Are You A Scientist Facing Online Harassment? Here Are 7 Strategies To Help You Cope

February 1, 2022

Sridhah Naminathan, PhD

Clinical Psychologists & Advanced Practitioner, Glasgow, UK

Summary

If you or someone you know is experiencing online harassment, remember that you are not powerless. There are concrete steps you can take to defend yourself and others. The guidance below will help you decide how to act if you, or one of your colleagues or students, is affected by this.

Last week, a 24 year old man from the Essex market town of Chelmsford, 40 miles east of London, UK was sent to jail after admitting harassing the Professor Chris Whitty, the epidemiologist and Chief Scientific Advisor to the UK’s Department of Health & Social Care.

Footage that emerged last year had showed Mr. Jonathan Chew, together with his accomplice, Mr. Lewis Hughes, attacking Whitty, and holding him.

Luckily for the many of us not in the direct limelight, physical attacks such as those on Whitty are relatively rare. But we can relate to online attacks, either directly or on those we know. Online attacks at scientists and academics have become a major issue today, and going by the number of posts online, the signs are that things are not abating.

In a 2021 study by Nature, many scientists reported receiving death threats, hateful slurs, and physical intimidation or threats of sexual violence. Many scientists with a public profile have experienced some form of attack on their credibility or been threatened with violence.

Online abuse is not new-it begun with the arrival of the internet, the difference is that the problem is growing. In the middle of a global pandemic, conditions have become ripe for online conspiracy theories, hate and harassment, fuelled polarisation around vaccines and treatment options.

These attacks pose a direct and critical threat to free expression, and are an attempt to stifle the voice of science, by intimidating experts that provide the public with the information and guidance needed by governments and the public.

Against this background, I spoke with experts and survivors of online harassment to compile a quick list of tips and resources for coping with online abuse without being silenced or forced offline.

If you or someone you know comes under attack, here are some of the steps you can take to protect yourself and others.

Identify the threat

The first step is to make out what’s really happening. Is it simply an unkind remark (“You’re not a good scientist” “Where did you train from?”), a disparaging comment? (“You’re a fool!”) or categorically abusive, for example, gendered or racist?

Online abuse covers many behaviours and technologies. It happens when a person (or bot) acts in a manner that causes distress and harm to another person. It is usually repeated and targeted, but may not always be obvious. Some of the common tactics — albeit ever-evolving and often overlapping — include: hateful speech, sexual harassment, threats of physical and sexual violence, impersonation, doxing, pornography, message bombing, and many more. You can find detailed guidance here.

The bottom line is that if you’re being criticised or insulted, you can choose to refute it or ignore it. If the attack is sinister and you’re being abused, distilling what you’re experiencing not only signals that it’s a tangible problem, but can also help you communicate with family, friends, employers, and authorities.

Document the attacks

What is often overlooked is platforms take down abusive content that violets their terms of service, meaning that any evidence you might have of the abuse is removed. For this reason, it’s necessary to have a separate log of the abuse before you report it. You should aim to save emails, voicemails, and texts. For social media, take screenshots on and copy links, if possible. Where the abuse is coming from one specific individual or group, you should document it as thoroughly as possible as this can help uncover any patterns and shore up evidence.

A record of abuse is indispensable if you chose to engage authorities or take legal action. It can also be hugely helpful in conversations with line managers at work, as it obviates repeating abusive comments aloud, which is often unpleasant. Pointing to a screenshot is often less uncomfortable, and actually more impactful.

Review your personal safety

It is not impossible for online abuse to morph into physical abuse. Therefore, it is important to assess whether online abuse is presents a real danger to your own physical safety or that of your family or colleagues. Granted, online anonymity makes this onerous to figure out. Here are a set of questions to help you assess the significance of a threat, which you can do with a friend or colleague as a sounding board:

Do you know your abuser? Do they have a history of violent behaviour?
Is the threat targeted and specific? Does it include your name, a time, a place, or a method of attack?
Does the abuser seem irrational, for example, threatening you using their real name, email, or phone number?
Has the abuser migrated across platforms or moved offline (e.g., voicemails, physical mail, or packages left at your door or workplace)?

These are some of important red flags. They signal it’s time to take steps, particularly if you’re being made to feel physically unsafe in any way. You may need to temporarily relocate, such as a hotel or a friend’s place. You may also need to report the threats to authorities who are best positioned to deal, not just with online threats, but also physical dangers.

Ignore, block, mute, and report

Most bullies, perpetrators of online abuse are in it to get a reaction from you. Don’t play into their hands and get into a fight online. Sometimes, simply ignoring the comments can make the individual move on. You can also consider blocking, muting, and reporting abuse. Platforms offer option that allow you to block or mute accounts or even specific posts (so you don’t have to see them). You can report abuse that violates terms of service to try to get a post taken down or an account suspended.

Understandably, while helpful, these actions are temporary and often counterproductive. For instance, blocking an account can escalate abuse or move it offline. Muting can make it hard for you to monitor the scale of threats, and reporting is often ineffective.

Reinforce your online security

Just like physical security, taking time to bolster your online security can ensure trolls don’t get an easy ride accessing and broadcasting your private information. Protect yourself from hacks and intrusion by improving password strength (use long passwords which combine words and symbols with at least 12 characters), never re-use passwords, use invented answers to security questions, and set up two-factor authentication (OTP) on your key personal and professionnal accounts (email, social media, banking, etc.). A password manager is another tool you can use to take care of this.

Speak out

Speaking out against abuse can be empowering. The key is to be careful and deliberate. There are several strategies you can deploy. One option is to practice counterspeech, which you can read about through this link. Some people use highly creative strategies, such as sending a picture of a kitten or puppy in response to an abusive message, or telling the abuser that their mothers or employers will be notified about their unbecoming behaviour. Do what you’re comfortable with—being mindful of your employer’s social media policy.

Look after your wellbeing

Online abuse often elicits feelings of fear, self-loathing and guilt. It can be exhausting and demotivating, and leaving lasting damage to your mental, emotional, and physical health. The mistake is ignoring how you’re feeling.

Therefore, it’s important to make time for your wellbeing. This can include meditation, cooking, listening to music or going for walks. Whatever you choose, it must involve taking regular breaks from your devices so that you get that crucial mental headspace.

If matters escalate and you’re not coping, seeking professional mental health care can make a big difference, especially if you get to a point where you feel hopeless or paralyzed by fear, talk about your abuse obsessively, struggle to enjoy things, or have difficulty eating or sleeping.

And finally…

Every day, scientists in and out of the limelight hate and violent threats, and some of them choose to respond directly in order to refute or undermine it. If you’re affected, you don’t have to follow each every step listed above, let alone in the nominated order. It may well necessitate implementing a number of these in tandem or skipping some and coming back to others when they are most helpful. It is also important to remember that like many other aspects of human behaviour, trolling and online abuse are multifarious, and there is almost no way of predicting what an individual will do, or even prevent it. It is up to organisations, platforms, governments and wider society to recognise this and put into place the correct institutional mechanisms to address this scourge.

What I have suggested here is what you can do at an individual level. I hope that it offers you a good starting place if you’re experiencing abuse. With the right tools, support of others, and confidence in your own self, you can take a stand and push back against online abuse, and protect the voice of science.

6 Simple Tips for Compelling Scientific Presentations in 2022

January 4, 2022

Eric Monlin | Public Speaking Coach & Founder, Public Speaking Inc., New York

The twenty-first century is a century of ideas, and ideas, when effectively packaged and delivered, are changing the world. Some people are exceptionally good at presenting their ideas. They have the skill that elevates them and gives them influence over their peers and society. As scientists, we all have ideas and passions, and yearn to inspire others. So, wouldn’t be amazing if we can identify the exact techniques used by the world’s greatest communicators, and apply their secrets to wow our audiences? In this article, I provide insights, based on personal research of hundreds of TED presentations, direct interviews with speakers and personal experience from years of coaching ordinary leaders and speakers over a 20 year period, to help you speak with confidence and authority, whether it is delivering presentation at your company, or a major scientific conference.

The anatomy of great presentations

In 2012, civil rights lawyer Bryan Stevenson gave a talk to an audience of 1,000 people in California. He received a standing ovation and his TED talk has been viewed online over one-and-half million times. For around twenty minutes, Stevenson captivated his audience by appealing to their heads and hearts. At the end of the talk, the attendees donated a total of $1 million to his charity, The Equal Justice Initiative. That’s equivalent to $50,000 for each minute he spoke!

What is remarkable is that Mr. Stevenson did not use any Power Point, visuals or props. It was only through the power of his narrative that carried the moment. I am sure you have viewed other riveting presentations. Some of these were probably backed by engaging slides and graphics. What is clear that there are many ways to share ideas. Some speakers tell stories, and others provide rich data. Great speakers are entertaining, captivating and inspiring; they understand the science and art of persuasion.

The late Steve Jobs, Apple cofounder and technology visionary is famous for his presentation skills. His iPhone launches and commencement speech at Stanford University in 2005 show his ability to captivate audiences. It is little wonder that CEOs everywhere have now adopted Steve Jobs methodology.

Dale Carnegie – The Art of Public Speaking

A key starting point for students of public speaking is Dale Carnegie self-help book, The Art of Public Speaking, first published in 1915. Dale Carnegies recommended that speakers keep their talks short. He said stories where powerful ways of connecting emotionally with audiences, and suggested the use of rhetorical tools such as metaphors and analogies. He understood the role of enthusiasm, practice, and strong delivery to touch people.

Now, while everything Carnegie recommended over 100 years ago remains true today and is the foundation of effective communication today, he did not have the tool we have today. Today’s speakers have Power Point, video and the internet.

We’re all Salespeople

It also is the case that the most effective speakers have understood the knack of getting their ideas to stand out in a sea of noise. Effective salespeople are good at inspiring potential buyers. This is the same blueprint if you want to be an effective speaker. You need to learn how to sell yourself and your ideas more persuasively. If you can’t inspire anyone else with your ideas, it doesn’t matter how great your technology is – there will be no takers!

What makes a presentation compelling?

All great and inspiring talks have three components:

Emotion-they touch hearts
Novelty-they reveal something new
Memorable-they present content in ways people never forget

Emotion

Great communicators reach heads and touch hearts. The problem with the majority of us (especially within the sciences) is that we forget the ‘heart’ bit. We therefore need to learn how to identify our passions and use them in our stories, thereby creating deeper connections with audiences.

Novelty

Novelty is one of the most effective way to capture a person’s attention. Humans, it seems, are hardwired to give attention to new things. Research released by YouTube Trends has shown that content that is truly unique and unexpected gets noticed on the platform. Thus, a key aspect of effective communication is engaging audiences is to give them new perspectives, the wow moments.

Memorable

What’s the point of sharing great ideas if nobody remembers what you spoke about the moment you hand over the microphone? Research shows that to be memorable, a presentation has to be of an ideal length of time, and has to create vivid, multisensory experiences that allow the audience to recall the information successfully.

Here are 6 tips to effective presentations

Better than average communicators are generally more successful than most people, but great communicators are the ones that start movements. They are remembered long after their speeches. Think Jefferson, Churchill, Gandhi, Kennedy, King, Mandela and Obama, to name but a few.

Failure to communicate effectively in science can means research won’t get funded, products won’t get sold, projects won’t get backing, and careers won’t thrive. As career scientists, your ability to deliver captivating talks can mean the difference between acclaim and toiling in obscurity.

So here are my six simple tips you can adopt in 2022 to move your presentations to a new level, enabling you to communicate in ways that are passionate, powerful, and inspiring.

Tip #1: Unleash the Master Within

Thomas Jefferson, the third President and Founding Father of the United States of America is highly regarded even today as one of America’s most influential leaders. He was a passionate believer in democracy and considered it essential to the expression of society. He promoted national self-determination, public education, and a free press.

As the principal author of the United States Declaration of Independence, he wrote many inspiring speeches, which went on to shape the course of history. The preamble to the Declaration of Independence, for example, evokes the original spirit of the American nation:

‘We hold these truths to be self-evident, that all men are created equal, that they are endowed, by their Creator, with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness….’

Passion and public speaking are intimately linked. To touch your audience, you need to dig deep to identify how you’re uniquely and meaningfully connected to your presentation topic. This is where you’re operating at people’s emotional level. Passion is your why, or inspiration. It is not a passing interest or a hobby but rather that thing that’s core to what makes you, you! It is what gives you the authority, mastery and command, and your presentation will be empty without it.

Bear in mind that in some situations, what fires you up might not be obvious. Often, it is dressed up as something else. Howard Schultz, the former Chairman and Executive of Starbucks once said his passion was not coffee, but rather creating a third place between work and home! Coffee was only the by-product.

Passion is what makes successful speakers always enthusiastic about sharing their ideas. They have bags of charisma. They radiate joy and positivity about their ideas, and they are motivated by ‘good’ intentions, such as a desire to make a difference, create impact or leave a legacy.

Just as we know that happiness at and passion about the work are vital to career success, it is the same with public speaking. If you’re not having a great time in your job, how do you expect to generate enthusiasm in your presentation about it?

So while we can talk about effective storytelling, designing beautiful PowerPoint slides or how to use body language more effectively in your public speaking but the fact, and it is a fundamental fact, that effective presentations require passion first. Effective stories, slides or body language mean little if the speaker does not radiate passion and enthusiasm about what they’re communicating.

Tip #2: Master the Art of Storytelling

In this information-saturated age that we live, you won’t be won’t be heard unless you tell compelling stories. Facts and figures, and all the rational things that we think are important in science actually don’t stick in our minds that well. However, stories create “sticky” memories by attaching emotions to things that happen.

Stories also affirm who we are. We all want affirmations that our lives have meaning. And nothing does a greater affirmation than when we connect through stories.

This is why people who know how to weave stories about their work and share good stories have a powerful advantage over others.

But what constitutes a good story? Consider the case of major film studios, such as MGM, Pixar and Disney. They have individually mastered the ability to move audiences deeply, causing adults to tear up next to children, while persuasively transporting us into make-believe worlds.

Their perennial success in the business of movies is down to the way they choose ideas, create compelling characters, invoke empathy, drama and conflict, create villains and heroes, and the endings (the moral), that is, storytelling. It is the same with great speakers.

Aristotle, the Greek philosopher, believed that persuasion happened when three components were represented: ethos, logos, and pathos. Ethos is credibility. We tend to trust and agree with people we respect for their achievements, titles, experiences, etc. Logos is about persuasion through logic and data. Pathos is the act of appealing to emotions.

You can see this approach in Stevenson’s TED talk. For instance, he started with his personal experiences. The first five minutes (30 percent of the presentation) were on his personal stories and experiences. Data about incarceration in U.S. prisons came in later to support his ideas. He chose his approach to make it easy for the audience to connect with him on a personal and emotional level.

Studies have shown that inspiring communicators use three types of story.

The first types of story are personal stories about who we are. They should be descriptive and rich with imagery to enable the listener to imagine themselves with you at the same time. Delivered well, a captivating story makes your audience know something about you, which builds trust. Granted, personal stories are a sensitive subject, but if you choose them carefully, nothing comes close to grabbing the audience’s attention early on. A personal experience that produced an unexpected outcome often works well. The key thing is not to make them show how great you are, etc.

The second types of story are stories about other people who have learned a lesson the audience can relate to. The power of such stories is that they shed light on our shared humanity. So while personal stories can evoke empathy, it is stories about other people that audiences mostly empathise with. Empathy is the capacity to recognise and feel others’ experiences.

The third type of story are stories about successes or failures of products or brands. Harvard Business School is famed for the Case Method to teaching MBA students. These cases usually tell stories (real or simulated) about challenges faced by business executives and lessons that can be learnt from their experiences. This way, students are able to relate to business theorems with particular challenges.

Just as a great novel or movie goes about storytelling, a great presentation has to have a narrative, a cast of characters (hero and villain) and the moral of the story. The story should reveal a challenge (villain) being faced, a protagonist or hero (your solution) who is committed to rising to the challenge, the townspeople (customers) to be freed by the villain, and the outcome (the people who will be freed and live happily ever after their struggles are ended).

Tip 3: Have a Conversation

Great speakers deliver their content in a natural, authentic way, akin to having a comfortable conversation with a friend. It is a skill learned through practice and is not something that can just be memorised and perfected in an instant.

Think of the times you had a genuine conversation with a friend. Hopefully, you’re typically operating in a zone of emotional rapport. You were able to persuade your friend because you had gained their trust, and your voice, gestures, and body language were all in sync with your words.

This authenticity does not happen spontaneously. It is something that is learned, through practice. It takes hours of practice, searching for the right words that best represent the way you feel, delivering those words in a powerful way for maximum impact.

Good verbal delivery is based on what is called in the military as ‘commanding presence’. Commanding encompasses the following key elements:

Rate: the speed at which you speak
Volume: the loudness or softness
Pitch: high or low inflections
Pauses: short pauses to put emphasis on key words
Gestures, facial expressions, and body language

Great communicators speak at the right rate (the ideal rate of speech is between 180 and 200 words per minute), they speak concisely and precisely, and their voices project across the entire room because they speak from their diaphragms. They compliment the words with the gestures and facial expressions, to make a strong argument even stronger.

Tip 4: Reveal Something New

Great speakers incorporate new information or perspectives that are completely new to their audiences. The information may be packaged differently or presented in a way to solve an old problem. Revealing new perspectives works because our human brains love novelty. Unfamiliar, unexpected or unusual outcomes in a presentation audience, jolts them out of their preconceived notions, and provides them with new perspectives.

One of the most captivating public speakers on the web today is Professor Hans Rosling. He often talks about population, economic development and global health issues. As well as delivering data in a fascinating and easy-to-digest way, he is able to reveal completely new perspectives.

This is the same approach taken by all successful communicators. They opt to deliver content in ways that reveal something that is entirely new; things the audience was not familiar with.

Seth Godin, the popular blogger and author, has made a career out of delivering ideas differently. He told a TED audience in 2003 that in a society with information overload, the natural instinct is for audiences to ignore most of it. Thus, delivering the same old, tired content using the same boring methods as everyone else is bound to fail. Adding a little spin to content allows the audience to be more receptive to the message.

Tip #5: Incorporate Jaw Dropping Moments

A jaw-dropping moment in a presentation is when the speaker delivers a shocking, impressive or surprising moment that is very moving and memorable that it grabs the audience’s attention, and is remembered long after the presentation is over. Jaw-dropping moments are capable of heightening emotions, helping listeners recall and act on the message.

In 2009, Bill Gates, the founder of Microsoft delivered a talk at a technology conference about malaria. While on stage, he opened up a glass jar and said, “Malaria is spread by mosquitoes. I brought some here, just so you could experience this. We’ll let those roam around the auditorium little bit. There’s no reason only poor people should have the experience.” The audience roared with laughter, cheered, and applauded. Bill Gates had effectively delivered his jaw-dropping moment.

A few sentences earlier, Bill gates had talked about how many children lives’ could be saved through better medicines and vaccines. He was able to deliver an emphatic talk. He used shock and humour to drive his point home.

Journalists call the mosquito gimmick “the hook.” It’s the wow moment, the showstopper and the device used to capture the audience’s attention. Used cleverly, it allows listeners to share your story. So, before creating a Power Point presentation, take time to think about the story first. In the same manner a movie director storyboards the scenes before shooting, you should create the story before opening the tool. Aim to tap into al the senses – seeing, touching, feeling, and smelling.

Things that shock, surprise, bring fear, joy or wonder impact how vividly we remember them. It is the reason many of us remember our first kiss, the birth of a child, winning an award, break-ups or death of a loved one. It is as though these emotionally charged events are burned into our memories. Therefore, if you want to connect with an audience in an emotional level, you will need to present information that is vivid, using tools and examples that meaningful and concrete.

Tip #6: Be mindful of Cognitive Backlog

Most memorable presentations are noted for three key elements:

Are concise and organised systematically
Use multisensory approaches to paint mental pictures in their audiences
Are authentic, open and transparent.

Conciseness and Organisation

It is an undeniable fact that listening is mentally draining. Thinking, speaking and listening are physically exhausting. Think of the last time you sat through a one-hour lecture or power Point presentation. Too much information prevents the effective transfer of ideas, leaves the audience anxious and even frustrated. Researchers refer to this information overload as “cognitive backlog,” which is akin to piling on weights, which makes the mental load heavier.

This is the reason all TED talks are required to be no more than 20 minutes. TED believes that 20 minutes is short enough to hold one’s attention, and long enough to cover anything relevant.

If you must give longer presentations, it is necessary to split them into chunks, for instance, by adding breaks, videos, stories or demonstrations, every 10 minutes. The longer the presentation, the more the listener has to work to organise, comprehend and recall information.

John F Kennedy, the 35^th president of the United States, gave a famous speech at Rice University in late 1962. It was here that Kennedy outlined his vision for America to explore the moon. The speech, which lasted just over 17 minutes, captured the nation’s imagination about the importance of exploring space.

But it is not enough to be concise. In fact conciseness means nothing if the information is haphazard and unstructured. This is why some influential communications professionals talk of the rule of threes. This rule simply means that people remember three pieces of information well. Add more items and retention starts to wane quickly.

To make use of the rule of three, structure your story in three key chunks or messages around a central theme. It turns out that the rule of three pervades our work and social lives on a daily basis. You will find it in literature (the three little pigs and, the three musketeers), in the arts (three primary colours), politics (the three arms of government), etcetera. If it works for the world’s greatest writers and painters, it will work for presentations, too.

Use of Multisensory Experiences to Paint Mental Pictures

Think again about a particularly boring talk you had the misfortune of attending. What made it boring? What was your level of engagement? Chances are that it had too much text, lacked structure, was visually unappealing and the content was unengaging.

The fact is that boring does not wash well with the human brain. The brain craves multisensory experiences and will quickly switch off when it is exposed to stuff that is boring. Having presentations that include more than one sense: sight, sound, touch, and smell are difficult to ignore. This is why great talks use mesmerizing images, captivating videos, intriguing props, beautiful words, and more than one voice to bring the story to life.

Granted, some of these experiences, such as smell and taste, are difficult to incorporate in presentations. The key thing is to build a presentation around one or two main senses, and incorporate one other. The harder experiences can be simply described.

Slides should incorporate images and videos rather than text whenever possible. The audience is far more likely to recall information when it is presented in a combination of pictures and text rather than text alone.

The other important sense to use is sound. The auditory sensation is very powerful and how the content is delivered (pitch, rate, volume, intensity, sound effects) can all touch the listeners soul.

The final sensation to use is feeling. Feeling has been described as the “holy grail” of presentations owing to its ability to transport audiences to another place. The visual display of information helps the audience to see it while touching allows them to complete the journey.

Being Authentic, Open and Transparent

Although public speaking is an artform, it is not act one can put on. Am sure you have met a person who acts and speaks one way in private only to sound completely different when delivering a presentation. Such people act, look and sound like two different people. They lack authenticity, openness and transparency. Unfortunately, audiences are not thick – they can see through a fib, so trying to be somebody you’re not is a sure way to fail at building rapport with your audience.

If your goal is to inspire the audience and take them with you, you must be real. Here are some things to do:

Use your own voice – there’s no need to sound ‘posh’ or adopt some ‘esoteric voice.’ Chances are that it will make it difficult for your audience to keep up.
Disregard the fact this is a presentation. Instead, regard it as a conversation, the kind you typically have with family and friends.
Relax! This is not a sermon on the mountain, rather you’re just sharing your knowledge and expertise for people to take as much, or as little, as they wish.
Be yourself – you’re fantastic at it!

Finally, try to recapture your inner 3-year old-the times you were carefree, and had no hang ups. If you can get back to that, you’ll be an impactful public speaker.

Medication Swallowing Difficulties: The 3 Steps Needed To Improve Patient Experience

December 1, 2021

Dr. E Vickers (with additional contributions from E Mwesigwa) | Pharmacentral.com

Individuals with swallowing difficulties face inequalities in their access to safe medicines and could be at a greater risk of poor health outcomes compared with the general population. This article sets out to highlight the scale of the problem and suggests actions that the pharmaceutical industry and regulators can take to improve the situation.

What are Swallowing Difficulties?

Swallowing, the act by which we ingest solid food, liquids or medication, is in fact a highly intricate process that requires the interplay of several nerves and muscles in the oral cavity, pharynx and oesophagus in order to safely transfer bolus into the stomach.

While the vast majority of us do this simple act without much thought, there are millions of people who, for one reason or another, struggle to swallow. For them, the ability to initiate and complete a normal swallow is tortuous, accompanied by anxiety, pain, choking or aspiration.

Swallowing disorders occur in all age groups, either as a result of congenital abnormalities, damage to structures in the oropharyngeal anatomical structures and or short-term or long-term medical conditions. In some age groups and populations, however, swallowing difficulties are far more significant and pernicious. For example, in children with learning disabilities as well as senior citizens who need daily medication to alleviate their conditions.

In some situation, an inability to swallow solid medication can be a matter of life and death. For instance, in those with Parkinson’s disease where 70-80% of sufferes have swallowing problems or those who have had a stroke, where swallowing difficulties run at 90%.

Read about our article on Empathy – What the pharmaceutical industry can learn from the IT Industry

The main causes of swallowing difficulties catalogued in the medical literature include:

Dysphagia, the most well-known among swallowing disorders, refers to a group of disorders characterised by changes in the structures or neurological control of the swallow. Studies show that dysphagia affects 3 % of the general population.
Odynophagia which refers to pain swallowing caused by irritation or infection of the oral mucosae and oesophagus, particularly in individuals with acquired immunodeficiency syndrome, oesophagitis or disorders of motility of the oesophagus.
Phagophobia which is the fear and avoidance of swallowing foods, liquids or medication, usually based on the person’s fear of choking. It is on a psychological dimension and characterized by swallowing complaints but no abnormalities upon physical examination or investigation.

Note that difficulty to swallow is not in itself a disease, rather it may be an indication of an underlying structural, neurological or other dysfunction for which proper medicare should be sought since factors that lead to abnormal swallowing, whether it is dysphagia, odynophagia or phagophobia, can be life limiting, and if severe, life threatening.

Anatomy and Physiology of Swallowing

The normal swallow permits an individual to handle a wide range of solid and liquid products of varying volumes, textures and consistencies. This process can generally be divided into different phases, depending on whether the material is a liquid or a solid.

But first, it is essential to quickly review the anatomy and physiology of swallowing as a basis for appreciating swallowing difficulties and how to design effective interventions.

The anatomy of the oral cavity, pharynx, larynx and the innervations of the muscle in the oral cavity are shown in the figure below:

The tongue has both oral and pharyngeal surfaces. The oral cavity is separated from the pharynx by the faucial pillars. The pharynx has a layer of constrictor muscles that originate on the cranium and hyoid bone, and the thyroid cartilage anteriorly.

Note that the anatomy of the head and neck of infants is different from that of adults. In infants, teeth are not erupted, the hard palate is flatter, and the larynx and hyoid bone is higher in he neck to the oral cavity. The epiglottis touches the back of the soft palate so the larynx is open to the nasopharynx, but the airway is separated from the oral cavity by a soft tissue barrier.

The physiology of normal eating and swallowing is described by two models: the four stage model for liquids and the process model for solids.

Although there are differences in the sequence of events in the two models, it is possible to reduce the swallow to three main phases as follows:

Oral Phase

Upon introducing a liquid or solid into the mouth, the material is prepared into a bolus and or transported to the middle of the tongue. During this stage, the posterior part of the oral cavity will be sealed by the action of the soft palate and tongue, thus preventing premature leakage of bolus into oropharynx before the swallow. Note that the tendency for leakage increases with age.

After a brief moment the anterior tongue rises, touching the alveolar ridge of the hard palate just behind the upper teeth. The posterior tongue drops, opening the back of the oral cavity. The surface of the tongue lifts upward, propelling the bolus back along the palate and into the pharynx.

Pharyngeal Phase

The pharyngeal swallow is a swift activity that follows the oral phase. It serves two main purposes:

(1) to permit bolus to be propelled through the pharynx and the upper oesophageal sphincter and into the oesophagus, and

(2) to protect the airway by preventing entry of food into the larynx and trachea.

In this phase, the soft palate elevates and contacts the walls of the pharynx, leading to the closure of the nasopharynx at the point the bolus hurtles into the pharynx. The base of the tongue retracts, pushing the bolus against the pharyngeal walls. Constrictor muscles of the pharynx then contract, squeezing the bolus downward, and together with retraction of the base of the tongue, pushes the bolus downward.

For obvious reasons, the ability to safely pass bolus through the pharynx without aspirating or regurgitation into the nasal cavity is important in human swallowing. Therefore, there are several mechanisms at play which the body uses to prevent entry of food particles into the airway during swallowing.

Oesophageal Phase

The oesophageal phase describes the transport of the bolus through the oesophagus. The oesophagus is a tube-shaped structure originating from the lower part of the upper oesophageal sphincter and terminating at the lower oesophageal sphincter.

During the swallow, the muscles relax allowing the bolus to pass down. Movement is facilitated by a series of peristaltic waves, as well as gravity, both of which effectively transport the bolus through lower oesophageal sphincter and into the stomach.

Swallowing Abnormalities

Abnormal swallowing can result from a wide range of conditions and disorders related to the anatomy and or physiology or the oral, pharyngeal and oesophageal dysfunction.

Swallowing difficulties manifest in different ways, which include:

Painful chewing or swallowing
Dry mouth (Xerostomina)
Difficulty controlling solids or liquids in the mouth
Hoarse or wet voice quality
Coughing or chocking before, during or after swallowing
Feeling of obstruction (globus sensation)

Dysphagia

Dysphagia arises from abnormalities in structure or motility and ranges from inability to initiate swallowing to solids getting stuck in the oesophagus.

Generally, two main types of dysphagia are recognised:

Oropharyngeal dysphagia, whereby patients are unable to transfer food into the oesophagus by swallowing. Oropharyngeal dysphagia is subdivided into structural/obstructive and neurological/propulsive.

From a clinical point of view, any difficulties swallowing solids indicates either structural or propulsive oropharyngeal dysphagia, while difficulty swallowing liquids indicates propulsive or neurological oropharyngeal dysphagia.

Oesophageal dysphagia is when patients can initiate swallowing process however as the food passes down the oesophagus and into the stomach, they experience discomfort. The underlying causes can also be structural or propulsive abnormalities.

The table below lists some of the most common causes of oral and pharyngeal dysphagia

Common Causes of Oral and Pharyngeal Dysphagia

Neurological disorders and stroke

Structural lesions

Psychiatric disorders

Cerebral infarction

Brain-stem infarction

Intracranial haemorrhage

Parkinson’s disease

Multiple sclerosis

Motor neurone disease

Poliomyelitis

Myasthenia gravis

Dementias

Thyromegaly

Forestier’s disease

Congenital web

Zenker’s diverticulum

Ingestion of caustic material

Neoplasms

Psychogenic dysphagia

Polymyositis

Connective tissue diseases: Polymyositis & Muscular Dystrophy

Iatrogenic Causes:

Surgical resection

Radiation fibrosis

Medication

From: Palmer Jb et al, 2006. In Braddom R (ed): Physical Medicine and Rehabilitation, Elsevier, Philadelphia. Pp 597-616.

Odynophagia

Odynophagia is the disorder in which swallowing is associated with pain. It differs from dysphagia, which is simply difficulty when swallowing — and does not associate with pain, whereas odynophagia always does.

Odynophagia can be caused by infective and non-infective inflammatory processes, benign and malignant esophageal disorders such as achalasia, gastro-esophageal reflux disease and carcinoma.

Some of the conditions associated with odynophagia include:

Gastroesophageal Reflux Disease
Esophagitis
Candidiasis
Esophageal Cancer

Phagophobia

Phagophobia is a relatively rare type of anxiety disorder associated with swallowing. It is often mixed up with pseudodysphagia, which is the fear of choking. The key difference between these two phobias is that individuals with phagophobia are anxious about the act of swallowing whereas those with pseudophagia are afraid that swallowing will lead to choking.

Irrespective, phagophobia and pseudodysphagia can be life limiting, and in the case of medication, life threatening. This is especially the case in the small but significant cohort of individuals, who for reasons still to be known, have phagophobia and pseudodysphagia related to medication.

Unfortunately, the causes of phagophobia are poorly understood and may even be multifactorial, involve past experiences, underlying health conditions or simply learned through observing others who struggle to swallow certain things.

It has been found that individuals who watch others experience difficulties (e.g pain or embarrassment) when swallowing may go on to develop phagophobia.

Finally, phagophobia may occur in the absence of any underlying triggers.

Symptoms of phagophobia include:

Anticipatory anxieties before ingestion of meals
The tendency to eat very small mouthfuls or drinking frequently or large amounts of liquids during meals as a way to aid swallowing
Extreme anxiety and fear at the thought of swallowing
Panic attacks
Rapid heart rate and breathing
Reluctance or avoidance of eating or drinking in front of others
Sweating
Switching to an all-liquid diet as a way to alleviate anxiety around swallowing
Weight loss (skipping medication and exacerbation of illness if related to medication)

Oral Medicines and Swallowing Difficulties

The prevalence of swallowing difficulties varies greatly, including population under consideration, comorbidities and assessment methods. Experts contend that prevalence may actually be greater than published figures would indicate since many patients may not report symptoms.

Generally, 70 – 90% of all seniors have some degree of swallowing difficulty. In certain cases, for instance, Parkinson’s disease and Stroke, swallowing difficulties are the norm, and have been reported to be as high as 90%. According to a recent study, swallowing difficulties run at 3% in the world adult population, but are 10 times higher in those with neurological and or psychological conditions, such as learning disabilities, severe mental illness or dementia.

With oral administration of medication being the most preferred route, the swallowing of solid medication, particularly tablets and capsules, presents specific challenges to anybody with swallowing problems. To make matters worse, solid dosage forms need to be taken with water, which requires the same individuals to control a thin fluid, which complicates matters even more.

Which medication types are suitable for dysphagia and other swallowing difficulties?

Most medication in use today is formulated as tablet dosage forms. According to the British Pharmacopoeia, a tablet is circular in shape with either a flat or convex faces prepared by compressing the active pharmaceutical ingredients with excipients.

In reality, they are available in a wide range of sizes, shapes, colours and indentations. In addition, tablets may be sugar or polymer film coated as well.

The oral route of drug administration is the most preferred route of taking medicine, and understandably, manufacturers of medicines recognise this. As a result, oral medicines account for more than 70% of all medicines in use.

Tablets (and more specifically, standard compressed tablets) are the single most popular dosage form, responsible for 50% of all pharmaceutical preparations manufactured and sold. Some of the reasons for popularity of tablets include:

Tablets allow accurate dosage of medicament to be prefabricated and administered simply and conveniently
Tablets are consistent with respect to weight and appearance
Drug release rate can be fine-tuned to meet physiological and pharmacological needs of patients
Tablets can be mass-produced simply and quickly, which allows the wider public to have access to medicines that would otherwise be too costly.

However, to anyone with swallowing difficulties, swallowable tablets are a nightmare. Problems with the neural control or the structures involved in swallowing mean that swallowable tablets are not ideal sufferers of dysphagia. Too big (frankly, most are) and they are a choking hazard. Too small and they become difficult to detect on the tongue and move around in the mouth to initiate a safe swallow.

If the tablets can be crushed beforehand, it can greatly help pass them down however, as with anything that requires precision, the possibility of errors increases with the number of additional manipulations. Thus, having technologies that enable dosing without the need for additional dilution, elaboration or mixing as is always needed in paediatric, geriatric or other swallowing disorders would be of great benefit.

There are alternatives to swallowable tablets, which depending on the type of drug substance and its intended use, may be considered:

Buccal Tablets
Caplets and Coated Tablets
Chewable tablets
Effervescent Tablets
Lozenges
Mintablets
Multiparticulates
Orally Disintegrating Tablets (ODTs)
Powders for reconstitution
Sublingual Tablets
Hard Gelatin Capsules
Soft Gelatin Capsules
Chewing Gums
Gummies
Topical Products (Ointments, Creams, Lotions and Transdermal Patches)
Parenteral Products
Inhalation Products

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Key Characteristics of Different Tablets Types

Type of tablets	Description and Advantages	Key Considerations
Swallow Tablets	The vast majority of tablets fall in this category. These tablets are designed for per-oral administration by swallowing	Most tablets belong to this category. They are designed to be swallowed whole although some may be crushed/split up to ease ingestion.
Buccal Tablets	Buccal tablets are designed to be placed under the cheek mucosa or between the lip and gum. Typically designed for slow release and absorption.	Buccal tablets permit administration without the requirement for water/swallowing Drugs should not be bitter or unpleasant in the mouth Usually very small and flat and do not require addition of a disintegrant
Sublingual Tablets	Sublingual are designed to be placed under the tongue. Unlike buccal tablets, they allow rapid absorption through blood vessels under the tongue while avoiding 1st-pass effect.	Sublingual tablets permit administration without the requirement for water/swallowing Drugs should be soluble, typically low dose and not be bitter or unpleasant in the mouth Careful selection of excipients required
Orally Disintegrating Tablets (ODTs)	ODTs are designed to rapidly disintegrate on the tongue into a smooth solution or suspension that can be swallowed without the need for water.	Two key characteristics that a dosage form labelled as an ODT must possess is a rapid disintegration time of 30 s or less, and a tablet weight of 500 mg or less
Chewable Tablets	Chewable tablets consist of a mild effervescent excipient base which can be chewed and broken down into a smooth consistency which can be swallowed.	To provide fast disintegration and dissolution, the tablet should be designed to be soft or easy to chew. The active drug substance must not be unpleasant to the taste, and frequently, flavours and sweeteners are required.

Unfortunately, too many products on the market today are formulated with little consideration of those with swallowing difficulties. Products for children are perforce prepared from products designed for adults; and the same applies for the elderly, who often have swallowing problems while also requiring prolonged, non-crushable tablets. In 2020, for instance, out of the 200 best-selling medicines in the United States, only six were offered in easy-to-swallow formats. It is not funny any longer. It is unsafe and something needs to be done soon.

That people have to crush medication in the 21^st century so that children and seniors can be treated despite the wide availability of technologies and excipients and knowhow is disgraceful.

Actions needed to reduce inequalities in dysphagia

The prescription remains the most widely used medical intervention today. Yet it is estimated that up to 50 % of all patients prescribed medication fail to take it correctly. This not only leads to waste of resources but could lead to treatment failure and sub-optimal outcomes.

If society is to equitably offer quality healthcare to all, it will be necessary to take a whole person approach, by recognising the many root causes of inequality, and engender system-wide action, from regulators, pharmaceutical companies, patient groups as well as healthcare workers as the immediate contact points for patients.

Here is a range of preventative actions that local areas can take to reduce inequalities and improve health outcomes and the lives of people with mental illness.

1. A better understanding of the scale of the problem

Although dysphagia and other swallowing disorders are widespread, the scale of the problem, especially as it relates to medication, is still poorly understood.

It is generally known that patients, for one reason or another, tend to underreport their problems during contact with healthcare providers. The lack of understanding on the scale of the problem generally hinders society’s ability to deliver equitable healthcare.

Therefore, investment in data gathering is urgently required if we are to fully understand the scale of this problem. When delivering care, providers and institutions need to ask patients if they have issues swallowing solid medicines and know the implications of not offering working solutions.

In the 21^st century, it is not just a patients’ physical comfort that is important but also their emotional well-being. This way, more joined-up interventions can be implemented.

2. Partnership between the public, government and pharmaceutical companies

With growing healthcare needs, increasing expectations from the health systems, and challenges of insufficient resources, it is unlikely that health services can be provided solely by a single actor. More than ever before, healthcare requires profit and social purpose to converge.

Public-private partnerships (PPPs) have traditionally taken many forms, varying in the level of participation or risk taken by different parties. We are not talking about PPPs as such, but rather, collaborative framework in which patient organizations, the pharmaceutical industry and healthcare providers work together, get closer to patients and gain deeper insights about their individual issues and not just as patients.

Although there is no-one-size-fits-all model, such a collaborative model can actually facilitate development of better therapies.

3. Legislation and incentivisation of marketing authorisation applicants

Providing medicines for marginalised or neglected demographics, such as those with swallowing problems, has been an endemic oversight in the pharmaceutical industry. This has been partly because marginal groups have not always been a viable commercial market or because companies were simply not bothered.

Given how prevalent dysphagia and other swallowing issues are, urgent action is required. There is need to join forces to pressure regulators and drug producers to address this inequality. One way is to require applicants for marketing authorisations to provide introduce alternative formats aimed at those with swallowing difficulties at launch in return for reduced regulatory fees or marketing exclusions.

It is clear that the current strategy of relying on the largesse of individual companies is not working, and a more sustainable approach is required.

Final thoughts

The vast majority of medication available today is in the form of swallowable tablets. These formats are often not appropriate for patients with dysphagia or other swallowing difficulties. Lack of availability of suitable formats for suffers predisposes these groups to sub-optimal treatments and contributes to healthcare inequalities.

If society is to equitably offer quality healthcare to all, it is necessary to take a whole person approach, recognise the many root causes of inequality, and engender system-wide action, from regulators, pharmaceutical companies, patient groups as well as healthcare workers as the immediate contact points for patients.

Sources Used

Overview of Drug Therapy in Older Adults. The Merck Mannual. (available at https://www.msdmanuals.com/en-gb/professional/geriatrics)

Wright, D., 2014. Prescribing Medicines for Patients with Dysphagia. New York: Grosvenor House Publishing, pp.1-101.

Lisa Tews, Jodi Robinson.,2007. Dysphagia. In Kauffman T, L et al., (editors). Geriatric Rehabilitation Manual (Second Edition), Churchill Livingstone, pp 381-385. https://doi.org/10.1016/B978-0-443-10233-2.50063-8. (https://www.sciencedirect.com/science/article/pii/B9780443102332500638)

Dysphagia. National Institute on Deafness and other Communication Disorders. (available at https://www.nidcd.nih.gov/health/dysphagia)

Beating Burnout: A Practical Guide for Pharmaceutical Scientists

October 30, 2021

Unrealistic pressures to perform and deliver results are creating burnout among many career scientists. If not adressed, work-related chronic reduces productivity, mental health deterioration.

At the last summer Olympics in Tokyo, Simone Biles, the four-time Olympic champion, stunned and also won applaud when she announced her withdrawal from the gymnastic team final and women’s individual finals to focus on her mental health.

For most of us engrossed in the world of chemicals and drug substances, the pommel horse is as far away as it gets, yet we can easily relate with the daily struggles of work, very much like Ms Biles. We may hate Mondays, find it hard to get motivated for even the smallest tasks, we often feel like we’ve lost skills, and the career that excited us and brought so much happiness is no more! Some of us have even contemplated leaving the field altogether, or even worse.

According to recent studies, these feelings are very common. It is just that among scientists, the rates of mental health are higher than those in the general public. In some reports, one in three PhDs is at risk of developing a mental-health disorder, including depression.

Many mental health problems are driven, in part, by the immense pressure on scientists to win funding, publish work in reputable periodicals, land jobs or create innovations in an unforgivingly competitive environment, where tolerance for failure is low. And COVID-19 has not helped matters.

To cap it all, studies have identified that scientists have poor mentorship, poor access to counselling services and those in their line management lack the training to manage wellbeing. This is why universities and employers are now being urged to improve mental health support services, revise leave-of-absence policies, and provide mentorship training all those in line management roles.

In this article, I describe burnout, a common cause of mental health deterioration among working professionals. I describe its causes and risk factors and how it can be prevented. Finally, I outline practical steps on how to recover if you have work-related stress.

What is burnout?

Burnout or chronic work-related stress, is a condition characterised by exhaustion. According the World Health Organisation, burnout is a syndrome arising from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
reduced professional efficacy.

Three of the world’s experts on burnout, Susan Jackson, Christina Maslach and Michael Leiter, all agree that burn-out is an occupational phenomenon, specifically defining as a psychological response to interpersonal stressors of work. It is different and apart from experiences in other areas of life.

It is important to mention that work-related stress is not an official medical condition in itself, it is usually only a symptom of other underlying issues, such as depression.

The sinister thing about burnout is that it may even go unnoticed and sufferers may not even be aware that the source of burn-out is their job!

Suffice to say burn-out, whether formally diagnosed or not, has the ability to impact both mental and physical health. And for this reason, it is important that burnout is recognised early and a plan put in place to help one recover from it.

How to tell if you have work-related stress

According to psychologist Susan Maslach, burnout manifests in the form of three symptoms, namely exhaustion, cynicism and inefficacy due to chronic stressors at work.

Exhaustion is the main symptom of burnout. It encompasses deep emotional exhaustion, physically, cognitively and emotionally, leading to an individual’s inability to function.

Cynicism or depersonalisation refers to a loss of connection and engagement with one’s work. Essentially, the sufferer of chronic burnout feels mentally removed from work, including colleagues, customers or assignments.

Inefficacy refers to feelings of failure and a lack of sense of accomplishment or productivity. Individuals who experience inefficacy feel their skills are eroding and may worry that they will not be successful in other areas of work.

The signs or symptoms can be physical, psychological and behavioural:

Physical symptoms include:

Fatigue
Muscular tension
Headaches
Heart palpitations
Sleeping difficulties, such as insomnia
Gastrointestinal upsets, such as diarrhoea or constipation
Dermatological disorders.

Psychological symptoms include:

Depression
Anxiety
Discouragement
Irritability
Pessimism
Feelings of being overwhelmed and unable to cope
Cognitive difficulties, such as a reduced ability to concentrate or make decisions.

Behavioural symptoms include:

An increase in sick days or absenteeism
Aggression
Diminished creativity and initiative
A drop in work performance
Problems with interpersonal relationships
Mood swings and irritability
Lower tolerance of frustration and impatience
Disinterest
Isolation.

Questions to ask yourself:

Do you constantly feel like you do not have energy for anything?
Is your sleep interrupted? For instance, do you sleep during the whole day or have problems falling or staying asleep?
Do you feel like you have to force yourself to go into work? Do you struggle to get started with work tasks?
Do you notice that you are easily irritated or impatient with work colleagues, clients or customers?
Have you become particularly critical or cynical about your work or others at work?
Do you feel you’re not as productive as you were in the past? Are you struggling to focus on your work?
Do you feel you no longer take interest in your achievements? Has your passion for the job gone?
Are you increasingly binge-eating to feel better? Are you using alcohol or drug to improve your mood?
Do you frequently suffer from headaches, unexplained stomach problems or any other unexplained pains or twitches?

Note that the mere fact that you answered yes to any of these questions, it does not necessarily mean you have work-related stress. Equally, you shouldn’t have to live with any of these feelings. Seeking help from professionals will help you deal with it early enough so that you can regain your mojo back and start living life to its fullness.

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Common causes of burnout

Chronic work-related stress is a growing concern in the workplace around the world. Health experts attribute the rise in burnout to increase in work demands and lack of awareness on practical ways to manage it.

All the following issues have been identified as potential stressors at workplaces. A risk management approach will identify which ones exist in your own workplace and what causes them. They include:

Organisation culture
Bad management practices
Job content and demands
Physical work environment
Relationships at work
Change management
Lack of support
Role conflict

If a job saps a lot of energy and exposes you constantly to stress, for instance the pressure to meet very tight deadlines, absence of social and supportive network or if the job is chaotic or monotonous, the chances of experiencing burnout are much higher.

Some of the factors that commonly cause burnout include:

Long hours
Heavy workload
Changes within the organisation
Tight deadlines
Changes to duties
Job insecurity
Lack of autonomy
Boring work
Insufficient skills for the job
Over-supervision
Inadequate working environment
Lack of proper resources
Lack of equipment
Few promotional opportunities
Harassment
Discrimination
Poor relationships with colleagues or bosses
Crisis incidents, such as an workplace death
Unclear expectations

How to prevent or handle early stages of burnout

Thanks to ongoing research by psychologists and health professionals, our understanding of causes and solutions for burnout is much improved. We have a better understanding of what to do once the symptoms of burnout are picked up.

So here are some strategies that have been successful across the board:

Focus on self-care and wellbeing

It’s crucial to refill your physical and emotional energy, as well as your ability to focus by prioritising sleep hygiene, nutrition, exercise, social networks, and practices that promote mental calmness, such as meditation, journaling and nature appreciation.

If for one reason or another you find it difficult to squeeze in these activities in your schedule, take a week to examine how you spend your time.

You can then take a look at each block of time in your day and record how you spend time, i.e., what you do, the people you spend the time with and how you feel. Then score each activity in terms of how valuable it is or how it leaves you (1 = drained, 10 = energised).

This can enable you find breaks and opportunities to reduce exposure to situations that do not build you, and this way, find breaks for rejuvenating moments away from work.

Shift your outlook

Although relaxation, resting and rejuvenation can help alleviate exhaustion, address cynicism and improve productivity, they do little as far as mollifying the underlying causes of burnout.

Back at work, you may still have to contend with the same unmanageable workload, conflicts or lack of resources. It is therefore important to take a look at your expectations with respect to work:

Which aspects of work can be changed? It helps to ask yourself what tasks can be delegated to free up energy for other meaningful tasks. Perhaps some aspects of your work could be changed to allow you regain some level of control over your workday.

And if it is cynicism, look into ways of sheltering yourself from parts of the workplace that antagonise or frustrate you and instead re-engage with those aspects of the job that are most meaningful.

It also greatly helps if you can find supportive relationships and networks that can help counteract those that drain you.

Eliminate or reduce exposure to stressors

Reduction of job stressors requires you to recognize those particular activities and relationships that trigger unhealthy stress. This might require a reset of expectations from colleagues, clients and even family members regarding what and how much you are willing to take on as well as the ground rules for walking together.

You may, of course, experience resistance as you go about this; the most important thing, however, is to assure yourself that the changes you’re making will improve your long-term productivity as well as protecting your wellbeing.

Invest in connectivity

It has been found that one of the most effective remedies for burnout, especially when its driven by cynicism and inefficacy, are finding and making rewarding interpersonal connections and seeking professional growth. Reaching out to and engaging in coaching and with suitable mentors that can help identify opportunities for growth can be highly rewarding.

Another issue is finding opportunities to volunteer in your community or to help others in similar situations can be a very powerful way to break out of a negative cycle of cynicism and lack of motivation.

Finally, given the role of the situational dimension to burnout, chances are that others in your organisation have burnout, too. So finding and identifying with others in a similar predicament will help identify organisation-wide problems and lasting ways to address them.

Nip burnout in the bud

Getting aware of the problem is the first step to addressing burnout. However, this is often the most difficult simply because we tend not to accept ‘weakness’ or reassess aspects of our behaviour.

If you hear family or colleagues express any concerns about your work, its important to take heed. Granted, accepting that you are heading into a crisis will be hard to take, however, and at the end of the day, your wellbeing is what counts.

Get support

It is crucial to find someone who is willing to challenge your assumptions and give you a different take on things. This may be a trusty friend, a coach, family member or therapist. This is because burnout has the potential to cloud your thinking and decision making. Hence, if you can be helped with finding and mapping out work-life boundaries, it will be easier to to find that happy medium.

Take time to recharge even if you love your job very much

It’s common to get exhausted from time to time, particularly on those occasions when the job is all consuming. This is not full burnout. Still, it is important not to let things slip, so here are some quick ways to recharge:

Take breaks during the day. In order to perform at your best consistently, you need to find opportunities to restock your mental energy. Taking regular breaks allows to step away and clear your headspace.

Put away digital devices for a moment. Today, we find ourselves carrying our offices wherever we go with no downtime at all. It is a good practice to place your work phone away when you arrive home so that you’re not tempted to check work emails during out of office hours.

Take weekend breaks. Short breaks have been shown to help reduce stress, aid with maintain peak performance while also reducing the need for long lay-offs. Make sure that while you’re away, you completely switch off from work.

How to recover if you already have burnout

The first step to take in order to recover from burnout is to regain your perception of control of your situation first. During the state of burnout, people often feel as if their circumstances are out of their grasp, a few others may even feel the rest of the world is working against their interests. This mentality creates a virtuous cycle and block them from dealing with their circumstances.

But what is resilience? Simply it is an individual’s ability to positively respond to stress, pressure, risk and adversity.

To fully appreciate resilience, we need to borrow from the British Army’s highly acclaimed mental resilience programme for its soldiers. This programme recognises soldiers do not only need physical strength but also mental toughness if they are to effectively face the many challenges of their careers. It comprises the following principles:

SELF-BELIEF – confidence in your own abilities and judgement

POSITIVE AFFECT – the ability to interact with life in a positive way

EMOTIONAL CONTROL – the ability to understand and express your emotions

MENTAL CONTROL – the ability to control thinking, attention, concentration, focus, self-awareness, reflexivity, problem-solving

SENSE OF PURPOSE – the motivation that drives you forward

COPING – adaptability, natural coping strategies you have learnt through coping in previous stressful situation

SOCIAL SUPPORT – the social network you have and the ways you use it.

Here are some of the things you can do to build mental toughness:

1. Develop a positive mindset

To increase your resilience, the first thing that one has to do is refocus on building a strong, positive mindset in everyday life.

2. Know your why

Another aspect of building resilience is constantly being aware of your “why” when it comes to your short and long-term goals. If you’re going to achieve a big goal knowing why you need to do it in the first place cushions you against discouragements and disengagements as soon as you experience your first setback.

3. Find strength in others

Developing resilience is much about your inner fortitude as much as embracing the idea that you’re not in it alone. Even the most successful people among us rely and count on others for support, mentorship, guidance and encouragement when times are difficult. So you should have the confidence to do the same.

4. Learn to pick yourself up

Finally, it is worth remembering that building resilience isn’t easy! Anyone who’s ever achieved massive success knows that obstacles, setbacks, and failure are inevitable, and you’re no different.

As you work on your goals, you’re going to face many ups and downs, but this doesn’t mean that you don’t have mental toughness, willpower, or discipline.

In summary, you can build resilience through learning to recognize negative tendencies and taking action to correct them early on with healthy habits. Developing resilience is not about eliminating weakness, but learning how to deal with it and overcome it.

Final Thoughts on Burnout

The never-ending pressures to deliver new knowledge and products and be on top of things have undesirable consequences for scientists’ wellbeing. Burnout, the term that is sometimes used for all sorts of work-related stresses, is, in realty a serious red-flag that things are not going well. Unmanaged, chronic burnout leads to low productivity, negative emotions and mental ill-health. Recognising burnout early and taking steps to deal with its causes is important. But equally, all stakeholders, from line managers, to the boardroom, need to understand and recognise burnout and institute processes to address it so that workplaces are supportive and more productive.

Reference

Diane Wood. Corporate burnout affecting the mental health of 20% of top performers in uk businesses. Personnel today, may 3, 2017.
Christina Maslach and Susan E Jackson. The Measurement of Experienced Burnout. Journal of Occupational Behaviour 2 (1981): 99-113.

Opinion | What Does the Recent Pig-to-Human Kidney Transplant Mean for Tissue Therapeutics?

October 29, 2021

In a pioneering procedure, a team of surgeons at New York University Langone Health Grossman School of Medicine in New York City managed to attach a pig kidney to a human patient. The kidney functioned normally for 54 hours.

Last week, a team of surgeons in New York City were to able to successfully attach a pig kidney to a human patient and watch the organ function normally for a whole 54 hours. While procedures of this kind are not new in nonhuman primates, it is the first time that a pig kidney has been transplanted into humans and not been immediately rejected.

The process of transplanting living cells, tissues or organs from one species into another is what scientists call xenotransplantation. However, owing to genetic differences between species, past xenotransplantation efforts have not been successful, leading to immediate organ rejection by the human immune system.

The breakthrough procedure, which was announced at a news conference and widely reported in the media on October 21, represents a giant step towards the aim of increasing availability of life-saving organs for transplantation. Waiting list for donated organs around the world are in the millions, and demand is not expected to drop anytime soon despite a rise in organ donation registrations.

Speaking on condition of anonymity, a nephrologist at Abbott Northwestern Hospital, Minneapolis, MN said the fact that transplant survived three days with full function and no signs of rejection was an “incredible achievement,” and gives fresh confidence that “patients will have access to additional sources of organ for transplantation in the near future”.

However, several years of more of research, clinical trials and regulatory scrutiny are required before we can start to see pig kidneys on surgical tables.

In a press release, Robert Montgomery, MD and chair of the department of surgery at NYU Langone and director of the NYU Langone Transplant Institute, noted that the future of this work is not limited to kidneys.

“Transplanting hearts from a genetically engineered pig may be the next big milestone,” he said. “This is an extraordinary moment that should be celebrated — not as the end of the road, but the beginning. There is more work to do to make xenotransplantation an everyday reality.”

Why pigs?

In the quest to address the chronic shortage of organs, scientists have long sought the use animal organs. Pigs have emerged as an interesting choice because their organs are anatomically similar to those of humans, and they can be easily bred in a highly controlled manner.

However, it is more that ease of breeding. In the mid-20th century, xenotransplantation scientists noticed that transplanted animal organs quickly turned black, a phenomenon known as hyperacute rejection.

As knowledge has improved, scientists have been able to use genetic engineering to overcome some of these challenges. For example, it was found that aggressive immune responses seen after a pig xenotransplant was due to antibodies detecting alpha-gal, a sugar moiety found on porcine vasculature.

Disabling the gene that codes for alpha-gal was key to addressing hyperacute rejection of pig organs. Until now, a test of this sort of transplant hadn’t been done successfully in humans.

So what did the New York University Langone Health team do?

In order to overcome the many ethical hurdles of performing such an operations in humans the surgical team approached the family of a woman with brain stem death kept alive on a ventilator. Although the woman was an organ donor, her organs were not suitable for donation.

Over a period of several hours, the surgical team worked to attach the pig kidney, which had been genetically engineered to remove the alpha-gal sugar to blood vessels, in the upper leg of the patient. The kidney was kept outside of the body so the team could assess its function in real time.

In order to improve chances of acceptance, the team also transplanted the animal’s thymus gland, which aids the education of the immune system to recognize the kidney as part of the body. The patient was also given specific drugs that suppress the immune system.

Within minutes, the kidney started producing large amounts of urine and showed other signs of normal functioning. The pig kidney functioned just like a human kidney transplant. The research team stopped monitoring at 54 hours in line with IRB ethical guidance.

The patient was taken off life support after the procedure.

What’s next for these sort of transplants?

To survive 54 hours represents a significant development but to become mainstream, animal kidneys will need to survive for years not days. For this to happen, researchers will need to show that these organs can withstand immune system attacks for years in the human body.

A key aspect of this journal is to show that transplants are safe in the long-term and obtain approval from health authorities, including the U.S. FDA and the European Medicines Agency.

Are there any ethical concerns about breeding pigs for organ harvesting?

Using any animal for the sole benefit of humans raises important ethical questions. Advocates for xenotransplantation argue the potential benefits of expanding the organ supply are worth any potential harm done to animals.

The jury is still out on how acceptable the idea of breeding millions of pigs in order to harvest organs for human transplantation is.

PETA (People for the Ethical Treatment of Animals), a campaigning organisation against the use of animals in research, contests the whole idea that we should consign animals as sources of spare parts for humans (see their statement through this link).

Questions or comments on this article? E-mail us at editor@pharmacentral.com.

Sources

NYU Langone Health. Progress in xenotransplantation opens door to new supply of critically needed organs. Published online October 21, 2021.

What does COP26 mean for the pharmaceutical sector?

October 29, 2021

The stakes for this year’s UN Climate Change Conference couldn’t be higher. But what can we expect from the talks in Glasgow? And how will the summit impact industry?

From the 31st of October to the 12th November 2021, the United Kingdom and Italy will jointly host the 26th UN Conference of the Parties on Climate Change (COP26) in Glasgow. Heads of state, climate scientists and other stakeholders will gather to flesh out and agree on joint steps to combat climate change.

What is a COP?

‘COP’ simply means ‘Conference of the Parties’. In the world of climate change, ‘the Parties’ are the governments that have signed the UN Framework Convention of Climate Change (UNFCCC).

The COP brings these signatory governments together once a year to discuss how to jointly address climate change crisis.

COP conferences are attended by world leaders, ministers, and negotiators but also by representatives from civil society, business, international organizations, and the media.

The COP is hosted by a different country each year and the first such meeting – ‘COP1’ – took place in Berlin, Germany in 1995.

COP26 is the 26th climate change COP. It is being co-hosted by the UK and Italy. COP26 was originally scheduled to take place in November 2020 in Glasgow, UK but it was postponed by one year due to the COVID-19 pandemic. It is now due to take place 31 October-12 November 2021.

The ‘pre-COP’ (a preparatory meeting) took place in Milan, Italy, from 30 September-2 October.

COP26 builds on the Paris Agreement, an international treaty signed by almost all countries in the world at COP21 in Paris in 2015. This landmark treat aimed to keep the rise in the global average temperature to ‘well below’ 2 degrees above pre-industrial levels, strengthen the ability to adapt to climate change and build resilience; and align all finance flows with ‘a pathway towards low greenhouse gas emissions and climate-resilient development’.

The Paris Agreement has a ‘bottom-up’ approach, namely, each signatory country was to decide by how much it would reduce emissions by a certain year. These countries communicate these targets to the UNFCCC in the form of ‘nationally determined contributions’, or ‘NDCs’.

Goals of COP26

COP26 arrives at an important time in the global climate action debate. If the world is to have a chance of limiting warming to 1.5 degrees, emissions must halve by 2030 and reach ‘net-zero’ by 2050. Unprecedented action is needed if this goal is to be achieved.

It has long been argued that the NDCs submitted in 2015 were not ambitious enough to limit global warming to ‘well below’ 2 degrees, never mind 1.5 degrees. The signatories of the Paris Agreement are, however, expected to submit new – and more ambitious – NDCs every five years, known as the ‘ratchet mechanism’.

COP26 is the first test of this ambition-raising function. One of the main ‘benchmarks for success’ in Glasgow is that as many governments as possible submit new NDCs and, when put together, these are ambitious enough to put the world on track for ‘well below’ 2 degrees, preferably 1.5.

As of September 2021, 86 countries and the EU27 have submitted new or updated NDCs to the UNFCCC.

A few governments, like China and Japan, have pledged new 2030 targets but are yet to submit them officially.

The UK has, for instance, pledged to reduce emissions by 68 per cent by 2030 compared to 1990 levels, and 78 per cent by 2035. The European Union (EU) is aiming for a reduction of at least 55 per cent by 2030 relative to 1990 levels, and the US target is ‘a reduction of 50-52 per cent’ compared to 2005 levels.

However, the NDC updates only narrow the gap to 1.5 degrees by 15 per cent at most.

Around 70 countries are yet to communicate new or updates targets. And several – Australia, Brazil, Indonesia, Mexico, New Zealand, Russia, Singapore, Switzerland and Vietnam – have submitted without raising ambition.

A successful outcome in COP26 is for developed countries to honour a 2009 pledge of mobilising $100 billion per year by 2020 to support climate action in developing countries. This goal has not been met to date.

The recent announcement by President Joe Biden to double US climate finance has been welcomed but more will need to be done to restore credibility and strengthen trust between developing and developed nations.

No doubt discussions at COP26 will focus on mobilizing finance but other issues will be touched upon, especially how best to operationalise the Paris Agreement’s.

Against this background, here below are COP26 main goals:

Securing net-zero by the middle of the 21st century in a bid to keep global temperature increases below the critical 1.5C threshold.
Making progress on climate adaptation measures to protect lives, ecosystems and economies from the impact of global warming.
Mobilising private finance to address the climate challenge.
Fostering international collaboration to accelerate progress on climate goals.

Ways your pharmaceutical business can get involved

The World Economic Forum has identified environmental degradation, climate and environmental disruptions (like extreme weather, droughts, wild fires and resource depletion) as the greatest dangers to businesses going forward.

This is because of the ability of these factors to reduce the availability of raw materials, disrupt supply chains, wither demands for goods and services, and change resource availability while increasing costs.

The New York Times referenced a study which asked companies to calculate how climate change could affect their business financially. After analyzing submissions for 215 of the world’s 500 biggest corporations, it was potentially put at $1 trillion in costs related to climate change.

But it’s not just the Fortune 500 firms that face substantial losses, because when the environment loses, the whole world loses. According to a report by insurance giant Swiss Re, the world’s global domestic product (GDP) could drop up to 18%, or $23 trillion, by 2050 if no action is taken.

Experts agree the poorest nations would be most adversely affected by climate change, although even the major economies would suffer irreparable harm. The U.S. GDP could dip as much as 10.5% by 2100.

This is not just an issue for companies that rely on oil, natural gas, or other natural resources. Any business that uses petroleum-based plastics (over 99% of plastic is produced using fossil fuels) along its supply chain or generates greenhouses gases has a part to play. The pharmaceutical industry is not immune – the vast number of precursors used in synthesis are petroleum derived, not to mention the energy used as well as other inputs need to make pharmaceutics.

This is why every company, irrespective of size, influence, or availability of resources, can and should make a collective effort to address climate change.

So here’s how pharmaceutical businesses can join the climate action plan and do their bit:

Set science-based and net-zero targets

Setting a net-zero target in line with a 1.5°C future is necessary for businesses to make a dent in limiting the worst impacts of climate change. Join the Business Ambition for 1.5°C, which is an urgent call to action from a global coalition of UN agencies, business and industry leaders, in partnership with the Race to Zero.

Take the lead by going 100% renewable

While many companies are already reducing their carbon emissions, they could go further and commit to using 100% renewable power and resources.

Switch to electric transportation

Keeping global average warming below the 1.5°C thresholds requires a large shift in the way companies operate. Making the switch to electric vehicles is something that many companies should immediately consider, if they have not yet done so.

Reassess supply chain choices

All good charity starts at home, and while companies can concentrate on their own internal practices, greater change can be achieved if businesses reach out across their value chains, and probe the environmental commitments of suppliers and partners to ensure they are aligned with their own environmental goals

Prepare to be held accountable

All around the world, people want companies to lead on climate change instead of waiting for governments. They expect CEOs to speak out and champion change and not just talk the talk. But expectations come with accountability, and businesses can soon expect the public to start demanding answers.

Final thoughts

Pharmaceutical businesses can play a pivotal role in achieving new climate targets, and also integrating needed changes. Climate changes creates risks to all businesses regardless of the exact outcome of the conference, with changes needed within corporate strategy, governance, finance and operations.

We hope that COP26 acts as a catalyst for businesses to set the new standards on climate stewardship, with a specific focus on practices and encourage them to step up to the challenge, tackling climate risk head-on.

Resources:

UN Climate Change Conference (COP26) at the SEC Glasgow 2021 (https://ukcop26.org/uk-presidency/what-is-a-cop)

These 5 technologies were supposed to change the pharmaceutical industry. They haven’t (and probably will never)

October 4, 2021

By Dr. Enosh Mwesigwa, Pharmacentral Guest Writer

Innovation in the pharmaceutical industry can have far reaching impact on society. Just think about antibiotics, vaccines or recombinant DNA (rDNA). Vaccines have enabled humanity to eradicate diseases like polio and smallpox in a single generation. The impact of rDNA technology spans medicine, agricultural and law and order.

But innovation is inherently risky. Numbers vary by firm but generally up to 90% of new product and service innovations fail to deliver expected results. When it comes to technology innovations, it could be even higher. By technological innovation, I mean improved or new processes that aim to provide significantly superior characteristics than before. These innovations are particularly important as they permit the creation of new productivity frontiers and new competitive positions as incumbents’ sources of advantage decline.

The high failure rates of new technology innovations correlate with a pervasive disconnect between what new technologies promise and the willingness by the industry to exploit them. Reasons for the gap (between technological potential and willingness to adopt that lead to so many genuinely promising technologies to remain unexploited) are complex, and explored elsewhere.

Here though, is my list of five highly anticipated technology innovations that have failed to scale and will likely never deliver new, cheaper medicines. It is not that they lack scientific fundamentals, for one reason or another, the distance between potential and wide-scale deployment has not narrowed and will probably never narrow for society to experience their full benefits.

Supercritical Fluid Technology

In the early 1990s, scientists started to explore how principles of green chemistry could be used to address excessive production of toxic solvent waste. Among the technologies considered was supercritical fluid technology (SCF), which was envisaged as an option for extractive and processing pharmaceutical processes. In drug delivery design, SCF promised to permit encapsulation of drug substances in polymeric systems at low temperature and in dry state, opening up additional manufacturing advantages. Money was liberally poured into SCF followed by a flurry of patents. However, despite its attractiveness SCS failed to become mainstream, perhaps due to the complex commercialisation landscape, which hamstrung efforts to adopt and exploit it.

Pharmaceutical 3D Printing

The wide-scale introduction of 3D printing technologies into the pharmaceutical industry started in the late 2000s as scientists imagined its prospects in pharmaceutical R&D. It was widely speculated 3D printing would enable scientists to produce small batches of badly needed medicines, each with personalized dosages, shapes, sizes, and release characteristics. Eventually, on-demand printing of personalised medicines would be possible in pharmacies, surgeries, vending machines and difficult-to-reach places underserved by traditional supply chains.

It is 2021 and the quest is, are we there yet? No. Are we likely to reach there? Probably not. As we have discovered, there are still many technical challenges in terms of cheaper raw materials, plus (and more importantly) a lack of scalability in the pharmaceutical industry, meaning that it will be sometime before we see 3D printing dominating the pharmaceutical manufacturing scene anytime soon. Instead, it will likely remain a fringe tool, useful in very limited instances, such as very early prototyping and academic institutions.

Artificial Neural Networks

Artificial Neural Networks (ANN) is a subfield of machine learning (ML) and artificial intelligence within the broader field of computer science. The underpinning idea in ANN is how past actions, observations and decisions can be used to make predictions or improve future decision, much the same way the human brain works. So by integrating AAN into drug discovery and development programmes it can permit automation of some important but repetitive tasks, and with soaring costs and tottering productivity, boost drug pipelines, reduce costs and speed up R&D. Thus, in the early 2000s, ANNs were widely trumpeted. In pharmaceutical development, however, it was soon found that ANN algorithms did not have meaningful statistical inference components to allow scientists to understand the accuracy of results or how they were derived. Another key limitation was the uneven and non-representative nature of data in drug discovery and development. These and many other factors have limited the usability of ANN, and instead, focus has shifted to ML and AI.

Bioinformatics

The field bioinformatics emerged to meet the huge data generated from the human genome project. Scientist envisaged bioinformatics as a bridge between experimentation and computation—enabling scientists to manage the huge volumes of data generated so that they could make sense of what lay behind it. From drug discovery view point, bioinformatics nirvana was the identification of a section of DNA that denoted a novel drug target for treating a disease, say Cancer, migraine or diabetes. As the years rolled on, data handled within bioinformatics become more complex, going beyond DNA strings to protein function and structure and cell signalling pathways. The euphoria around what bioinformatics could provide quickly begun to fade when it became apparent that that nirvana could not be delivered within the development timelines that were being expected. As a result, bioinformatics remains just that, a tool and service in support of experimentally driven research.

The Human Genome Project and Druggable Targets.

It has been two decades since the human genome was unveiled. During these twenty years or so, scientists have made enormous progress in applying genome information to diagnosing and treating diseases such as cancer, as well as identifying drug targets. In this sense, the value of genomics to disease genes is unquestioned, exactly how useful it is as a pointer to novel drugs remains to be seen. Indeed, many years after their identification, the genes involved in single-gene disorders such as muscular dystrophy and thalassaemia have proved to be not easily druggable as initially hoped. It is the same case for important diseases such as diabetes, high blood pressure and hyperlipidaemia, where successful identification of disease-linked genes is yet to pay dividends.

A comparative appraisal of the utility of broad-spectrum biocides

October 4, 2021

Dr. Enosh Mwesigwa, Pharmacentral Guest Columnist

This article reviews several antimicrobial actives widely used for antisepsis and disinfection. The focus is on the performance attributes of the most important broad-spectrum biocides and their use in homes and institutional settings.

Introduction

It is a plain fact that our ability to effectively control microbial proliferation is an innovation of the same standing as electricity and the internet in facilitating our modern ways of living.

Biocides supplement chemotherapeutics and underpin management of pathogen proliferation in food production, healthcare settings and many other environments where critical activities take place. Put simply, without biocides life would not be very different.

But first, what is a biocide? Generally the term biocide describes chemical agents that inactivate microorganisms (bacteria, fungi and protozoa), as well as viruses. Owing to its general applicability, other more specific terms, such as bactericide or fungicide, etc are often used. For more information on terminologies used, click here.

There are currently many different biocides available for use in antiseptic and disinfectant products, many of these have been in use for several years. They require careful selection since their indiscriminate and/or incorrect application can lead to sub-optimal results, and in the worst case scenarios, the development of resistant strains with catastrophic consequences for human welfare.

The purpose of this article is to review the properties and advantages of a selection of broad spectrum biocides with respect to their use in antisepsis, preservation and/or disinfection in the home or institutional settings.

Criteria used to select biocide

Antimicrobial activity is affected by many different factors, including formulation, presence of organic load, synergies, temperature, and concentration. With the emergence of resistant organisms the importance of using the most appropriate biocide products has become especially important.

Thankfully, there are guidelines from health protection agencies, such as the World Health Organisation and the Centre for Disease Control that we can use when evaluating a biocide product or chemistry:

Speed of action

Antimicrobial agents do not exert their actions immediately upon contact with microorganisms. Each product has a minimum “contact time” that’s needed in order for the biocide to exert antimicrobial effects.

In the case of disinfectants, contact time must be adhered to in order to achieve terminal disinfection. For instance, if a product were to dry out from the surface before its contact time has elapsed complete disinfection may not be achieved.

The ideal biocide is one that offers rapid and practical contact time, unaffected by formulation excipients, organic load or other external conditions.

Spectrum and Efficacy

In the microbial underworld, no single microorganism has a monopoly over the ability to cause us harm. And unfortunately for us, it is not possible to detect beforehand which microorganism is present on a given surface at a given time.

For this reason, having the option to select broad-spectrum biocides, including action on bacteria, spores, fungi and all viruses is highly beneficial. Thus, the ideal biocide has broad antimicrobial effectiveness, with the ability able to stop the proliferation of a broad range of microorganisms, including resistant strains.

Cleaning Capacity

A biocide’s cleaning properties are often overlooked, with emphasis instead being placed on spectrum or killing speed. However, cleaning efficacy is equally important because dirt and organic matter can create a barrier or protective reservoirs for pathogens.

Thus, a biocide that is also an effective cleaning agent can help eliminate the requirement for a secondary cleaning product. Biocides with concurrent surface active properties or products that include surfactants exhibit enhanced cleaning efficacy while ensuring complete and even coverage of surfaces with the biocide.

Compatibility

The optimum biocide is one that is compatible with and suitable for use on all surfaces. At the moment, there is no single material that exhibits 100 percent compatibility with all surfaces. A number of biocides do show excellent material compatibility profiles for their intended uses, but also fail miserably for particular applications or substrates.

For this reason, understanding and taking into account the likely uses of a biocide when formulating a product is necessary. Failure to do this can predispose users to reduced protection and greater harm.

User Health and Safety

As society modernises and ages the needs for infection control also grow, not just within traditional settings such as hospitals, but in the community and industrial settings as well. The resulting increase in exposure to biocides requires safer chemistries to be available. Thus, when selecting a biocide, chemistries that are non-toxic, non-irritating and non-sensitizing are highly desirable.

Environmental Profile

Increased introduction of biocide chemicals into the environment intensifies the need for chemistries that are sympathetic to the environment. It should not be forgotten that biocides are by their nature killing machines for microbes, both good and bad. Products that are non-selective, especially for aquatic life, are not sustainable in the long-run.

Properties and benefits of broad-spectrum biocides

Alcohols

In the context of biocides, ‘alcohols’ refer to a select number of compounds having the OH functional group and exhibiting antimicrobial properties. In this regard, ethyl alcohol, isopropyl alcohol and n-propanol are the most relevant.

The biocidal effect of alcohols is achieved through denaturation of proteins. Alcohols show rapid broad-spectrum activity against vegetative bacteria, mycobacteria, viruses and fungi. They inhibit sporulation but they are not sporicidal. Isopropyl alcohol is more effective against bacteria while ethyl alcohol is more potent against viruses.

Usage and Applications

Alcohols are mainly used as skin antiseptics in a variety of consumer products. Antimicrobial activity is optimal in the 60 to 90% concentration range. Lower concentrations can be used as preservatives and to potentiate other biocides e.g chlorhexidine.

However, due to their lack of sporicidal effects and inability to penetrate protein-rich materials, alcohols are not used as a sterilants for medical and surgical devices except for small implements, such as thermometers, pagers, scissors and stethoscopes but not for hard surfaces.

Alcohol wipes are used to disinfect small surfaces such as rubber stoppers of multi-dose vials or vaccine bottles or external surfaces of equipment.

Biguanides

Biguanides are organic compounds with the biguanide [-HN(C(NH)NH₂)₂-] functional group. Chlorhexidine is the most widely used biguanide within the biopharmaceutical field but other biguanides are also available, including polyhexanide and alexidine.

Chlorhexidine

Chlorhexidine is a cationic bisbiguanide that has been used in the UK over several decades. Depending on concentration, it exhibits both bacteriostatic and bactericidal action, mediated via its ability to disrupt microbial cell membranes and precipitation of cell contents.

Chlorhexidine is known for being highly effective against Gram-positive organisms as well as against Gram-negative bacteria (at high concentrations). It is effective against fungi, yeasts and enveloped viruses, such as SARS COV 2 and HIV. Chlorhexidine has a much quicker kill rate than many other antimicrobial agents. Activity against mycobacteria and spores is, however, limited.

Usage and Applications

Chlorhexidine is used in consumer topical products as an antiseptic. Typical usage levels are 2-4% in topical products.

It is also used as catheter lubricant (intra-urethral), as well as a component of medicated mouthwashes (0.12%). A number of medical devices, such as implanted surgical mesh, intravenous catheters and topical dressings incorporate chlorhexidine.

Within hospitals chlorhexidine is used as a disinfectant to prevent spread of antimicrobial-resistant organisms. In this respect, it is often referred to as the gold standard for infection reduction.

Iodine and iodophors

Iodine’s biocidal effects have long been known. However, owing to its skin staining and irritating effects, iodine is largely superseded by iodophors as the active ingredient in these antiseptics.

Iodophors consist of elemental iodine, iodide or triiodide, bound to a polymer carrier (complexing agent) of high molecular weight, such as povidone or poloxamer. Complexation of iodine with a polymer increases the solubility of iodine, promotes sustained-release of iodine and reduces skin irritation.

The biocidal mechanism of action is via the formation of complexes with amino acids and unsaturated fatty acids in the cystol of microorganisms, impairing protein synthesis.

Usage and Applications

Iodine is potently bactericidal against Gram-positive, Gram-negative and some spore-forming bacteria. It is also active against mycobacteria, viruses and fungi. Povidone-iodine is a safe and effective antiseptic. Most preparations used for hand hygiene contain 7.5–10% povidone-iodine.

An important property of iodophors is their “available Iodine” which refers to the total amount of iodine that can be titrated with sodium thiosulfate. Typical 10% povidone-iodine formulations contain 1% available iodine and yield free iodine concentrations of 1 ppm.

The downsides to iodine compounds is that antimicrobial activity can be affected by pH, temperature, exposure time, concentration of total available iodine and the amount and type of organic and inorganic compounds present (e.g. alcohols and detergents).

Silver Compounds

Silver is a transitional metal element. It may exist as a pure element, as an alloy in combination with other elementals, as a mineral or as an organo-metallic compound. Silver and silver compounds have a long history of use as antimicrobial agents. Some of the well-known derivatives include silver sulfadiazine, silver nitrate and nano or colloidal silver.

Silver and silver compounds have a long history of use as antimicrobial agents. Some of the well-known derivatives include silver sulfadiazine, silver nitrate and nano or colloidal silver. Silver’s antimicrobial action is thought to be through:

Pore formation and puncturing of the bacterial cell wall when silver ions react with peptidoglycan components
Entry of silver ions into the bacterial cell, inhibiting respiration and other metabolic pathways, and
Disruption of DNA replication.

Usage and Applications

Silver has a broad spectrum of microbial activity. It is active against bacteria, fungi and viruses. Activity is more pronounced against Gram negative bacteria than Gram positive bacteria. Colloidal silver nanoparticles are advantageous due to their lower toxicity and higher antimicrobial activity due to their ability to penetrate bacterial cells more easily.

At present, the main use of silver compounds is in the area of topical chemoprophylaxis of burns. In this sense, silver-impregnated dressings and antimicrobial coatings are commercially available for use in infection management and stimulation of wound healing as well as in dental amalgam.

Silver is also impregnated into medical devices, such as heart valves. Silver nitrate and Silver sulfadiazine are used as topical antibacterials for the treatment of skin infections, including acne.

Quaternary Ammonium Compounds

Quaternary ammonium compounds are a group of related compounds composed of a nitrogen atom linked directly to four alkyl groups of varying structural complexity.

In the biopharmaceutical industry, commonly used quaternary ammonium compounds are benzalkonium chloride, cetrimide, cetylpyridium chloride and cetrimonium bromide (cetyltrimethylammonium bromide (CTAB)).

While primarily bacteriostatic and fungistatic, quaternary ammonium compounds can be virucidal, too, particularly at high concentration. Biocidal action is initiated through adsorption of the alkylammonium cation on the cell surface, diffusion through the cell wall and disruption of cytoplasmatic membrane, which releases potassium ions and other constituents, leading to the death of the cell.

Benzalkonium chloride, one of the most common QUAT, is actually a mixture of closely related QUATS (mainly benzyl (dodecyl) dimethyl ammonium chloride, benzyl (tetradecyl) dimethyl ammonium chloride). It is a cationic surfactant with broad-spectrum antimicrobial activity, making it suitable for use as a preservative, antiseptic, disinfectant, solubilising and wetting agent.

Cetrimide mainly consists of trimethyltetradecylammonium bromide and smaller amounts of dodeyl trimethylammonium bromide. It exhibits good bactericidal activity, particularly against Gram positive species but is less so active against Gram negative species. Pseudomonas aeruginosa, may exhibit resistance. Antifungal activity is variable and it is inactive against bacterial spores and viruses.

Usage and Applications

Benzalkonium chloride is widely used in cosmetics, wet wipes, hand and surface sanitisers. It has also been used as a spermicide.

Benzalkonium chloride has also been formulated into lozenges for use in the treatment of common mouth and throat infections. It remains one of the most commonly used preservatives in ophthalmic and nasal preparations.

Cetrimide, on the other hand, functions as an antimicrobial preservative in cosmetics and pharmaceutical eye drops and topical formulations as well as an antiseptic in topical creams, sprays and medicated shampoos.

The other uses are as a cationic surfactant, cleanser and disinfectant for hard contact lenses.

Bispyridines

Octenidine dihydrochloride is a cationic antiseptic that belongs to the bispyridine class of chemical substances. A relatively new biocide, Octenidine was developed just over two decades ago. It exhibits broad antimicrobial activity and is effective against biofilm-forming organisms, including MRSA, plaque-forming bacteria such as Actinomyces and Streptococcus, Chlamydia and Mycoplasma and also binds to negatively charged surfaces.

Usage and Applications

Octenidine dihydrochloride is a versatile biocide intended for use in human and all animal species for skin and mucosal disinfection. It works well as short-term supportive antiseptic in wound treatment as a 0.1% aqueous solution for cutaneous use as well as for long-term antisepsis.

In addition, octenidine is used for sterilization of IV catheters, and in dental medicine, it is used as mouth rinse, gutta-percha disinfectant, for biofilm inhibition on restorative materials, and as an irrigant in root canal procedures. It has been utilised in mouth rinses to prevent plaque and gingivitis, as well as whole body wash for methicillin-resistant S. aureus decolonization and for skin disinfection of premature new-born infants.

Conclusions

The true test of a biocide is to demonstrate that the product has reduced surface bioburden, prevented proliferation or killed microorganisms. Given the variety of factors at play, the selection of an appropriate biocidal agent can be a complex and challenging process.

Finally, the selection of biocides should not be considered as a one-off decision; it must remain part of the on-going quality review process of the formulator and institutional user.

References

McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999 Jan;12(1):147-79. doi: 10.1128/CMR.12.1.147. Erratum in: Clin Microbiol Rev 2001 Jan;14(1):227. PMID: 9880479; PMCID: PMC88911.

Bloomfield, S. F. Resistance of bacterial spores to chemical agents. In A. D. Russell, W. B. Hugo, and G. A. J. Ayliffe (ed.), Principles and practice of disinfection, preservation and sterilization, 3rd ed., 2013. Blackwell Science, Oxford, England.

CITATION

When referring to this article, please cite as: E. Mwesigwa, A comparative appraisal of the utility of broad-spectrum biocides. Pharmacentral Science and Technology Bulletin 01 (09) 2021

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How to navigate the global chip shortage crisis if you buy pharmaceutical equipment

August 1, 2021

Thinking of purchasing new pharmaceutical equipment? These are our tips on how you can minimise the global chip shortage impact on your operations.

The global chip shortage crisis is already being felt across many industries. While most of the news has focussed on the auto industry, industries ranging from medical devices to home appliances and consumer electronics are experiencing a crunch. In this article, we provide a status update on chip shortages and pharmaceutical equipment manufacturers.

By Emma G McConnell, Science Reporter

What’s driving the global semi-conductor shortage?

In a nutshell, a surge in demand from the consumer electronics industry and supply-side disruptions.

With up to 75% of global chip supply coming from Asia, some of the supply-side disruption can be tracked back to COVID-19. But the problem of chip shortages in all equipment categories (automotive, medical, home appliances, etc) we’re experiencing runs deeper than the pandemic.

The main issue is one of raw material shortage. Imagine all the devices and equipment that use chips, not just the pc or laptop or mobile device you’re using to read this but countless other smart devices. Audio, Wi-Fi chips, imaging devices, process control modules, and displays. All these compete for the same semi-conductors and materials as they rely on the same technological underpinnings. So as chip usage has grown, raw materials shortages have become an increasing problem.

A few companies have exacerbated the crisis by stockpiling chips

It has been widely reported that a few companies—for example, in China—embarked on stockpiling chips in the hope of riding out the chip shortages. Unfortunately, this action has only compounded shortfalls, making it difficult for other equipment manufacturers to get in chips they require.

“Pharma equipment manufacturers are have reported no supply disruption”

What are the long-term consequences of chip shortages?

The good thing is manufacturers of pharmaceutical equipment have been aware of microchip shortages and have been exploring ways to avert any potential disruptions. All the companies we recently spoke to, including IMA, GEA and Agilent said they were not experiencing supply disruptions and delays. A sales manager at Freund Vector echoed the same sentiment when asked by PharmaCentral.

Things may be different with other companies so it’s important to assess how microchips are relevant to the company and how shortages may affect you as an equipment buyer. Speak to sales managers and ask them to confirm whether you may expect:

Longer wait times to have orders fulfilled and shipped
Specific brands shortages meaning that you may have to select alternative brand or model
Price increases

For now, the message we’re getting is that there’s no need to panic, even though many experts believe the impact may carry into 2022.

As a buyer of equipment, what practical steps can you take to mitigate the impact of pharmaceutical equipment microchip shortages?

PharmaCentral recommends several proactive steps you can take today to help minimize the potential impact of chip shortages and manage challenges.

Plan well ahead

The number-one recommendation for buyers of pharmaceutical equipment is to plan ahead. If you expect needing equipment within the next 6 to 12 months, consider ordering it now—so you’re at the front of the line as companies work through their production backlog.

It is advisable to take time assessing whether you need to acquire new technology as part of your ongoing hardware lifecycle management, perhaps to support projected growth, or to have inventory on hand to replace non-functioning equipment. This prevents having to compromise or troubleshoot around a long-term delays .

Factor in some delays

Even if you place an order now, fulfilment times may be longer than expected. So it’s advisable to plan for delays. Communicate with your vendor to have visibility of timelines, and manage expectations with your stakeholders accordingly.

Be flexible

As a company or individual buyer, you may have a preference for specific brand or model of equipment. This is understandable. However, you should be open to being flexible if the brand or model of equipment you always buy is on backorder. Consider other brands and models even if they are not the exact model or brand you are familiar with so as to minimise disruptions.

Evaluate other options

Purchasing hardware isn’t always the only option. Remember, the main reason for acquiring equipment is to support a specific process or objective. This business objective can be supported through leasing or outsourcing. The decision should be based on detailed assessment of requirements and all options carefully costed.

While pharmaceutical equipment chip shortages are yet to be felt, the global crisis will likely linger a little longer. It is likely that pharmaceutical equipment buyers will see some impact over the next several months. The message, though, is that if you’re looking to buy equipment, there is no need to panic. Be proactive, flexible, and think strategically ahead.

European Patent Office 2020 Annual Review report published, reveals successful year, despite COVID-19 challenges

July 8, 2021

The European Patent Office published its Annual Review 2020 report on 29 June 2020. The report which was accompanied by a video, reveals a year of accelerated change as the organisation seeks to adapt to many challenges from COVID-19 pandemic.

The Annual Review 2020 shows that demand for European patents has remained nearly on a par with last year. A total of 180 250 European patent applications were received, representing a 0.7% drop compared with 2019. In addition, the Office published 133 715 European patents in 2020, -3% compared with 2019, but well above its target of 120 000.

The pandemic arrived at a time the Office was in the midst of implementing its Strategic Plan 2023. So it was necessary for the organisation to switch to a mostly virtual working model and be highly flexible. The review recognises the significance of these two factors to many of the main achievements and activities of 2020, which are outlined in the review under each of the Strategic Plan’s five clear goals.

You can find all details about this report on the EPO website or through this link.

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When referring to this article, please cite as: E. Mwesigwa, A comparative appraisal of the utility of broad-spectrum biocides. Pharmacentral Science and Technology Bulletin 01 (09) 2021

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