have a lot of debt, more easily spiral downwards into a situation with even more debt.

So far we have covered familiar territory, but now I ask you to consider that the same thing that applies to money, also applies to your habits and skills.

The Direction of Habits and Choices

Let’s look at two simple habits. Firstly, brushing your teeth. Spiraling downwards: if you forget to brush your teeth for a day, you’re probably okay. However, if you don’t do it for a year, the exponential effect of bacteria feasting in your mouth, will likely cause significant decay of your teeth. In addition to that direct negative effect, there are others collateral ones too. Just think of the social implications of not brushing your teeth for such a long time. A spiral downwards thus pulls down other things in its wake.

Spiraling upwards: if you read in a book every day, you’re likely to read quite a few books in a year. There is knowledge acquisition even if you remember only a fraction of what you read. Though, the real impact comes after, where if you keep doing this consistently, you can make connections between concepts that you learned previously yielding non-linear gains in knowledge.

Skill Acquisition: A brief diversion into learning

Interpreting a post like this requires the skill of reading. While you probably don’t remember it, reading was incredibly difficult at first. The foundations for this skill were created from the very first time you heard anything. Further growth relied heavily on your environment. You only later learned to link sounds to symbols. Learning to do this consistently and growing a vocabulary large enough to read a text like this took many years. However, currently you are probably not exerting conscious effort to read the letters, or to understand the sentences.

Most adults find learning something new very challenging. One reason for this is that initial progress is usually slow which can be quite discouraging. However, this slow growth is entirely to be expected: like the ten euro’s growing very slowly during the first month in our money example.

Unfortunately, many people simply give up too early, perhaps being thrown off course by their linear expectation of returns. This happens especially for the effort they put in early in the process, where the return on the time spend is still fairly low. After all: when picking up something new you first need to master the basics. Getting through that stage can be though. There is no quick fix for this.

The Shape of Learning

When you are learning something new, you should not expect linear gains for the time you put in. Rather, when you are consistent and stick with it, you will see some large jump in competence every so often. This is somewhat similar to the compound interest effect. Let’s look at an example learning curve.

As I alluded to, learning curves share some similarity with the compound effect, but they are certainly not identical. Learning is not a smooth process that continues forever for a specific skill. Rather, as shown in the example graph above: it is full of plateaus, regression and tapers off at certain point. Beyond this point more and more time needs to be invested to get the skill to a higher level. We can see this if we ignore the details and look at the curve at the distance. This reveals an S-shaped curve. The learning plateaus form smaller S-curves inside a larger S-curve.

Looking at learning through these curves is useful, as they reveal both accelerating and decelerating effects visually. However, they are also limited to specific skills that have a clear path towards mastery. The interplay between different skills and the fluidity in many fields makes their real-world application limited. After all, even if you can identify a letters on a page flawlessly, that does not mean that you can actually understand what you read. And, even if you do understand a text at some level, you may not understand it at all levels the author intended to convey.

After this brief diversion into learning, let’s return to the topic of habits and choices and how we can more practically apply compound effects there.

Choices

We are continuously presented with the challenge of making decisions. The effect of all the small choices we make can lead us to either remain level, spiral upwards or downwards.

Consider three areas: things that you are, things that you have and that you know. In all these areas you can make choices daily, that snowball you in a direction with a positive or negative outcome. An important precondition for this is that you own the outcome itself. After all, outcomes are the result of many small decisions that you yourself made in the past.

These choices really are moment-to-moment things. Do you go to the gym or stay at home? Will you impulsively buy something you see in an ad, or stick to your financial plan and budget? Do you stay at the mediocre job you have or find a better one where you can develop new skills?

What is right for you is what aligns with your personal goals. These goals can be in the areas of physical and mental health, financial and job security, and acquisition of knowledge and skills.

Goals

Once you decide on some area to improve, it is time to make a plan and stick with it. Here is were most people are too ambitious about what they can achieve in the short term. They choose process goals that are hard to keep up. Like going to the gym every day, living in an unusually spartan way, or overloading their brains with information.

Instead it may be better to choose very modest process goals that you can keep up over a long time. Go to the gym twice a week and eat hundred calories less per day, transfer five percent of your income to a savings account automatically, choose one on-line course and spend an evening per week to complete it at most. As we have seen many exponential effects are the result of doing something consistently over a long period of time.

Conclusion

If you start doing something consistently, your progress at first will be slow. However, after some time the effect of whatever you do will start compounding. This process is not intuitive. The outcome will surprise you, even if you understand the concept of compounding rationally.

The effect of compounding is that you will either start to spiral up, or down, in any given area based on the many small choices that you make. Setting modest process goals helps in creating long term consistency which will in turn lead to a noticeable compound effect in your outcomes.

If you are not satisfied with were you are with respect to some specific areas of your life: find places where you can leverage compound effects by making small consistent process changes. Take ownership of the result by setting clear goals and tracking your progress. Then enjoy your outcomes spiral upwards.

References

  1. Hardy, D. (2010). The Compound Effect.

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Chronoception

I was once took part in a class where the instructor performed an interesting experiment. He asked us all to close our eyes, and then raise our hands and open our eyes when each of us thought a minute of time had passed. After that he would tell us how far we were off. To my amazement there was quite some difference, with some people raising their hands quite early, some quite late, and some nearly spot on. Now, this was not a test of aptitude at timing, it was a test of a specific type of perception: chronoception.

I remember being quite bored at times as a child. Many mundane things seemed to take very long. Yet, the older I have become, the faster time seems to pass. Asking around, I found out that I am not the only one with that experience. During that class I raised my hand slightly later than the one minute marker. However, now, many years later, I am convinced that if I’d take it again, I’d raise my hand quite a bit later than the minute mark.

Time of course passes at a steady rate for everyone, that is: time in the physical world. However, that is not the same rate at which time appears to pass: our chronoception. How do physical and perceived time relate? Let’s dive deeper.

Fraction of Life Argument

When you were one, that one year represented one hundred percent of your life. Conversely when you turned two, the first year constituted half of year life and the second year as well. Following this logic, by the time you turn eighteen that eighteenth year adds only about five and a half percent to your life up to that point.

Going ahead in time, the hundredth year of your life would add only one percent. The basic idea of this fractional argument is that each additional year you live is a smaller part of your life. If we discount things that happen before age five, as most people have little recollection of this, and look at this strictly numerically, we get the graph shown below.

Life in Quarters: relative age as we get older [5]

Let’s interpret: roughly your teenage years are about as long as your twenties and thirties combined according to this graph. Although mathematically attractive, there are some problems with this perspective.

Consider that this theory implies that time at age ten seems to go five times more slowly than time at age fifty, and that is not quite what really seems to happen. A ten year old does not see his fifty year old uncle respond in slow motion, and juxtaposed: the fifty year old uncle does not see his ten year old niece dart around five times more quickly. Of course there are differences in time perception, but a five fold difference seems like an unlikely stretch.

In addition to this, there is one other major problem with this fractional argument: it does not accurately represent perceived time, as that does not pass at a constant rate, our chronoception is variable as we’ll see next.

Flow Control

Waiting in a line in the supermarket, particularly when you are in a hurry, seemingly takes forever. You notice the old lady fidgeting with her hands to get the cash money out of her wallet. Then a kid that just can not seem to stop screaming. Followed by someone who nervously taps his foot standing next to you. However, when you finally exit the supermarket and drive home, taking that more quiet route that you know all to well, time passes by very quickly.

Gears of Time by Majentta: https://www.deviantart.com/majentta

This example already shows that perception of time is relative to what occurs around us. When we are bored or blocked, time seems to slow down. Contrast this with when we are performing either routine tasks or are deeply engaged in something: time seems to literally fly by. So, it is easy to disprove the fractional argument on a moment-to-moment basis, but in fact: this holds even for longer spans of time.

Novelty

There is a difference between how we experience time in the moment and how we remember it when we look back. Waiting in line seemingly takes forever in the moment, but after a day or two, in hindsight, it was really just a very small part of that day.

In a similar vein: holidays always seem to go by very quickly. At least: that is what many conclude as soon as theirs are over. However, during your holiday, time actually seems to slow down. There is a good reason for that: new experiences.

In your daily life you see many of the same things every day, you do many of the same routine tasks everyday, and if you enjoy your work you are likely quite engaged in it. In this day-to-day life you have become highly skilled at filtering out distractions. Contrast this with your vacation where you have to do all kinds of non-routine tasks even to get to your destination, and then have complete days to fill in by yourself.

If on those days you do all kinds of activities you do not usually do, that’s all novelty for your brain. These novel things take more mental processing power and occupy more mental space. Your filters don’t work there, and hence everything seems to last longer. This is noticeable in the moment, but also if you start episodically telling others about your novel experiences.

The reverse is also true: if you would not do anything on your holiday, you will experience boredom, which also makes time appear to pass more slowly, at least: in the moment, perhaps not on retelling. Hence, the benefit of holidays for altering your perception of time, whether you do something or just sit there, either way: it helps slow down time perception at least as you experience it in the moment.

Excitement

This same phenomenon of things seeming to take much longer than they actually do also occurs when there is something physically happening that is exciting. People can overestimate the actual time something took by orders of magnitude.

I once had the genius idea to step into a wooden roller coaster, after not having been in one for many years, and not remembering how much I actually disliked such experiences. While the cars were being pulled up, I started remembering that roller coasters were not a pleasant experience, but by then it was too late. As the carts were released at the apex, and my stomach started to turn, I had no other option than to simply endure it. That ride probably took only a minute or two, but really: it seemed way longer than that.

The Brain

As anything in the reality you experience. Time perception too is a construct of your brain. And as your body becomes less agile with age, so does your brain. In fact your brain uses most energy to perceive new things when you are about five, and this tapers off from that point onward.

Consider that as you get older, you have had more opportunity to learn. Hence, the more you learn, the more complex the networks in your brain to represent what you’ve soaked up. Hence the size and complexity of the webs of connected neurons in your brain increases, which leads to longer paths that signals need to traverse.

When these paths themselves start to age, they degrade, giving more resistance to the flow of signals. This causes the rate at which mental images are acquired and processed to decrease as you get older: chronoception changes. Since your brain is perceiving fewer new images in the same amount of time, it seems as though time is passing more quickly. While in fact it is your own brain slowing down. This is an interesting form of perceptual relativity: the world around you is not going faster, you are going slower relative to it.

Your brain also becomes better at filtering out signals irrelevant to whatever you are doing. This is evidenced for example when something small changes in an environment you have been in for a long time. It is very common not to notice that change for a while, since you have tuned out certain details in your environment. The net effect is not only that you see less images, but that you also see less detail in those images. A complete change-up of environment can of course work wonders here.

Conclusion

We know that the older we get, the faster time seem to pass, but the question is: by how much? We know that for people in their early twenties physical time and chronoception are almost equal: they experience time approximately as it passes in physical reality. Seniors, between sixty and eighty, are off with their estimates by approximately twenty to twenty-five percent.

This leads me to conclude that as a rough rule of thumb what on average feels like a week for a twenty year old, feels like about five and half days for a senior. However, that’s an average. This strongly fluctuates based on the moment-to-moment experience.

As anything that you experience, chronoception too is a construct of your brain. It seems that as we get older we literally gradually lose track of time. One of the few ways to mitigate this to some extent is to expose yourself to novelty in any form, in short: go to new places, learn new things and meet new people. But most of all: enjoy your time.

References

  1. Kingery. K. (2019). It’s Spring Already? Physics Explains Why Time Flies as We Age.
  2. Muller, D. (2016). Why Life Seems to Speed Up as We Age.
  3. Livni, E. (2019). Physics explains why time passes faster as you age.
  4. Haden, J. (2017). Science Says Time Really Does Seem to Fly as We Get Older.
  5. Bonwit, H. (2012). Time Dilation & Back to the Future.
  6. Kiener, M. (2015). Why Time Flies.
  7. Spencer, B. (2017). Time Perception.

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