Monthly Archives: December 2024

Reflections Upon Political and Phamaceutical Deceits Perpetuated During the Covid Years – An Epitaph to Humanitarianism in Modern Times

DOI: 10.31038/PSYJ.2024651

 
 

A almost laughable to ponder upon where it all started and nearly grim and shameful when we realise as humans that we are reckless, careless, and foolish (Santosh Kalwar).

Looking back upon Covid’s entry into our lives, in the following narative we remove the wrapping of fraudulent news, to reveal how the spectre of a pandemic was used to coerce society into submission. To thank for all this we note the co-ordinated forces of a greedy pharmaceutical industry, shadowy governmental control plus an over-trusting population compliant in their own ruination. Not to mention the related pandemics of bankruptcies, depressions and suicides subsequently fermented. Ongoing are the results of ineffective vaccinations [1] causing more hospitalisations than the original virus (dones 2022); growing cases of autoimmunity [2]; nor is this yet over for the consequences are with us still [3,4]. Many vaccine effects are being covered-up by the term long-covid, where the guilty blame the disease rather than the longer term effects of vaccination. If this weren’t enough, and especially pertinent to modern times, are long-lasting effects steming from destruction of human rights and desecration of the human soul. As psychotherapists we see it in our clients plus those upon the streets. At the last, through complience, we all played a part in this all too real-life horror story. Many who previously believed in a more humane, just, compassionate and democratic society, now realise they were hood-winked into allowing all that’s best in us be destroyed. It’s not entirely our fault we fell for the prevailing chronicle, were we not primed to believe that politicians and medical experts, for all their personal flaws were trying to do the best they can? But to enhance compliance, governments used mass psychology and orchestrated fear [5], plus censored news [6] to keep us malleable. These ploys worked excellently and on far too many are working still. But now, finally, we perceive a wind of change blowing in the air (Mandavilli New York Times 202@. Indeed, the public’s belief in vaccination, since Covid, remains still at an all time low [7].

From the jig-saw of information arrayed below, drawn from multiple research studies, social and statistical surveys, news leaks and the accounts of ex-insiders at tbe time, we invite you to build your own picture, very different from the one officially broadcast by government, news media and big pharma – all guilty agencies who had a vested interest to supress the truth. Personally, although we would love to believe otherwise, reading between the lines it appears likely a group of powerful people regard the ordinary members of the public as surplus to their requirements. We, the public, don’t see through all this because evil makes us feel bad, sad, desturbed and deeply uncomfortable; so we resist accepting the world could work this way, for denial of unpleasant reality is part of our everyday coping mechanism. Nevertheless, uncomfortable facts must be faced if we are to awake fully to what’s before us. With Covid, even if we accept pharmaceutical bribes, commercial corruption and medical incompetence, there has to be another over-arching agenda for conspiracy of this proportion to thrive? How could blunders of such magnitude have been tolerated, condoned and succesful without large scale subterfuge sanctioned by our appointed guardians and rulers? There are few nurturing parents in our story, but many controlling and power-hungry ones. Are we then ‘Lost Children’? Regards the criminal reasons behind the Covid pandemic, the following are most widely circulated in public fokelore:

  1. Culling of the world population via vaccination;
  2. Experimental Implementation of mass control;
  3. Pathing the way for an economic power-driven global financial re-set.

Sadly, there is some confirmation these were designed to work hand-in-hand.

Everyhing ofcourse remains unproven to the uninformed public eye, but disturbing enough data nevertheless keeps pumping out via litigation within law courts, whistle blowers jumping ship and courageous individuals like J. F. Kennedy Jr [8] for us to consider some pretty shocking accusations, which we survey under the following headings:

Suspicions of a Plan-demic…

Bribes and inflated figures of pandemic deaths…

Formally denied side-effects of vaccinations now emerging…. The ineffectiveness of vaccination…

Culpability of Big Pharma…

Draconian intentions of governments and WHO… Press and News Supression…

Over-estimation of vaccine take-up…

Under the above we share factual reportage prior to a brief synopsis, and at the close share a summary of our findings and personal impressions.

We hope the information herein will bring you upto speed and initiate you into the ranks of the ‘informed public’.

Looking back at our earlier reflective studies listing lethal side-effects and the ineffectiveness of vaccines, bribery in high places and corruption plus propoganderisation of the news [9,10] are all too sadly proving true. After reading this article you will have to hand sufficient data to make up your own mind.

What a story to tell the world how Coronavirus has become impotent and Triendless to reward ultra rich with more rights (Qamar RaTiq).

Suspicions ofa PlanQemic

“Each wave of terrorizing creates its effects more easily — añer a breathing spell — than the one that preceded it because people are still disturbed by their previous experience. Morality becomes lower and lower, and the psychological effects of each new propaganda campaign become strongep it reaches a public already soñened up” (doost Meerloo).

The Research and Evidential base:

In 2017 and 2018 every nation on earth started buying and selling millions upon millions of virus test kits labelled ‘Covid19 Test Kits’, you can still see this on the website of the World Integrated Trade Solution! How could so much be prepared and so many nations be in ‘the know’ so early on? What is more, only five months before the coronavirus outbreak WHO instructed all the nations to immediately prepare for an imminent World influenza pandemic. Similar foresight caused the Australian government to publish a manual for a coronavirus pandemic, a few months before it even surfaced.

  • If the above weren’t enough to raise suspicions, why do American Government records show that the S. Department of Defense (DOD) awarded a contract on the 12th November 2019, to Labyrinth Global Health Inc, for ‘COVlD-Research’, interestingly in the Ukraine, one month before the alledged emergence of novel coronavirus and 3 months before Covid was officially dubbed Covid-19 or even known to exist? Further more, in relation to this spectre of bacterial warfare, Peter Daszak appears as a bridge, in that he was previously involved with weaponising drugs and subsequently employed by the US government as a Covid Health Advisor. And his health advice? In a minuted public meeting: he advised “We must create public h)/pe to get the public to accept an international virus vaccine”[11]. What are we to make of this? In relation to the link of germ warfare to Covid, although Corona virus was declared a dead issue and supposeably written off by WHO in 2007, why did the US government continue to spend millions of dollars upon it? Could it be Corona was still seen as a highly malleable bio-weapon so its research went underground in military laboratories? More disturbingly, it appears we all eventually became the enemy it was directed towards!
  • The person who technically owns the World Health Organization through his financing of it, is Bill Gates, the number 1 vaccine dealer in the world, who predicted: ‘There is no doubt in an)/one’s mind that we will experience a surprise outbreak of an infectious disease during the first term of the Trump administration’ (Kennedy 2021). Such foresight! He even went on public record threatening “We’ve Not Seen the Worst of Covid”. Clearly a continuing pandemic mind-set was in certain people’s interests. It is common knowledge that The World Health Organization had an official plan primed for 10 years of ongoing infectious diseases in waiting, from 2020 to 2030, which they entitled ‘A Decade of Pandemics’ – all ready and willing to go when Covid arrived! 2030 is also the year when ‘Agenda 2030’, a formally recognised United Nations, WHO and Bill Gates initiative geared to a worldwide centralization of eco-political power is envisaged as coming into Again, it appears someone knows something we don’t and is merrily planning a take-over!
  • To iron out any further doubts consider again Dr David Martin’s testimony to the Corona Investigative Committee [12], in which he states: ”The National Institute of Health’s grant Al23946-08, issued to Ralph Baric at the University of North Carolina at Chapel Hill (officially classified as affiliated with Dr. Anthony Fauci’s NlAlD by at least 2003), shows they began work on synthetically altering the Coronaviridae (the coronavirus family for the express purpose of general research, pathogenic enhancement, detection, manipulation, and potential therapeutic interventions targeting Covid, as early as May 21, 2000, at which time Dr. Baric and UNC sought to patent critical sections of the coronavirus family for their commercial benefit”(Ibid). In one of several papers derived from work sponsored by this grant, Dr. Baric published what he reported to be the full length cDNA of SARS CoV in which clearly stated that SAR CoV was based on a composite of DNA segments: “Using a panel of contiguous cDNAs that span the entire genome, we have assembled a full-length cDNA of the SARS-CoVUrbani strain, and have rescued molecularl)/ cloned SARS viruses (infectious clone SARS-CoV) that contained the expected marker mutations inserted into the component clones”(Ibid). In line with this, on April 19, 2002, the Spring before the first SARS outbreak in Asia, Christopher M. Curtis, Boyd Yount, and Ralph Baric also filed an application for U.S. (Patent 7,279,372) for a method of producing recombinant coronavirus. In the first public record of these claims they sought to patent a means of producing: “an infectious, replication defective, coronavirus”. In short, the U.S. Department of Health and Human Services was involved in the funding of amplifying the infectious nature of coronavirus between 1999 and 2002, way before SARS was detected in humans. Following evidence of the Patents Office how can we ever doubt that Coronavirus came from a lab? With great difficulty we respectfully suggest. Many portants of the Covid have reached the public since 2000, which caused some to suggest we were being softened up for the kill! In 2003 the TV series Dead Zone aired an episode entitled ‘The Plague’, showing a coronavirus pandemic. Everything we have experienced was shown: Chinese origin of the virus, masks, lockdowns, quarantines, test swabs! Even the cure was mentioned: chloroquine! In like vein, a musician in 2013 composed a song about a coronavirus pandemic, that would occur in 2020! He said he could predict this because he had been investigating so called ‘conspiracy theories’. Supporting the notion that some people knew before-hand about the pandemic, in 2006 a movie was also released called V for Vendetta, which depicts a coronavirus pandemic that results in worldwide tyranny. The theme repeated throughout the movie is ‘This is for your safety”! So clairvoyance or something else more sinister? One has to ask were we being subject to subconscious psychic preparation and subliminal preparation? Even the UN got into the act of prophesying the pandemic when in 2012 it published a comic book titled ‘INFECTED’, which tells the story of a global pandemic that starts in a market in China, leads up to worldwide medical tyranny which is praised as the best solution. You can download this comic from the UN website cited in the bibliography of this article {U/V 2012). Taken together, all these tend to suggest, as in mass psychology, we were possibly being primed and softened-up (an old KBG ploy) to expect a pandemic?
  • Dr. Reiner Fuellmich, is an international trial lawyer who has successfully sued large fraudulent corporations like Volkswagen and Deutsche Bank, has a worldwide network of lawyers who have listened to over a hundred experts from every field of science. Reiner claims to have collected undeniable evidence that the Covid pandemic was in fact a planned criminal operation. According to him, a second Nuremberg trial may be needed to prosecute all who are complicit in this unprecedented crime against humanity. Besides enrolling international lawyers and a judge, Dr. Fuellmich has organized a Grand Jury proceeding, where experts from the WHO, UN, CDC, Pfizer, Military, Secret Services are all presenting evidence that Covid was a criminal planed operation [13]. Either Dr Fuellmich has gone mad and his many witnesses likewise, or mass conspiracy is well nigh proven! Note that a criminal court in Peru has already ruled that this pandemic is a criminal operation run by Bill Gates, the Rockefellers, George Soros and other billionaires! But don’t worry, it may only be another conspiracy theory for us to dismiss!
  • The notion of a plandemic is further credited by the testimony of Marion Koopmans, a WHO virologist from the Netherlands working at the Wuhan bio-lab, who confirmed on Dutch television that the World Health Organization had been working on the Covid agenda for many years, while at the same time developing a Pandemic Treaty, which gives them complete totalitarian control over all the nations in the world, so that whenever they declare a pandemic, something they can do whenever they want based on any test they choose – governments had to obey! Luckily WHO’s megalomaniac macinations of a Pandemic Treaty was derailed by a consortium of 3rd World nations and Russia, who refused to sign their consent, though it had been already signed by governments in Europe and the USA.
  • As widely predicted, another “pandemic”, namely Monkeypox (dones 2022), stands currently waiting in the wings poised to take Covids This infection mimics many of the symptoms of COVID jab- induced shingles — so much so, the Department of Health in Queensland, Australia, used the same photo to illustrate both infections (the photos have since been removed from the website). Please note: “Unless there has been some genetic alteration, either through evolution or intentional genetic manipulation, fmonkeypozj is not a significant biothreat, and has never been considered a high threat pathogen in the past. So, stop the Tear mongering, misinformation and disinTormation”Dr. Robert Malone (Fearless Speech). Monkeypox is a virus endemic in Africa which emerges sporadically after transmission into humans from animal hosts; is typically spread by close human contact and is readily controlled by classical public health measures. It does not have a high mortality rate. So please please remove from your mind the necessity of standing in line for your Monkey-pox vaccination. Ask also what happened to Omicron, Delta and Alpha? Did they just go out of fashion as fear mongering moved on?

Authors Comments: The conspiratorial nature of Covid was picked up early [14,15] and its man-made origins confirmed in records from The Patents Office January 2000 to June 2008, firstly addressing investigation of canine coronavirus gene uses on Jan 28th 2000) by Pfizer Inc (https.fff patents.justia.comfpatentf6372224);in the subsequent isolation of Corona virus from humans on April 12th 2004, also by Pfizer (https.fffpatents.justia.comfpatentf7220852);plus in the ongoing investigation into antiviral agents for the treatment, control and prevention of infections by coronaviruses on Apr 28th 2004 by Sequoia Pharmaceuticals Inc (https.fffpatents.justia.comfpatentf7151 163); finally, and most incriminating of all, by the investigation of amino acid sequences directed against envelope proteins of a virus and polypeptides for the treatment of viral diseases upon Jun Sth 2009 by Ablynx N.V (https.fff patents.justia.comfpatentf919378). It all becomes very difficult to believe that Coronavirus came from any other than a lab or that it was ever a new or novel strain. Sceptics amongst you please click any one of the above patent references to see for yourself. WHO, appear to have very powerful political ambitions on a world wide scale, not forgetting a principle funder in vaccine multimillionaire Bill Gates. Personal and comercial interests, we suggest, may have corrupted WHO’s stated purpose. We all tend to forget how large commercial enterprises have more wealth than many countries and wield much more power than most nation states, enabling their wealthy owners to force ‘their version of reality’ on us. Add to all this Patent Office records extending back to 2000, military involvement, leakage from public meetings and overlap of warnings from whistle-blowers, plus preparation of the public mind-set by pandemic films and dramas, and the notion of a Plan-demic, to our minds, is much more than merely circumstantial What is more, WHO in trying to push through Monkeypox as an International Emergency, even though US Government data agrees it is impossible to distinguish between Monkeypox, chickenpox and shingles, all appear highly invested in repeating their earlier Covid success! More tellingly, as the Covid-1 9 vaccination increases the risk of singles by a shocking 4925Oó (The Ezpose 2022Ç, they would appear to have set the conditions for a further pandemic? Unsurprisingly the main clusters of Monkeypox (vaccine induced shingles) are emerging in areas where Pfizer vaccinations predominated! Intriguingly, when I clicked on Dr. Reiner Fuellmich’s website and sites relating to his legal legal actions against Covid, most were rapidly blocked or otherwise made impossible to access! A host of attacks on the validity of his inquiry also litter the net. This is common practice I find when ‘the authorities’ and Google do not want discomforting facts to energe!

“Menticide (brainwashing) is an old crime against the human mind and spirit but systematized anew. It is an organized system of psychological intervention andjudicial perversion through which a fruling class can imprint their own opportunistic thoughts upon the minds of those they plan to use and destroy” (doost Meerloo).

Bribes and Inflated Figures

“We’ve seen repeated cases of corruption, and that is the second pandemic in many ways” (dohnathan Cushing Transparany International Global Health Team)..

The Research and Evidential base:

  • Dr Scott Jensen, Senator of Minnesota, put on public record via Fox News, that “Hospitals receive as much as 13,900 dollars for every patient they register as Covid-19. For every death resulting from Covid-19, that amount is tripled to. 30,900 USD”[16]. On a far lesser scale some Romanian GPs offered a hundred pounds to poor peasant folk in the provinces to take the vaccine! If that much was offered to patients how much were GP’s themselves getting? We personally have already uncovered, locally in Romania, monetary incentives for re-classification of those otherwise dead, to Covid deaths.

One of the informants for our earlier articles was an Orthodox Priest who was asked to confirm a Covid death for a road traffic accident victim. He refused and went public on TV! Also consider, death from any cause within 28 days of a positive test for SARS-CoV-2 was recorded in several countries as a “Covid death”. With case-rates and Covid deaths highest among the Triple Vaccinated many governments are now asking where did the ‘Science’ of the pandemic go wrong? The hype and the statistical facts don’t add up!

There are literally scores of viruses, even common cold viruses, which infect the human airway in elderly and infirm people to give rise to severe illness. But these appear to have been intentionally or accidently re-coded as Covid-19 – how else can we account for the disappearance of the common cold and seasonal influenzer during our Covid years? Least we forget about prior conditions contributing to Covid deaths, of 29,135 Covid deaths registered in Romania until April 2021 (Statistica, 2021), only 227 were admitted by the Minister of Health to have died of Covid alone, without severe aggravating prior conditions! Thus proving a massive exaggeration of figures to the tune of 28,908 excess deaths! A similar over estimation of deaths was similarly reported in the UK and USA. Please ask yourself why was it so important to lie to us by official bodies?

Authors Comments. Obviously, there was a concerted effort from many quarters to inflate and escalate Covid figures to glorify the pandemics potency. Bribes were also paid to this end and health policies modified. Why was it important for us to be deceived? We mentioned in an earlier article that if you once test positive in the UK, you can end up being registered ‘Covid positive for life’, to later be attributed ‘a Covid death’ statistically. In this way viral deaths soar frighteningly and swell existing figures. Not surprisingly, in this fear inducing context, no figures for recovery from Covid were ever circulated thus magnifying its potential as an imagined death sentence in public eyes. As we have evidence of the UK weaponising fear [17], we shouldn’t be too surprised by this petty dramatisation. More peturbingly, is money the main reason for all this? Or is there something more sinister afoot? De- populatuon perhaps? So does Covid and its vaccination shade into this? The argument politicians like Kissenger [18] and philosophers such as Yuval Noah Harari [19] espouse, is “we need to depopulate the planet out of necessity or we won’t survive as a species”. It’s an old cover story. Evil always believes itself to be doing good. Over-population and the burden of an aging populance have been live issues for many decades. The older we get the more pressure we put on state pensions, health services and public spending. Should a man of my age of 76 in light of such logic then be let live?

°The masses have never thirsted añer truth. They turn aside from evidence that is not to their taste, preferring to deity error, it error seduce them. Whoever can supply them with illusions is easily their master; whoever attempts to destroy their illusions is always their victim”(Gustav Le Bon)

Formally Denied Side-effects of Vaccinations Now Emerging

“Maybe it is not COVID-19, but the government should come out and explain what’s causing these deaths. We don’t have the freedom or the Tacts to say iT it is COVID-19” (AdoIT Mkono).

The Research and Evidential base:

  • Official UK Government data shows a 73Oó increase in the number of Young Adults and Teens suffering Heart Attack, Myocarditis and Stroke since the Covid-19 Vaccine roll-out. Another study found Covid-19 Vaccination increased risk of suffering a Stroke by 11,361Oó [20]. Is this just the tip of the iceberg? When they discovered there was a spate of heart attacks in children post vaccination, ‘Pfiser added an extra anti heart-attack ingredient (The Ezpose 2021), as if to acknowledge their culpability around vascular side-effects, ‘Sudden Death Syndrome’ appears to be a catch all diagnosis, invented by medics to cover vaccine induced heart attacks, such as the worrying number of Professional Athletes (890) who suffered cardiac arrests and deaths (579) post vaccination, and FIFA’s increase in Football Deaths to the tune of 300Oó over the past year (The Ezpose 2022e). So much evidence yet authorites are still loath to link it formally to But its not just strokes, why are so many post vaccination also going blind? And how come Covid-19 vaccination increases the risk of suffering miscarriage by 1517Oó? And the poison cherry upon the vaccination cake, a recent study found Covid-19 Vaccination increases risk of Death by whatever cause by at least 4,800Oó{//tid}/ Just let that sink in! Do you remember queing for your booster shot? Lucky you – not!
    Data recently published by the UK’s Office for National Statistics indicates that it only took 4 to 5 months after a Covid-19 vaccination for so much damage to be done to our immune system that some suffered death (The Ezpose 2022c), many are still suffering now (Dutcher et al 2024; & Lam et all 2024). In light of this, whilst we were all distracted by the Russia-Ukraine war, the UK Gov. confirmed that the Triple Vaccinated seem to be more rapidly developing Acquired Immuno-deficiency Syndrome (AIDS) than others, a finding also confirmed by a follow-up Canadian study. The damage has sadly been done, and we, the guinea-pigs,p are still bearing the consequences.
  • A New Modelling Study, no doubt funded by Big Pharma, goes against all others to conclude ‘Unvaccinated are a danger to the Vaccinated’; but Real-World Data and a growing number of authenticated studies prove COVID Vaccines increase risk of Covid infection by around a whopping 400Oó! There was an obvous war of disinformation going on out there. Andreas Schíifbeck, a director of a large German medical insurer, reported his company’s data indicated serious adverse effects were running at approximately 1 0 times the official rate reported by the Paul Ehrlich Institute (PEI), the official German vaccine regulator. Mr Schíifbeck got summarily fired for his troubles, despite only calling for further anaIysis. Two months on, an extensive study at the Charité Universitãtsmedizin Berlin (a large medical research university owned by the Federal State of Berlin in Germany), came up with data from long-term observational research sustaining his concerns. They reported: “The number of serious complications a€er vaccinations against Sars-CoV-2 is 40 times higher than previously recorded by the Paul Ehrlich Institute” (HART 2022). They further observed that suspected cases are not officially reported, and so the numbers of serious vaccination reactions at the Paul Ehrlich Institute remain significantly lower than in the Charité study (Ibid). As under-reporting is standard, it is estimated that only 1 0Oó of serious reactions and between 2 and 4Oó of non-serious reactions were ever If only government advisors and others had read the British Medical Journal’s warning and hesitated longer before adopting experimental and untested vaccinations [21]. Sadly, the BMJ’s caution fell on deaf ears.
  • Damage to our immunity by vaccination just won’t go away, a CDC (Centre for Disease Control & Provention) study found Covid-1 9 Vaccination increases risk of suffering Autoimmune Disease Myocarditis by 13,200Oó; another demonstrated that children’s risk of death due to lowered immunity increases by 51 00Oó following Covid-1 9 Vaccination compared to Unvaccinated Children (Office of National Statistics data). Add to this a more recent peer-reviewed study by Scandinavian researchers who looked at 1 million people in Denmark, Finland, Norway, and Sweden, that concluded almost two years ago, that the mRNA-based CVD ’gene vaccines’ caused myocarditis and pericarditis, and we can’t say we weren’t fore-warned. Heart and vascular conditions, plus autoimmunity, shout out in all statistical returns
  • but where is investigative journalism on all this? Nowhere! The National Health Service has also confirmed, in response to a freedom of information request, that ambulance call-outs relating to immediate care required for heart conditions doubled in the whole of 2021 and are still on the rise in 2024. But the most concerning figures, published by The Office for National Statistics, reveal that between January 2021 and March 2022 a total of 69,466 people died within 28 days of Covid-1 9 vaccination, and 1 09,408 people died within 60 days of vaccination in England [22]. Where were the news services? Why were we not informed of the facts? Doctors were also reporting, somewhat paniced, that a sudden upsurge in ’Sudden Adult Death Syndrome’ had emerged amongst vacvinated adults under the age of 40. Consequently, GP’s are still urging all under 40’s to go for a heart check-up. Covid-1 9 Vaccination is also being blamed for the UK Office for National Statistics data showing vaccinated adults aged 18 to 39 having a 92Oó higher mortality rate (per 1 00,000) than unvaccinated adults. Public Health Scotland data similarly reveals there has been a 67Oó increase compared to the historical average in 15 to 44-year-oIds suffering cardiac arrest, myocarditis, stroke, and other cardiovascular diseases since this age group was offered Covid-1 9 injections. One can understand full well why the pharmaceutical companies negotiated a no sue no liability clause in their supply of public vaccinations with side effects running rampant even today! Again, we have to accept the fact that untested vaccinations and profits came before responsibility for maimed lives!
  • Talking to grave diggers in our local cemeteries, we were personally informed, that since Covid the death rate amongst the young and old has tripled!

Authors Comments: Panic appears to be growing in many governments as the Fully Vaccinated have a higher Covid Hospitalisation-Rate than the Unvaccinated. Growing figures also testify to the inefficiency of masks, lockdowns, vaccinations, Covid passports, thus opening the door for litigation! The more so as AIDS; as viral authorities predicted is still showing-up as a fact of full vaccination. Is it not time we stopped calling the pandemic of heart attacks in the young ‘Sudden Death Syndrome’ and give them their real name, ‘Death by Covid Vaccination’? This is after all the true cause, as most governments well know. But why should governments support the truth when it means political suicide? Understandably, medical doctors who supported vaccination and advised their community accordingly, are also reluctant to share statistics which make clear that Vaccinated Young Adults have a 92Oó higher mortality rate (per 1 00,000) than Unvaccinated Young Adults. Combine all this with ambulance call-outs for heart illness having doubled since the beginning of the Covid-1 9 Vaccination Campaign, and orthodox medicine, it would appear, has hung itself by its own petard! But the wall is crumbling, for even a World Health Organization study [23] concludes risk of suffering Serious Injury due to COVID Vaccination is 339Oó higher than the risk was of being hospitalised with COVID-1 9! It is interesting timing for WHO to now expose the inefficiency of vaccines, the very things they pushed – are they changing sides in order to survive the incoming tide turning against them? When WHO and the BMJ agree on a point, it can’t be ignored. Will Big Pharma do the same and fess up we wonder? Insurance companies, who have no reason to lie, in reports from 201 9 (the last normal year before the pandemic) to 2020 (the year of the Covid-1 9 virus) report an increase in Group Death Benefits of only 9 percent; but group death benefits in 2021 when vaccine was introduced, increased 164 percent. Indeed the precise numbers for Group Death Benefits taken from Lincoln National’s annual statements for these years are 201 9: 8500,888,808; 2020: 8547,940,260; 2021: 81,445,350,949 [24]. Please read these figures again. When commerce is God, all else, morals and Christain virtues it seems become expendable. There is also another area we need consider, assisted deaths. It is now being suggested in several quarters, somewhat cynically, that we gave up two years of our life because Midazolam was used prematurely to end the lives of thousands of over 70’s in care homes (Telegraph 2021), though relatives were told their next of kin had died of Covid-1 9. Legalised murder no less! Looking at the bigger picture, we were conned by health and government alike into believing Covid was so very very lethal! So the alternative motive? Euthanasia or an experiment in mass population control? Such notions as these we deemed unbelievable prior to Covid, but many now believe they are are worth considering – so low is civic trust! Lastly, regarding the prospect of vaccine induced AIDS, this was prophesied by an official German Government study in January 2022 [25], it came right on cue explaining many of the associated peaks of illness earlier described and is with us still. The amazing thing is, some people thrive following triple vaccination, so research is acutely needed to identify catalysts that counter the effects of vaccination; but here’s the catch, grants for remedial research can’t be allocated until vaccine damage is openly accepted – and there remain forces at work hell bent on preventing this!

“Logic can be met with logic, while illogic cannot – it confuses those who think straight. The Big Lie and monotonously repeated nonsense have more emotional appeal… than logic and reason. While the fpeople are still searching for a reasonable counter-argument to the Tirst lie, the totalitarians can assault fthemj with another” (doost Meerloo).

The Ineffectiveness of Vaccination

“Success belongs to those who accept mistakes as stepping stones” (Hermann d Steinherr)

The Research and Evidential base:

  • At the height of the Covid pandemic a report noted 89Oó New Covid Cases were mostly within the fully vaxxed, another that the fully Vaccinated accounted for a shocking 73Oó of all Covid-19 Deaths across New Zealand since the its beginning in March Indeed, triple/double Vaccinated accounted for 81Oó of the record breaking numbers of Covid Deaths in New Zealand as late as March/April 2022. Simply, in terms of Covid and its variations, we are currently in the midst of a pandemic of the vaccinated! There is also another factor worth considering: “Those who had received a second dose over siz months ago had higher monthly ASMRs {Autonomous Sensory Meridian Response) for deaths involving COVID-19 than those who had received a second dose less than siz months ago, indicating possible waning protection from vaccination over time” (Office for National Statistics 2022). With the risks of side effects and waning effectiveness, vaccinations appear to exacerbate the problem rather than resolve it! But if immunity is being compromised by vaccination is it any surprise more vaccinated folk are getting infected?
  • Pfizer research data of 80,000 pages, ordered recently to be delivered to the law courts by a High Court Judge, whom they had approached for the opposite, namely 50 years legal restriction from public access under the Data Protection Act, proves beyond doubt they knew that vaccinations harmed pregnant women and that the vaccine was only 12Oó Though they claimed it to be 95Oó successful! So what can we trust about them? It would appear nothing! As I write this the Federal aurhorities are still investigating executives of Pfizer to possibly charge them with multiple counts of fraud relating to Covid vaccine. Truth will eventually out, but far too late for too many.
  • A comparison of official Government reports from so many countries are confirming that Covid-19 vaccines are not only ineffective, but causing as earlier cited, large scale Antibody-Dependent Enhancement (The Ezpose 2022c). If this weren’t enough official figures from the United Kingdom’s PHE Vaccine Surveillance Report UK (Gov 2021) suggest ‘fully vaccinated’ people are losing on average of about 5Oó percent of their immune systems function per week! It is further reported that doubly injected “People aged 40-69 have already lost 40% of their immune system capability and are losing it progressively 3% to 6.4% per week” (Ibid). Current figures remain unavailable! Still governments continues to push vaccination! We pray the above figures and predictions are wrong, or that our bodies will be able to manufacture counter-measures to stop this deterioration, for everything points to fully vaccinated people suffering degrees of an ‘acquired immunodeficiency syndrome’ (AIDS) at a galloping rate.

Authors Comments: We wish to appologise to our readers that some of our quotes cannot be fully referenced, especially in this section, as they were taken off the website before we had time to formally record them! When we returned to many sites challenging vaccination, we also found these had also mysteriously disappeared, and in their place we found a plethora of pro-vaccination messages rubbishing earlier claims. Having said this, enough sites remain to support that the fully Vaccinated are nearly 3 times more likely to die of Covid-1 9 than the Unvaccinated. How do you feel about having been coned into considering, if not indeed having a proven useless Covid injection with life threatening side-effects? Not forgetting ever more follow up boosters where you are asked to willingly accept an even greater risk to your health? We personally know of too many local cases where vaccination has heralded cerebral changes, cardio-vascular problems and autoimmune reactions, for us to doubt the above statistics. Small blood vessels in the eye, brain and heart seem especially to suffer. As we speak ever more variants are being conjured up and we”re being offered further vaccinations for vaccination induced diseases! A brilliant commercial plan for Big Pharma yet again! It is no small wonder that statistics are causing government concern, with the fully vaccinated, on the international scene still having a higher Covid hospitalisation rate than the unvaccinated, and the triple vaccinated now up to 5 times more likely to be infected with Covid-1 9 than the unvaccinated. But this is small wonder when vaccine effectiveness has fallen as low as minus 391 Oó! A recent scientific study confirmed COVID vaccines were causing severe Autoimmune-Hepatitis days after WHO issued a ‘Global Alert’ about new Severe Hepatitis strain among Children! Was WHO offering a cover story for vaccine side effect? And why when we Google for ‘Covid vaccination side effects’ do we get sore arms and headaches but nothing about serious side effects?

Governments, through mis-information fostered by Big Pharma have damaged those they were appointed to protect, yet so many of us still turn a blind eye? An extensive wide ranging study by several universites, plus the editor of the BMJ, report via the Social Science Research Network (SSRN), have reported that Covid vaccines are more likely to put you in hospital than keep you out [26]. We rest our case.

“Totalitarianism is man’s escape from the fearful realities of Iife into the virtual womb of the leaders. The individual’s actions are directed from this womb — from the inner sanctum man need no longer assume responsibility for his own Iite. The order and logic of the prenatal world reign. There is peace and silence, the peace of utter submission” (doost Meerloo,).

Culpability oF Big Pharma…

“Medicine being a compendium of the successive and contradictory mistakes of medical practitioners, when we summon the wisest of them to our aid, the chances are that we may be relying on a scientific truth the error of which will be recognized in a few years time” (Marcel Proust).

The Research and Evidential base:

  • Pfizer, from their earliest vaccine trial-runs kept ‘adverse reaction reports’ which testify they were already aware of 1,223 deaths and 42,000 complaints describing 158,893 side-effects! Obviously this is less a case of neglegence than For they knowingly released a dangerous drug upon the population. Keean Bexte, an independent journalist formerly employed by Rebel News, pointed out how 1,223 people died within the first 28 days after being inoculated with the BioNTech Pfizer vaccine during trials — and it was still approved for use (https.fft.cofBPzXvjUTsa)!. There are also reports that the vaccine killed all animals during an earlier trial. Many are justifiably angry the vaccine was allowed onto the open market despite all proven risks. Pfizer, yet again are demonstrating they put money before lives! Just 90 days after the release of Pfizer’s mRNA vaccine they knew and reported mounting deaths and side-effects under a heading of “general disorders” (note how death is subsumed here under general disorders); the most frequently reported disfunctions were nervous system ones – over 25,957. Still Pfizer went full-steam ahead without further investigation. This information comes as consequence, as earlier noted, of 1,000s of classified research documents from Pfizer being released by court order.
  • “The immuno-compromised SHOULD NOT Be Given Covid Injections”, so said the AstraZeneca CEO, this again tends to confirm that Big Pharma was alerted to the autoimmune side effects of its vaccines from the earliest trials! Even the key inventor of mRNA vaccine, Dr Robert Mason, is on record as challenging the lack of transparency regarding vaccine side-effects. He is pro-vaccination but considers the with- holding of side-effects He is especially concerrned re the true number of cardio-vascular complications, which he claims are 20 per cent higher than reported. As Public Health Officials, are forced to make policy on a best-guess way forward rather than factual basis, so damage continues to rise.
  • Kennedy’s book ‘The Real Anthony Fauci’, reveals how Fauci launched his career during the early AIDS It is claimed Fauci partnered with pharmaceutical companies to sabotage safe and effective off- patent treatments for AIDS and orchestrated a series of fraudulent studies, before pressurising US Food and Drug Administration (FDA) regulators into approving a deadly chemotherapy treatment he had good reason to know was worthless against AIDS, but made him money! Shades of his role in Covid times?
    Kennedy further alleges Fauci repeatedly violated federal laws to allow his Pharma partners to use impoverished and dark-skinned children as lab rats in deadly experiments with toxic AIDS and cancer chemotherapies. Strangely, Kennedy’s account has not been legally contested by Fauci and hence he’s not been sued! Why?
  • Pfizer is on public record since 2000 as paying over $4,660,896,333 (four thousand six hundred and sixty billion, eight hundred and ninety six thousand three hundred and thirty three dollars) in 71 criminal fines due to corrupt practices, inclusive of false claims; flaws in drug and medical safety; unapporoved off-label promotion of medical products; missing research and healthcare records; improper government contracting and competition; plus environmental Pfizer has been found repeatedly guilty of Negligence, Fraud and Bribery over the past two decades and fined accordingly, but was aeemingly too established and powerful to be brought down! Why should we ever trust their plea for more preventative vaccines? Especially in light of a Bio-distribution Study of Pfizer Covid-19 Injections, which suggested use of mRNA Vaccines should be suspended immediately! How could a company like this be let continue to practice? I guess we must never under-estimate the power of bribes and the willingness of officials to accept them.
  • Ivermectin emmerged early in the pandemic as effective in Covid, yet big pharma, abetted by government and WHO reatedly quashed any and every alternative treatment. For example, we mentioned in earlier articles that India went against the instructions of WHO and mandated the prophylactic usage of Ivermectin, effectively eradicating COVID-1 9 in areas where it was used. The Indian Bar Association of Mumbai, subsequently brought criminal charges against WHO Chief Scientist Dr. Soumya Swaminathan for recommending against the use of Ivermectin. Similar repressive scenarios have been reported internationally and further court cases are pending.

Authors Comments : Big Pharma got itself quite a business plan! Working first with WHO to dilute the definition of ‘pandemic’; spending billions cosying-up medico-political support via free lunches and cash incentives; pouring money into viral research and when a suitable candidate came along declaring it with WHO’S blessing a ’pandemic’. They even committed the worst virological sin of all – vaccinating at the height of a pandemic forcing the virus to mutate to survive! Even first year student nurses know this is dangerous and eeckless! How did they bring in previously prepared vaccinations? By coercing goverments into signing-off their culpability for side-effects, thus allowing them to offer lame experimental vaccinations over-and-above existing legal safeguards and law. And when these untested vaccines produced varients such as Alpha, Amicron, Delta, and Monkeypox they sought to vaccinate againt these also! Grand plan don’t you think? Commercially sound, ethically barren. We must also note the concerted effort to suppress the following alternative treatments: HYDROXYCHLOROQUINE – Used by tens of thousands of physicians worldwide, FDA approved for over 65 years, hydroxychloroquine is considered a safe and virtually 100Oó effective medicine for Covid-1 9. BUDESONIDE – Discovered as a 100Oó effective cure for Covid-1 9 by Dr. Richard Bartlett, who saw over 500 covid patients recover after treating them with this asthma medicine. As his randomised control study proved. IVERMECTIN – Dr Pierre Kory treated numerous corona patients to discover that Ivermectin is a true miracle drug for Covid1 9. A more recent study by ten medical experts reviewed the evidence and concluded that Ivermectin both prevents and cures Covid-1 9. CHLORINE DIOXIDE – Biophysicist Andreas Kalcker was reported as bringing down the covid daily death rate in Bolívia from 1 00 deaths a day to almost zero, with this substance he has researched for over 13 years. Even now alternative treatments to vaccination are being rubbished upon the net. So why were alternative treatments not investigated more? Rather than quashed so quickly – follow the money line and ask who has most to gain? It all boils down, yet again, to money before human lives! And when ‘ mass formation’ cum collective hysteria was cited to explain the populations sheep-like behaviour, Gates and big pharma likewise rubbished the work of all scholars associated with mass hysteria from Gustave le Bon to Mattias Desmet. Bill Gates even put out media message to say it was a made up term with no value! From Nazies to Covid and back again! Lies from the powerful masquerade as shining truths.

The world is in the grips of mass formation—a dangerous, collective type of hypnosis—as we bear witness to loneliness, free-floating anxiety, and fear giving way to censorship, loss of privacy, and surrendered freedoms (Mattias Desmet).

Draconian Intentions of Governments and WHO

“The worrying issue is that all levels of government — not only Federal — are abusing the emergency decree to continue with direct awards without any restrictions” (Eduardo Bohârquez director of Transparency International).

The Research and Evidential Base

  • Research undermining the effectiveness of face masks suddenly became political when Covid arrived! Whar are we to believe? The facts or political message? The accepted research findings in total confirm the efficacy of face masks is lacking, while adverse physiological, psychological and health effects of masks are clearly Note Dennis Rancourt’s exhaustive review of all existing scientific literature on face masks which concluded that masks offer no protection against viruses [27]! Quote: ”No RCT study with verified outcome shows a benefit for HCW or community members in households to wearing a mask or respirator. There is no such stud)/. There are no exceptions. Likewise, no stud)/ exists that shows a benefit from a broad policy to wear masks in public”(Ibid). Two final points, firstly during the Spanish Flu in 1918-1919 most people died of bacterial pneumonia caused by extensive wearing of masks. Secondly, as any bright school-boy will tell you, at the molecular level viruses are too small to be deterred by paper face masks – they fly right through the molecular structure of paper masks! Like trying to repel mosquitos with chicken wire! Yet governments went ahead enforcing masks and lockdowns though both were proven to be scientifically indefensible! Forcing the population into masks would therefore seem more an issue of control than one of preserving health!
  • As director of the National Institute of Allergy and Infectious Diseases (NIAID), Anthony Fauci, dispenses $6.1 billion in annual taxpayer-provided funding for chosen scientific research, allowing him to dictate the subject, content, and outcome of scientific health research across the globe. Fauci uses his financial clout to wield extraordinary influence over hospitals, universities, journals and thousands of influential doctors and scientists – whose careers and institutions he has the power to ruin, advance, or reward in an authoritarian manner. As an influential force within WHO Fauci has played a major role in the mess we are in now. J. F. Kennedy (Jr) has gone on public record stating that in early 2000, Fauci shook hands with Bill Gates in the library of Gates’ $147 million mansion, cementing a partnership that would aim to control an increasingly profitable $60 billion global vaccine enterprise with unlimited growth potential. Through funding leverage and carefully cultivated personal relationships with heads of state and leading media and social media institutions, the Pharma-Fauci-Gates alliance exercises dominion over much global health policy. But not for much longer as this truth is now out in Kennedy’s best selling book.
  • An investigative 229 page report, early on in the Covid game, came out in 2020 by a consortium of Reserve French Army Officers which drew links between The Gates Foundation and WHO, 5G, governmentally controlled vaccination and It identified that Covid-19 pandemic as troublingly being ‘foreseen’ by representatives of the military, industrial complexes, governments, pharmaceutical giants and shadowy “philanthropic” organisations. As for the reasons for Covid: ”The management of the ‘health crisis’seems to be a pretext for a totalitarian global take-over, inclusive of an intention to impose a global cryptocurrency, a vaccine with nano-chips and a subcutaneous electronic chip”(AFRAO 2020). The report identified massive corruption at the heart of WHO; saw Covid-19 as a biological and electromagnetic war supported by a vast “smoke-and-mirrors” operation designed to sow confusion among the ranks of medical and hospital personnel; it speculated that “Covid-19” could be the preparation for a much larger-scale joint operation, combined with a smokescreen to conceal large-scale tests of the 5G weapon for criminal ends that remain to be clarified. Links were also made between: 5G installations, both terrestrial and aerial (Elon Musk’s satellites in low-Earth orbit), as all part of a “total war project”. This independent inquiry came out in 2020 and guess what, was labelled as a conspiracy theory and left unreported by the main media. It may read in part as somewhat over-stated but… could it be nearer the truth than we care to realise if ‘The Great Reset’ is set to occur this next year or two? Time will no doubt tell.
  • 160,000 COVID Deaths were claimed by the UK government, yet the NHS confirms just 5,115 people have died of COVID-19 in England since beginning of Pandemic! As earlier stated, we can’t reference this because the UK Government has taken anti-Covid stats down from its statistical and health service public view websites! A similar governmental falsified over-estimation of deaths was also discovered in the US, where Centers for Disease Control and Prevention (CDC) were directed to not count anybody as vaccinated within the first 14 days, until their second dose, so those who suffered death or side effects within this period would enter the records as unvaccinated! Thus blatently falsifying statistical returns. So why was it so important to panic the country? To magnify death rates? What answer would you give? Some suggest this was a ploy of government to weaponise fear {Dodsi+’oxh 202f}/ But to what purpose? An experiment in population control? Certainly the CIA has been implicated in the production and refinement of Digital Vaccine Passports (Daily Veracity. 2022), and many other countries are exploring tracking systems for their population, so the issue remains live.
  • Governments worldwide are, it appears, working in lock-step fashion to bring in Digital I.D. and a Social Credit The EU has already agreed to expand online censorship with a ‘Digital Services Act’. In similar vein, Vienna is becoming a testing ground for a Chinese-style social credit system, and Canada is moving forward with plans to implement digital coding of population, while Italy has announced the roll- out of dystopian Social Credit System where compliant citizens will be rewarded for “Good Behaviour”. All much in keeping with the digital Identity introduced by Nigeria’s federal government, which has ordered telecommunication companies to bar calls from phone numbers not yet linked to a National Identity Number. Today Nigeria tomorrow the world! But you see the patten – control and monitor the masses, irrespective of human dignity or civil rights or individual privacy?
  • As eluded to earlier, the UK Health and Security Agency has been forbidden to publish any further statistical data on Covid-1 9 cases, hospitalisations and deaths by vaccination status, because its figures embarrass government by showing the triple vaccinated population are on the verge of developing Acquired Immunodeficiency Syndrome and the double vaccinated are suffering Antibody-Dependent Enhancement. In this way the truth is formally buried, for fear of challenging their own double So the UK Gov. uses hardworking taxpayer’s money to advance their agenda to control an official version of ‘the truth’. The Ministry of Truth is patently invested in mistruth in the UK!

Authors Comments. The handling of Covid 19 has been cited as preparation for ‘Agenda 2030’, a UN initiative whose shadow intentions, if not its press hand-out, have been said to support a system of total, worldwide centralization of power, influencing everything from governments to free market economy, with the goal of full centralization to allow a handful of people to micro-manage every aspect of trade and business. WHO ardently backs Agenda 2030 and seems to be working towards a like goal. Covid is seen by some as an initial experiment serving the creation of this economic empire, where a concept called the “sharing economy” is created in which people own less property and have less privacy. Sounds far fetched, but a lot of material is on the net re banking reset geared towards ensuring the security of existing power holders! Worryingly, Obama, Zuckerberg and Gates have acknowledged adopting the philosophy of Yuval Noah Harari, a Jewish philosopher who states the role of culture is to forbid (Harari 2018) He acknowledges that if governments and corporations succeed in hacking the human animal the easiest people to manipulate will be those “who believe in free will”. Harari observes: “We now have the technology to hack humanity and let everyone think and feel what we want. Tyrants always wanted to do thai but now for the first time we have the ability to do this. We will eradicate faith in God, end all free will, and make sure that humans think exactly what we want them to think”. His book,”21 Thoughts for the 21 st Century,” which supports the political lobby for population reduction was promoted extensively by Bill Gates, who wrote a foreword upon the cover. More desturbing is that Harari is being promoted massively by the United Nations, the World Economic Forum, the World Health Organization – hence Agenda 2030 cited above. The spectre of de-population seemingly won’t go away. 5G, was cited earlier as linked to depopulation, was referred to by the president of Chile who threatened on national TV: “5G will not only read your thoughts, it will inseW thoughts and feelings. And we will make sure it reaches every home in the country.”’What a charming fellow – not! The Jury is out whether this is rhetoric or fact. The military, Big Tech and various governments have all been implemented as playing their part in 2030, now said to be in its final stages. Ten years ago we would have laughed at such notions – now we seriously consider them. Lastly we must with great sadness note that many sources, both governmental and pharmaceutical, are now suspecting that the Covid-19 vaccination may lead to mass depopulation. These suspicions, further backed up by mounting evidence from research studies and confidential Pfizer documents the U.S. Food & Drug Administration has released by court order, confirm a similar scenario.

One can but remember a Kessinger memo leaked out from the US Government in 2014 seriously considering depopulation as a viable way forward! Something unimaginable was seemingly being held in mind prior to Covid.

“Modern technology teaches man to take for granted the world he is looking at; he takes no time to retreat and reflect. Technology lures him on, dropping him into its wheels and movements. No rest no meditation, no reflection, no conversation — the senses are continually overloaded with stimuli. Man doesn’t learn to question his world anymore; the screen of fears him answers-ready-made” (doost Meerloo).

Press and News Supression…

*‘It is a Turore of disinformation and attacks — one in which credible journalists are subjected to online violence with impunity; where Tacts wither and democracies teeter”(dulie Posetti).

The Research and Evidential base:

  • A volume entitled “Journalists for Hire” (Ulfkotte 2020), tells how perks are used to bribe writers and opinion makers to twist their reports. It illuminates first-hand how a tone of corruption is set from the top
  • ‘play along or quit’, plus to what degree the long arm of a NATO press office enrolls media to get Europe to support foreign Press as a political tool? Just like the old communist days is it not?
  • J.F. Kennedy’s book lays bare how Fauci and Gates control the media outlets, both conservative and liberal news services, as well as scientific journals, plus key government and quasi-governmental agencies, global intelligence agencies and influential scientists and physicians so as to flood the public with fearful propaganda about COVID-19’s virulence and pathogenesis. Power to muzzle debate and censor dissent. As noted earlier, as Kennedy has not been sued for these accusations they would appear true?
  • The afforementioned press whistle-blower Ulfkotte 2020), a respected journalist in his own right, reported how government inspired under-cover agents wrote articles in editorial offices that were subsequently published later under the names of well-known He also pointed out which journalists received bribes for their warped reporting, plus how prestigious “journalism prizes” were a reward system for cooperation, going so far as to name who received them. It was further evidenced, by the author, who died later under suspicious circumtances [28], that respected journalist names and outwardly respectable organisations as the Trilateral Commission and German Marshall Fund were behind-the-scene players that were regularly paid to influence German media with one-sided propaganda.
  • For evidence of how the bought press turns upon the free press we need look no further than the case of Dr Rancourt, who we heard earlier dared speak against the official narrative of face Like many other scientists whose findings had a potential to rock government policy and pharmaceutical desires, Dr Rancourt was censored, had his academic reputation tarnished and his profile removed from ‘ResearchGate.net’. A host of character assasinations and de-buncking of his findings rapidly followed, flooding the internet! John Hardie’s world renknown study which proved masks increase infection [29], likewise was dug up from te past to suffer a similar debunking fate when the pandemic arrived.

The new black is obvously white! And truth is as ever decreed by those in power – are they not the ones to re-write history?

  • “The COVID-19 pandemic has demonstrated how vital it is for people to be able to speak out and share And yet medical professionals, journalists, activists and others who have informed the public or questioned the way the crisis has been handled have faced harassment and attacks” [30]. So speaks a professional body representing journalists. In the UK a pincer movement by the Treasury and Ofcom – the UK’s communications regulator, gagged our once proud news media through threats of fines and sanctions should they dare go against government guidelines. Not that the UK’s the only culprit. In its 2021 Index, Reporters Without Boarders [31] reported a ’dramatic deterioration in people’s access to information and an increase in obstacles to news coverage.” The RSF goes on to state that the COVID-1 9 pandemic has been used to prevent journalists from accessing other wide- ranging information so as to restrict critical reporting. According to RSF’s international survey, ” journalism is currently completely blocked or seriously impeded in 73 countries and constrained in 59 countries. Taken together, these figures represent 73% of the 180 countries assessed. Only 12 out of the countries ranked are deemed to have a Tree and favourable environment for journalism (one fewer than last year). Norway, Finland, Sweden, Denmark, Costa Rica, Netherlands, Jamaica, New Zealand, Portugal, Switzerland, Belgium and Ireland” [32]. Look at the glaring absence of the US and UK, France and Germany from this list! While the UK merely took down the National Statistics website relating to Covid deaths, in Iran, the authorities imposed measures to prevent news media from scrutinising the pandemic-related death toll, and “In Hungary and elsewhere, anti-Take news laws effectively criminalise legitimate journalistic reporting on the pandemic… Cases abound of how the ‘COVID-19 ezcuse’has led to the inability of journalists to do their job of reporting medically endorsed effective public health measures, or to challenge lethal disinformation” (Ibid). So we have a ‘gagged press’ not a ‘free press’, and propaganda rarther than factual reportage peppers our news (HART 2021). Investigative journalists continue to have their hands tied behind their backs! Indeed many have left employment or been dismissed because censorship has made their job untenable. In this future free speech has also been silenced. Speak truth at your peril!

Authors Comments: The UK government, while professing to be democratic, uses public money to bribe a publically funded news media – the BBC, to fear bombard the public with government approved propaganda furthering its own political agenda (HART 2021)/. They are also reported as paying experts in mass psychological manipulation to preserve their standpoint as the one and only way (Dodsworth 2021). There really is no room left for us to doubt press censorship. We personally have lost all faith in politicians and governments and consider the national news services a sick joke. Journalists themselves are likewise very concerned [33]. In terms of the impact COVID-1 9 is having on media there has been a renewed closure of civil space, especially in more authoritarian countries. In Egypt, for instance, there are new laws to suppress reporting, and leading journalists have been arrested. In Myanmar, under the cloak of COVID-1 9/fake news, independent media has been shut down (Ibid). All of which is deeply worrying. Sadly, the UK can’t report its own governmental censorship or abuses of the home press for fear of governmental and Ofcom fines and reprisals! Hypocritical or what?

“The social transformation that unfolds under totalitarianism is built upon, and sustained by, delusions. For only deluded men and women regress to the childlike status of obedient and submissive subjects and hand over complete control of their lives to politicians and bureaucrats” (doost Meerloo).

Over-estimation of Vaccine Take-up

Mis-information is a virus unto itselT (Brianna Keilar).

The Research and Evidential base:

  • Contrary to what the press and TV say fewer than half of people living in parts of London, Birmingham and Leeds have had the first Covid jab, and statistics show below the 50 per cent vaccination mark in 13 other wards dotted across the country, including Interestingly, the lowest uptake for vaccinations was amongst Ph.D’s! Practiced, well read and informed researchers like ourselves no doubt.
  • Even the UK Gov report admits 19.2 million people in England have not had a single dose of a Covid-19 “Vaccine” and another 12 million have refused a 2nd or 3rd Probing a little deeper on top of the 19.2 million unvaccinated, a further 2.6 million who had the 1st dose refused the 2nd dose, and a further 9.1 million who had the 2nd dose refused the 3rd dose (Fearless-speach 2022). Bringing the possible number of people who have now woken-up to the lies and propaganda spouted by the Government and mainstream media over the past two years up to 30.1 million.
  • A similar case to the above is reported for the USA. In light of Mr and Mrs average Joe seeing the ineffectiveness of vaccination to prevent repeated Covid infection, plus damaging side effects on their family, neighbours and friends, is it really surprising CDC (Centers for Disease Control and Prevention) reports 74.2 million people in the USA have not had a single dose of a Covid-19 Vaccine and another 157 million have refused a 2nd or 3rd dose? Are you dear reader aware of friends or acquaintances of yours who have suffered post vaccine effects? Many are seeing through the earlier hype. Are sheep now finally changing into rams?

Authors Comments

In an earlier report we mentioned if you once test positive in the UK you can end up being registered ’Covid positive for life’, to sooner or later be attributed ’a Covid death’! Such ploys as this cause Covid deaths to soar frighteningly. One could easily be led to believe no one recovers from Covid! But almost all recover unless with serious medical pre-conditions, or if incubated or otherwise harmed by medical intervention. So much stistical subterfuge! Hopefully the recent refusal of vaccination is evidence of the masses waking up to the harm inflicted upon us? But sometimes it’s much harder to admit our mistakes than to make them – so this may take some time!

“But the order of a totalitarian world is a pathological order. By enforcing a strict conformity, and requiring a blind obedience from the citizenry, totalitarianism rids the world of the spontaneity that produces many of Iife’s joys and the creativity that drives society forward” (doost Meerloo).[34-50]

Concluding Summary

“Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through i¿ dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it” (Arundhati Roy).

When you join up the dots of the information we have arrayed before you where does your reasoning take you?

For ourselves, reluctantly, we believe there is just too much data coming out to believe that Covid was a simple virus. Military path lab involvenent and patent office records, plus WHO macinations produce too much evidence of fore-knowledge and fore-preparation from such wide ranging sources, to suggest, Covid was manufactured and planned, and on a massive co-ordinated scale. Mass corruption from state governments and State suppliers of health, pharmaceuticals and WHO are all evidenced as keeping it going. Bribes of a very high calibre oiled the workings and governments silenced the press and TV. Though in the UK the public facing puppets kept it going almost seamlessly, here, in our home-base of Romania we saw through the cracks much sooner, as public facing systems were more flakey and politicians were thankfully less organised than elsewhere.

We wish there was more data that a straight forward virus was merely mis-handled and more proof that our conclusions are faulty. For there are no winners here! But such reliable sources as the British Medical Journal, Data Science Association, Health Advisory and Recovery Team, International Freedom of Expression Exchange, Social Science Research Network, UK Office for National Statistics, UK Statistics Authority and far too many university led research studies, plus records of The Patents Office back-up our findings. Deep down, we sincerely wish we were wrong, but we can’t find the verification for it. So we end up believing governments, spurred on by Covid, have ridden rough-shod over common good, human dignity and human rights, while exiziling humanitarianism, research and empirical observation to the wastelands. Consequently personal liberty has been restricted, justice and rationality suspended, and social responsibility all but forgot. The very things that make life the more enjoyable. In this light, as humanists, we feel morally compelled to write, as to sit idly by as moral cowards is not a self respecting option. Is silence during public atrocity not complience?

It took us some time to catch up with the Covid farce. Sinziana comes from a medical family and my first career was as a nurse and nurse teacher. Until Covid came along we both believed in vaccination. We were reluctant dissenters though ardent researchers, so research won us over in the end. In our earlier articles we were genuinely perplexed, now we have lost faith in government and medicine in general. At the last, the vaccinated are the ones paying the price. Prospectively, we fear they have a life vexed by possible auto-immunity and cardio-vacular problems ahead, not to mention a shortened life expectancy. This is a very hard reality to face, and we are past anger on the issue.

We know most people feed off the telly and news papers for their shot of truth, taking all other sources as suspect, so we will likely be enthroned further by writing this article as conspiracy theorists. But please, at least, survey the headlines of the references below to glean something of what propoganderised news is denying you. Feel free to shoot us down as the messangers but we beg of you – awake!

“It’s easier to fool people than to convince them that they have been Tooled” (Mark Twain).

References

  1. Van Beusekom M (2024b) MSCOVID vaccine efficacy against sevem illness just under E0&, per early estimates from CIDRAP.
  2. The Expose (2022c) New Govemmenr data confirms it can take just 8 months for the Covid-19 Vaccinated to develop Acquired Immunodeficiency syndrome.
  3. Ethan G, Dutcher EG, Epel ES, Mason AE, Hecht FM,et al (2024) COVID-19 Vaccine Side EHects and Long-Term Neutralizing AntibodyResponse: A Prospective cohort Annals of Internal Medicine, 177: 7. [crossref]
  4. Lam ICH, Zhang R, Man KKC, et al (2024). Persistence in risk and effect of COVID-19 vaccination on long-term health consequences afier SARS-CoV-2 Nat Commun 15: 1716
  5. Rayner G,Halligan L (2021) Life inside the fear Factoiy: how the Government keeps us on high aIeW.
  6. Ulfkotte U (2020) Confessions From the profession: ’Presstitutes’in service oFthe People’s World
  7. Van Beusekom M (2024a) Surveys reveaI Americans’persistent mistmst in COVID vaccine CIDRAP.
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Digital Light Processing-Based 3D Printing Using Gelatin Methacryloyl as a Ink for Tissue Repair

DOI: 10.31038/NAMS.2024732

Abstract

Tissue engineering technology has demonstrated significant potential for tissue repair, enabling the restoration of damaged tissues or organs in terms of both structure and function. The utilization of digital light processing (DLP)-based 3D printing has gained significant traction in tissue repair due to its remarkable advantages in terms of printing resolution and efficiency, as well as mild printing conditions. Gelatin methacryloyl (GelMA) has emerged as a commonly utilized ink for DLP-based 3D printing due to its unique photoinduced crosslinking properties, controllable mechanical properties, degradation characteristics, and excellent biocompatibility. This paper primarily presents state-of-the-art technologies and applications involving DLP- based 3D printed GelMA constructs for bone repair, skin repair, and peripheral nerve repair. It aims to highlight the promising potential of DLP-based 3D printed GelMA constructs in regenerative medicine.

Keywords

Digital light processing, 3D printing, Gelatin methacryloyl, Tissue repair

Introduction

The repair and functional reconstruction of tissue and organ defects pose significant challenges in the field of regenerative medicine. Currently, autologous or heterologous tissue and organ transplantation are the most commonly used treatments; however, they are hindered by limitations such as traumatic trauma treatment, insufficient donor availability, and immune rejection. Tissue engineering research focuses on three core elements: cells, biomaterials, and tissue construction technology [1,2]. The realization of tissue and organ reconstruction relies on obtaining an adequate number of seed cells with specific biological activities, combining them with suitable biological scaffold materials, and employing precise construction techniques to create personalized physiological structures and functional organs or tissues in vitro. Therefore, personalized tissue engineering holds immense potential for advancements in the field of tissue repair and replacement. 3D printing technology offers rapid personalized manufacturing capabilities that can greatly contribute to tissue repair [3-5].Digital light processing (DLP)-based 3D printing utilizes a digital microscope device (DMD) to project images onto photosensitive liquid resin or bioink through surface exposure, enabling layer-by-layer solidification for printing purposes. DLP- based 3D printing technology enables the creation of personalized biological structures with precisely designable geometries, effectively bridging the structural disparities between engineered and natural tissues. It has found extensive applications in fabricating constructs such as artificial skin, bone implants, and nerve conduits. In comparison to other printing methods such as extruded and inkjet 3D printing, DLP-based 3D printing offers significant advantages in terms of resolution, efficiency, and working conditions. Its non-direct contact approach provides relatively gentle conditions for cell printing.

The development and application of printing ink is an important research connotation of dlp-based 3D printing technology. Conducting research and developing innovative bioinks that strike a balance between printability, biocompatibility, and mechanical performance is crucial for the advancement of bioprinting applications. GelMA, a photocrosslinkable hydrogel derived from gelatin modified with methacrylic anhydride, exhibits exceptional biocompatibility, visible light curing capabilities, and controllable mechanical properties, rendering it a versatile ink for printing purposes. During the printing process, GelMA is typically combined with cells, growth factors, and other bioactive substances to leverage 3D printing in fabricating tissue engineering models with specific structures and functionalities. This paper primarily presents state-of-the-art technologies and applications involving DLP-based 3D printed GelMA constructs for bone repair, skin repair, and peripheral nerve repair (Figure 1).

Figure 1: Application of DLP printing technology in tissue repair

DLP-Based 3D Printing

Based on the continuous application of DLP-based 3D printing in tissue engineering, higher printing accuracy and faster printing speed are required for practical implementation of DLP technology. Constant advancements in new printing technologies based on DLP technology are being made [6,7].

John et al. have designed a rapid continuous printing process based on DLP technology, which creates an oxygen-containing “dead zone” between the forming section and liquid precursors to enable continuous exposure printing and significantly enhance DLP printing speed [8]. Callum et al. have developed a dynamic interface printing technique based on DLP that utilizes sound modulation and restricted gas-liquid boundaries to generate centimeter-scale 3D structures within tens of seconds. This approach does not require complex feedback systems, specialized chemical reagents, or intricate optical elements while maintaining rapid printing speed and exhibiting immense potential for high-resolution and biocompatible applications {Vidler, 2024 #6}. Brett et al., on the other hand, have developed Computed Axial Lithographic (CAL) printing technology based on DLP where materials can achieve volumetric polymerization of arbitrary geometric shapes. Compared to traditional layer-by-layer printing methods, CAL’s polymerization approach eliminates the need for support structures, is suitable for high-viscosity fluids as well as solids, and significantly enhances print speed{Kelly, 2019 #4}. Regehly et al. employed dual-color photopolymerization in DLP-based 3D printing, wherein photoswitchable photoinitiators were developed. This technique utilizes two intersecting light beams of different wavelengths to achieve complete object fabrication by inducing localized polymerization within a confined monomer volume, resulting in enhanced speed and resolution for 3D printing. Recent advancements in DLP-based 3D printing have primarily focused on improving print speed, with various novel techniques offering additional technological approaches for bioprinting applications. In the realm of biological 3D printing technology, the choice of bioink plays a crucial role; currently, commonly utilized bioinks include alginate series bioinks, collagen bioinks, and GelMA materials [9]. CAL technologies introduce a printing paradigm shift because they are able to create entire objects at a time, rather than by adding basic building blocks in sequence. The study of Bernal et al. introduced the concept of volume bioprinting (VBP), which can manufacture an entire carrier cell structure of arbitrary size and structure in a time range of several seconds to tens of seconds. Using GelMA as printing material, bone scaffold and meniscus containing were constructed by volume printing technology. The rapid manufacturing advantage of CAL technology in bioprinting is verified [10].

GelMA

GelMA exhibits excellent biocompatibility and promotes cell adhesion and proliferation through its biological motifs, particularly the RGD sequences on gelatin molecules. The crosslinked network structure of GelMA not only serves as a scaffold for cells but also facilitates material exchange{Yue, 2015 #56} [11-13]. By adjusting the substitution degree of MA in GelMA, its mechanical properties such as viscosity, compressive strength, and tensile strength can be tailored to meet specific printing requirements. Additionally, for tissue repair applications, it is crucial that bioprinted structures are biodegradable. GelMA’s matrix metalloproteinase (MMP) site allows it to serve as an enzymatic degradation site recognized by injured organism cells [14]. As native cells fill the GelMA construct, they initiate its degradation while simultaneously repairing the area with their own cells to achieve tissue regeneration. With its exceptional biocompatibility, tunable mechanical properties, degradability, and photoinduced cross- linking capability, GelMA holds great potential for personalized and customized engineered living tissues or scaffolds for tissue repair [15- 18].

Applications of DLP-based 3D Printing Using GelMA

Tissue engineering aims to enhance or replace biological functions for the purpose of repairing damaged tissues and organs. DLP bioprinting enables precise distribution of cells, materials, and biological factors, offering a novel approach for fabricating artificial tissues. DLP-based 3D printing exhibits remarkable advantages in terms of resolution, efficiency, and operational conditions; moreover, its indirect contact formation method provides relatively mild conditions for cell printing. GelMA and its composite hydrogel system are exceptional biomaterials for tissue engineering due to their excellent biocompatibility, tunable mechanical properties, and degradability. The utilization of GelMA in DLP-based 3D printing holds great promise in various tissue repair applications including bone regeneration, skin reconstruction, as well as peripheral nerve restoration.

Bone Repair

The incidence of bone defects caused by trauma, infection, tumors, and congenital or metabolic diseases has significantly increased. These defects often result in functional disabilities and deformities, posing a clinical challenge for treatment. Traditional autologous and allogeneic bone transplantation methods have several limitations including inadequate tissue supply, donor site damage, immune rejection risks, and potential infections. Therefore, the development of new strategies for bone defect repair has become an urgent problem to be addressed [19]. On one hand, 3D printing enables personalized customization for individualized precision treatment; on the other hand, it reduces the cost associated with large-scale preparation [20]. The architecture of the bone repair scaffold can affect the effect of cell-induced regeneration of damaged bone. Song et al. combined bionic microporous GelMA/SilMA with hydroxyapatite (HAp) to prepare a bionic microporous GelMA/SilMA/HAp ink. By utilizing DLP-based 3D printing, they fabricated layered bionic microporous GelMA/SilMA/HAp (M-GSH) scaffolds. Animal experiments demonstrated that these bionic microporous scaffolds significantly enhanced tissue integration and bone regeneration after 12 weeks of implantation. Tissue engineering scaffolds for repair require not only adequate structural stability, but also good biocompatibility [21]. Gao et al. successfully developed GelMA/PEGDA/F127DA composite hydrogel scaffolds by DLP-based 3D printing, which not only facilitated cell adhesion and proliferation but also effectively promoted osteogenic differentiation of mesenchymal stem cells in osteogenic inductive environments. Intramembranous ossification and endochondral ossification are two ways of bone regeneration, in which hypoxia-inducing factor-1 α (HIF-1 α) signaling pathway can promote endochondral ossification and angiogenesis [22]. Gao et al. DLP-based 3D printing to fabricate structurally robust and biocompatible GelMA/PMAA hydrogel scaffolds, capable of chelating iron ions and continuously activating the hypoxia-inducible factor- 1α (HIF-1α) signaling pathway, thereby promoting endochondral ossification and angiogenesis processes as well as late-stage vascular formation and bone remodeling. The balance between cell survival environment and hydrogel cross-linking density is crucial for light sensitivity to achieve high intensity and good cell viability in cell- borne cartilage repair materials [23]. Shen et al., employing GelMA/ SG as bioink, created high-precision networked DLP printed scaffolds with superior shape retention compared to GelMA alone. In vitro experiments exhibited significant chondrocyte proliferation, while ectopic cartilage formation was evaluated by subcutaneously implanting the GelMA/SG scaffolds in nude mice. The utilization of these scaffold materials along with their manufacturing strategy offers potential solutions for future clinical challenges in cartilage repair. “Sr” is a potent anti-osteoporotic agent with anti-resorptive and anabolic properties, but with side effects when applying systemic administration. GelMA-SR doped nanosized hydroxyapatite (SrHA) composite hydrogel scaffold with controllable Sr delivery capability [24]. Cosmin et al. DLP-based 3D printing developed a novel GelMA- strontium-doped nanohydroxyapatite (SrHA) composite scaffold for bone tissue regeneration featuring controllable strontium (Sr) release capabilities. They investigated the biocompatibility of the composite hydrogel scaffold. In vitro cell culture demonstrated that osteoblasts could adhere and proliferate on the surface of the hydrogel. The DLP- prepared GelMA composite hydrogel tissue engineering scaffolds offer innovative avenues for research in bone loss repair [25].

Skin Repair

The prevalence of burn and skin ulcer patients is significant, with chronic skin ulcers having a severe impact on their quality of life. Therefore, there is a great need for the development of scaffolds or biomimetic skin through tissue engineering. By utilizing 3D printing techniques that combine human keratinocytes, fibroblasts, and endothelial cells, rapid preparation of vascularized microstructures and perfused skin grafts can be achieved. DLP-based 3D printing provides a rapid manufacturing method to curing human skin fibroblast (HSF) and human umbilical vein endothelial cell (HUVEC) hydrogel material to form biomimetic skin. Zhou et al. utilized a biomimetic bioink (GelMA/HA-NB/LAP) and DLP-based 3D printing to fabricate functional living skin (FLS). FLS possesses interconnected microchannels that facilitate cell migration, proliferation, and new tissue formation. By mimicking the physiological structure of natural skin, FLS promotes skin regeneration and neovascularization. The three-dimensional (3D) artificial skin model provides a variety of platforms for testing skin transplantation, disease mechanisms and skin tissue. However, achieving physiological complexes in such hierarchical structures, such as the neurovasculature with living cells, is extremely difficult [26]. Choi et al. DLP-based 3D printing printed a full-thickness skin model by employing methacryloyl-modified silk fibroin (SFMA) and GelMA, incorporating multiple cell types. They evaluated the printability, mechanical properties, and cell viability of SFMA/GelMA construct at various concentrations in order to determine the optimal printing concentration for artificial skin models. The simulation model confirmed that epidermal growth factor could enhance wound healing in both epidermal and dermal layers [27].

Peripheral Nerve Repair

Peripheral nerve injury is a significant cause of disability, often resulting in motor and sensory impairments. Treating peripheral nerve injuries poses a major technical challenge in the fields of reconstructive surgery and regenerative medicine. Utilizing DLP-based 3D printing, the rapid fabrication of personalized nerve conduit shows promise as an effective method to enhance peripheral nerve healing.The nerve conduit is a promising treatment for long-gap peripheral nerve injury, but with limited efficacy. Drug-releasable scaffolds may provide a reliable platform to construct a regenerative microenvironment for neural recovery. Tao et al. A functional nanoparticle-enhanced nerve conduit for promoting peripheral nerve regeneration was prepared by DLP-Based 3D Printing. The conduit consists of a gelatin-methylacryanyl (GelMA) hydrogel and drug-loaded poly (ethylene glycol) -poly (3-caprolactone) (MPEG-PCL) nanoparticles dispersed in the hydrogel matrix. Such nanoparticles in the conduit can release Hippo pathway inhibitors to promote nerve regeneration and functional recovery [28]. Zhang et al. fabricated a biodegradable self-adhesive bandage by utilizing a series of clickable functionalized monomers, including azide-modified gelatin methacryloyl and dibenzylcyclooctyne-modified GelMA. This bandage possesses the capability to envelop injured nerves and selectively release drugs for neural repair purposes. Through electrophysiological assessment and histological examination using a rat sciatic nerve transection model, it was confirmed that the drug-loaded self-adhesive bandage developed by Zhang et al. effectively promotes peripheral nerve regeneration and facilitates recovery [29]. Zhang et al. A double-branched GelMA neural conduit was constructed by DLP-based 3D printing .The efficacy of the double-branch nerve conduit was evaluated by the transfer of the rat tibial nerve to the peroneal nerve. The results of functional and histological evaluation showed that the double-branch nerve conduit could not only promote the regeneration and functional recovery of the peroneal nerve in the injury, but also retain the function of the donor nerve, demonstrating the potential application of this conduit in nerve transfer [30]. Wu et al. successfully employed continuous DLP printing to manufacture elastic hydrogel conduits encapsulating nanodrugs, utilizing GelMA/methacryloyl-modified silk fibroin (SFMA) composite hydrogels. This material exhibited favorable effects on cell adhesion, proliferation, and migration. Electrophysiological, morphological, and histological evaluations conducted through animal experiments demonstrated that the conduit effectively promoted axonal regeneration, myelin sheath regeneration, and functional recovery by providing an optimal microenvironment. Peripheral nerve injury is a common condition that often causes disability and poses challenges to the surgeon. Drug-releasable biomaterials provide a reliable tool for regulating the nerve healing-related neurorepair microenvironment. A self-adhesive bandage was designed to form parcels around the injured nerve to promote nerve regeneration and recovery [31].

Conclusion

DLP-based 3D printing technology offers significant advantages in resolution, efficiency, and working conditions. Its non-direct contact forming method provides relatively gentle conditions for cell printing, making it a promising construction technology for tissue engineering. GelMA composite hydrogels possess excellent biocompatibility, adjustable mechanical properties, and good formability, presenting enormous application prospects in tissue repair. By adjusting GelMA’s substitution rate and compositing with other materials, hydrogel systems can be prepared to meet different application requirements. However, prior to the clinical implementation of GelMA construct, it is imperative to address concerns such as standardizing GelMA synthesis methods and ensuring the safety of photoinitiators and hydrogel materials. Additionally, material properties should be expanded to meet more complex clinical demands such as controlled degradability of GelMA materials. For DLP printing technology and equipment to fully realize its personalized advantages in 3D printing applications like bedside printing technologies need further development.

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Superwetting Materials with Different Dimensions are Used in the Study of Oil-Water Separation

DOI: 10.31038/AFS.2024613

Introduction

With global warming, the shortage of water resources is aggravated, and a large amount of oily wastewater produced by the petroleum industry poses a threat to the ecological environment. The traditional oil-water separation methods have some problems, such as low efficiency, long cycle, complicated operation and secondary pollution. The appearance of ultra-wetting materials has brought new hope for solving these problems. This paper focuses on the application of ultra-wetting materials in the field of oil and water separation, introduces the limitations of traditional separation methods, expounds the research progress of ultra-wetting materials, wetting theory, and discusses various types of ultra-wetting materials in detail, and finally summarizes the shortcomings of existing materials and looks forward to the future.

Superwetting Oil-Water Separation Material

Super Hydrophobic – Super Oil Wet Material

Summarizing this type of material, compared with the previous two, its three-dimensional structure is equivalent to a random stacking of multi-level two-dimensional materials, which significantly enhances separation efficiency. Additionally, small oil droplets undergo demulsification, coalescence, and separation within the internal space, thereby achieving emulsion separation and efficient “dewatering”. However, for most non-metallic substrates, further research is needed to explore and improve their mechanical stability, reusability, and durability.

Super Hydrophilic – Underwater Super Oil Phobic Material

In summary, in the realm of superhydrophilic–underwater superoleophobic three-dimensional materials, there still exist a series of application issues such as structural instability, poor overall wear resistance, and susceptibility to contamination in complex environments. These issues serve as inspirations for targeted solutions in subsequent development efforts. Additionally, practical applications of the material are often limited by factors such as synthetic preparation methods. Nevertheless, overall, these “oil-removing” type three- dimensional wetting materials exhibit higher emulsion separation performance compared with two-dimensional materials.

Superhydrophobic – Superoleophobic Materials

According to the previous discussion, three-dimensional materials can utilize porous nickel foam substrates, directly forming micro-nano rough structures on the three-dimensional framework. Compared with two-dimensional materials where particles adhere to the surface and are combined with binders, this approach offers superior performance and a more efficient preparation process. For non-metallic substrate materials, the three-dimensional structure provides sufficient space to accommodate inorganic hybrid polymers, forming a unique porous structure and significantly enhancing their mechanical strength.

“Special” Ultra-Wetting Materials

Compared with two-dimensional materials, three-dimensional “special” superwetting materials exhibit enhanced water absorption capabilities. Additionally, the selection of these materials increasingly considers the application of green, biodegradable materials. To address common oil–water separation clogging issues, porous superamphiphilic materials offer a fundamental solution, with aerogel materials selectively capturing the water phase to improve separation performance.

Smart Switchable Superwetting Material

Two-dimensional switchable superwetting materials focus on reusability and recyclability while conserving energy. They achieve on-demand emulsion separation under external stimuli, effectively addressing the single-use issue of one dimensional materials. Additionally, the in situ growth method overcomes the stability problems common in most superwetting materials.

Summary and Outlook

In the future, green and biodegradable base materials have enormous development potential and prospects. The green recycling of materials for renewable use is a key direction for future research. However, current recycled materials still exhibit some apparent disadvantages: cumbersome and complex recycling processes, high energy input, poor durability, and a short lifespan during use. The future aims to combine repairability, self-cleaning, high corrosion resistance, and material recycling to form a completely new industrial chain and breakthrough direction in technology development.

Does Water Immersion Have a Role in Cord BDNF Levels and Neurological Development of the Baby: A Case Control Study

DOI: 10.31038/IGOJ.2024713

Abstract

Background: Brain-derived neurotrophic factor (BDNF) levels in maternal serum and umbilical cord blood serum samples from women who underwent water immersion during labor and those who gave birth without water immersion were compared.

Objectives: This study aimed to investigate the impact of water immersion on maternal and neonatal serum BDNF levels. A total of 57 pregnant women were included in the study, 32 in the non-water immersion group and 25 in the water immersion group. Serum BDNF levels were measured by ELISA an Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons between groups, the independent samples t-test, Mann-Whitney U-test, and Spearman rho correlation test were used.

Results: No differences were observed in age, gravidity, parity, maternal BMI, infant weight, and infant sex (p=0.97, p=0.61, p=0.71, p=0.24, p=0.14, and p=0.88, respectively). There was no difference in maternal serum BDNF levels between the two groups were compared (p=0.152). Cord blood BDNF levels were found to be significantly different in the water immersion group compared to the conventional vaginal delivery group (p=0.03).

Conclusions: The high BDNF levels in the water immersion group suggest that this method may contribute to the neurological development of infants. We believe that water immersion can have a positive effect on the psychology of mothers and their babies.

Keywords

Hydrotherapy, Brain-derived neurotrophic factor, Immersion in water, Neurological development

Introduction

Hydrotherapy and water immersion are long-standing therapeutic techniques used in medicine. Thus, the popularity of this method has increased. Water immersion has become widely used worldwide as a non-pharmacological method for reducing the stress of labor pain [1-3].

Although water birth and hydrotherapy (water immersion or immersion in water) are thought to be similar techniques, they are different. While hydrotherapy is a non-pharmacological method to cope with labor pain, water birth is the use of hydrotherapy in the second stage of labor, and as the delivery takes place in water, it can be accepted as a birth method.

Studies have underscored the drawbacks of water birth, including the risks of maternal and neonatal infections as well as potential respiratory issues for newborns [3]. Water birth performed by skilled obstetric care providers in a hospital setting is a reasonable option for low-risk women and their newborns. In a recent study, the water immersion group demonstrated lower rates of neonatal intensive care, special care nursery admission, and perineal laceration than the control group. Furthermore, this review provides additional information on immersion water [4-6].

The benefits of water immersion for pregnant women are apparent. Owing to the buoyancy of water, hydrotherapy enables pregnant women to move their legs more easily. It has been proposed that water immersion during labor enhances maternal satisfaction and a sense of control [1].

Women who sense control during childbirth tend to have enhanced emotional well-being postnatally [1]. It is also known that immersion in water significantly reduces the anxiety of pregnant women [2]. Some professional associations, such as the Royal College of Obstetricians and Gynecologists and the American College of Nurse-Midwives, support uncomplicated healthy pregnant women having water births [7].

BDNF is a protein belonging to the neurotrophin subfamily that has various effects on the central nervous system. Neurotrophins is a crucial intracellular factor that contributes to the maintenance of neuronal function. BDNF forms neurotrophins, which are very important in protecting the nervous system and neuronal structure. BDNF plays a role in the differentiation of cells into neurons in the neural root during development by preventing neuronal death in cases such as trauma or ischemia in adult brain cells. It contributes significantly to the continuation of their vitality. In addition, BDNF has a significant impact on brain development in the prenatal and postnatal periods [8-10].

BDNF has been studied in mammals, mostly during the prenatal period and neurogenesis phase [8]. This stage is important because although neurogenesis is completed a few days before birth, most neurons in the hippocampus occur after birth [11].

We aimed to investigate the relaxing and pain-reducing effects of water immersion on maternal and infant cord serum BDNF levels.

Methods

Study Design

This prospective case-control observational study was carried out at the Zekai Tahir Burak Women’s Health Education and Research Hospital with the approval of the ethics committee (ethical approval statement: 58/2018) and in accordance with the Helsinki criteria. The women were divided into two groups: the control group consisted of 32 pregnant women who did not receive water immersion during labor and gave birth vaginally, and the case group consisted of 30 women who received water immersion during labor and gave birth vaginally.

Setting

We selected our study patients among full-term pregnant women between 37-40 weeks, hospitalized in the obstetrics clinic for delivery. Our study was conducted over a period of 6 months.

Immersion water was present in the special pools in the delivery room. Attention was paid to the cleaning of the pool. The bathtub was cleaned after each use as part of the precautions taken to prevent infection before immersion. First, the organic waste was removed and prewashed with running water. After preliminary cleaning with detergent and water, drainage pipes were cleaned and treated with chlorine tablets. The cleaning was completed after waiting for a certain period. Materials used in bathtubs, such as thermometers and hand dopplers, are also disinfected by surface disinfectants. After disinfection, cultures were collected from the bathtub surface, pool bottom, drain, and water flow areas. If the culture result is negative, the pregnant woman can be placed in a bathtub. All operations were performed by trained personnel.

Participants

A total of 62 pregnant women between the ages of 18 and 40 years, with pregnancies between 37 and 40 weeks, and who were in active labor during the examination, were included in our study. All pregnant women were in vertex presentation at the examination and had antenatal follow-ups in the maternity polyclinics of the same hospital. The amniotic membrane was observed to be intact during the examination. The exclusion criteria were as follows: pregnant women with a history of cesarean section, chronic disease, malpresentation, ruptured amniotic membrane, high-risk pregnancy, and medical and obstetric risks. Pregnant women with macrosomia fetuses and refugees on ultrasound who also had signs of active infection and fetal distress with bleeding were excluded from the study (Figure 1).

Figure 1: Inclusion and exclusion criterias.

The control group comprised of 32 patients with normal birth pain. No non-pharmacological or pharmacological pain relief methods were applied in this group. Labor was not induced.

Pregnant women in the case group (n=30) with cervical dilatation of 3 cm and 70% were taken to a pool, which had a temperature of 37–37.5⁰C and was wide enough for the woman to move freely. Fetal heart monitoring was performed at regular intervals using Doppler or non-stress tests (NST). The second stage of labor was carried out in a controlled manner outside the water. In both groups, as soon as the baby was born, it was placed on the mother’s womb, the cord was cut, and the delivery of the placenta and membranes was completed.

Venous blood samples were obtained from the mothers after birth. After the cord was clamped, blood samples were collected.

Measurements

Serum samples were separated by centrifugation at 5000 revolutions/min (2236 × g) for 10 min within 15–20 min of blood sampling. They were frozen immediately and stored at -80⁰C until the final analysis.

Serum BDNF levels were measured using an ELISA. The BDNF concentration was determined using the Elab Science Human BDNF ELISA kit (Elabscience Biotechnology Inc., Wuhan, China), which had a sensitivity of 18,75 pg/mL. The sandwich principle was used for the ELISA kit. The micro-ELISA plate provided in this kit was precoated with an antibody specific for human BDNF. Assays were performed according to the manufacturer’s instructions as follows: standards and samples were added to the micro-ELISA plate wells and combined with the specific antibody. Then, a biotinylated detection antibody specific for human BDNF and an avidin-horseradish peroxidase (HRP) conjugate were added to each microplate well and incubated. The free components were then washed away. The substrate solution was then added to each well. The enzyme-substrate reaction was terminated by the addition of a stop solution. The optical density (OD) was measured spectrophotometrically at a wavelength of 450 ± 2 nm. The OD value is proportional to the concentration of human BDNF. Maternal serum and infant cord blood BDNF levels (pg/ml) were recorded.

Bias

The case and control groups were selected from patients with the same characteristics. In contrast, only hydrotherapy was administered in the patient group. Five of the 30 patients in the case group were excluded from the study because their blood samples were damaged during transport. The number of cases had decreased to 25.

Statistical Analyses

Study Size

The mean standard deviation of BDNF in women giving birth in water was predicted to be 1200 ± 290 pg/ml. Thus, the effect size was calculated to be 0.741. With an alpha of 0.05 and power of 0.80, the sample size was determined to be 60 people in total, with at least 30 people in each group.

Variables

After birth, the weight and sex of the infants were recorded. In this study, age, gravidity, parity, BMI, baby weight, baby sex, and BDNF levels were compared between the two groups.

Statistical Methods

Whether the variables with numerical results in the study were normally distributed was examined using the Shapiro–Wilk test and graphs (histogram, boxplot, etc.). Normally distributed variables, such as age, infant weight, and BMI, were compared between the two groups using an independent sample t-test. While performing the independent samples t-test, Levene’s test was used for the equality of variances. The distribution of other numerical variables that did not show a normal distribution was compared between the two independent groups using the Mann-Whitney U test, which is a nonparametric test. Descriptive statistics are given as the mean standard deviation for numerical variables compared with parametric tests and median (min-max) for nonparametric tests. Sex, which is a categorical variable, was compared between the groups using the Pearson Chi-Square test. Yates’ correction was not used, and descriptive statistics for this variable are given as numbers and percentages. The relationships between numerical variables were analyzed using Spearman’s rho correlation coefficients. Statistical significance was set at p < 0.05. Analyses were performed using SPSS IBM Statistics 23.0 Program.

Of the 62 pregnant women included in the study, 32 were in the control group and all were considered suitable until the end of the study. As the serum samples of 30 pregnant women in the case group were collected during transportation, 25 were evaluated.

Results

Descriptive Data

When the demographic data of the two groups were examined, no differences were observed in age, gravidity, parity, maternal BMI, infant weight, and infant sex (p=0.97, p=0.61, p=0.71, p=0.24, p=0.14, p=0.88, respectively) (Table 1).

Table 1: Comparison of demographic characteristics, clinical features and BDNF levels of umbilical cord, and maternal serum between the control and case groups.

Variables

The control group (labor without immersion-no hydrotherapy) The case group (labor immersion in water-hydrotherapy)

P-value t/df/z/x²

Frequency

32

25  

Age (years) Mean ± SD

26 ± 5.5 26 ± 5.8

0.979

t: -0.027

df: 55

Gravida Mean ± SD (Median (Min-Max)

2.03 ± 0.7

2(1-4)

2.16 ± 0.8

2(1-4)

0.613

z: -0.505

Parity Mean ± SD (Median (Min-Max)

0.94 ± 0.6

1(0-2)

1 ± 0.6

1(0-2)

0.711

z: -0.370

BMI kg/m2 Mean ± SD

28.76 ± 4.7

27.49 ± 2.9 0.249

t: 1.166

df: 55

Baby weight kg Mean ± SD

3.304 ± 447 3.460 ± 329

0.149

t: -1.063

df: 55

Baby gender male/female n (%)

Male: 16 (50%)

Female: 16 (50%)

Male: 13 (52%)

Female: 12 (48%)

0.881

x²: 0.022

df: 1

Maternal serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

110.07 ± 79.89

85.49(39.16-359.68)

130.83 ± 79.44

113.79(13.90-332.57)

0.152

z: -1.431

Umbilical cord serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

160.47 ± 82.31

137.81(66.72-415.49)

226.48 ± 128.44

168.20(84.99-48.204)

0.033* z: -2.127

P-value <0.05 is considered as statistically significant.
BMI: Body mass index; BDNF: Brain derived neurotrophic factor; SD: Standard deviation.Min-Max: Minimal and maximal value.
An independent samples t-test (with t and df) was used to compare age, baby weight, and BMI. While performing the Independent samples t test, Levene’s test was used for equality of variances.
The Mann-Whitney U test (with p and z values) was used to compare gravida, parity, and BDNF.
The Pearson Chi-Square test (with value (x²) and df) was used to compare the gender distribution of babie. Yates’s correction was not us.

Outcome Data

When the maternal serum BDNF levels were analyzed, no statistically significant difference was observed between the two groups (p=0.152). However, cord blood BDNF levels were significantly different between the case group compared with the control group (p=0.03).

Neither maternal serum nor cord serum BDNF values differed according to sex (p=0.861 and p=0.718, respectively). A statistically weak but significant correlation was found between infant weight and maternal serum BDNF level (p=0.004; r=0.371). There was also no relationship between baby weight and cord BDNF level (p=0.642; r=0.063) (Table 2).

Table 2: Maternal and umbilical cord serum BDNF levels acccording to baby gender.

Variables

Female n=28 Male n=29 P-value

Maternal serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

126.77 ± 92.05

87.03(39.16-359.68)

111.85 ± 66.38

96.95(13.90-312.64

0.861

z: -0.176

Umbilical cord serum BDNF levels pg/ml Mean ± SD

(Median (Min-Max)

189.94 ± 117.05

191.84 ± 104.02

0.718

z: -0.361

BDNF: Brain Derived Neurotrophic Factor; SD: Standard deviation; Min-Max: Minimal and maximal value.
The Mann-Whitney U test (with p and z values) was used to compare BDNF.

Discussion

Immersion in the waterbirth method provides many benefits in the form of maternal satisfaction, pain control, and easy movement in water. In this method, pain is reduced by hydrotherapy by taking pregnant women into the pool during labor, but birth takes place outside the pool. On the other hand, during a water birth, the pregnant woman is taken into the water during labor, and the birth takes place in the water. Both methods have been found to be beneficial for the emotional comfort of postpartum mothers [1]. However, studies on the neonatal benefits of these methods are limited. There are selected studies on immersion in water and the absence of fetal side effects during birth [4,12].

This study was designed to investigate the potential benefits of water immersion. The advantages of water immersion during labor or birth encompass reduced pain, expanded functional diameter of the true pelvis, improved quality of contractions, heightened release of endorphins, diminished reliance on opiates, increased mobility for the mother, and enhanced positioning during various stages of labor [13]. We aimed to investigate whether hydrotherapy has an increasing effect on maternal and infant cord BDNF values, and whether hydrotherapy has a positive neurohormonal effect. We compared BDNF, a neurotrophic factor in the serum of maternal and infant cord blood, in hydrotherapy and conventional vaginal delivery and found that maternal serum BDNF levels were not different. Although there was no statistical difference between maternal serum BDNFs levels, the mean values in the hydrotherapy group were significantly higher. This may be because of the small sample size. Despite this, cord serum BDNF levels were significantly higher in the hydrotherapy group.

Neurotrophins are important regulators of neural cell survival, development, function and plasticity. Mammals have four neurotrophins that are derived from the same ancestral gene [26]. Neurotrophins support neuron survival and prevent neuron apoptosis [14].

Neurotrophins play an important role in axon growth during development, higher neuronal function, morphologic differentiation, and neurotransmitter expression [15]. Thus, neurotrophins can play an important role in the development of the brain before and after birth. However, data on the presence and effects of neurotrophins in preterm infants are insufficient. BDNF and NT-3 are highly expressed in the cortical and hippocampal structures and have been linked to the survival and function of multiple neuronal populations [16].

BDNF was found to be related to hypoxic-ischemic encephalopathy, mental retardation, and autism in newborns. The importance of BDNF and NT3 in neurodevelopment in the intrauterine period has been emphasized. There is evidence that prenatal or maternal traumatic stress has a significant impact on neurodevelopment. In general, the earlier and more severe the trauma, the more impaired the neurodevelopment [17]. The better the mother’s comfort during delivery, the easier the mother’s adaptation to the mother’s puerperium, and the lower the rate of postpartum depression. Therefore, we believe that immersion in water may be beneficial to neurological development.

BDNF is important in neuronal plasticity [18]. BDNF has mostly been studied in mammals during the prenatal and neurogenesis stages, but relatively less in the postnatal period [8]. This phase is important because, although neurogenesis is completed several days before birth, most neurons in the hippocampus appear after birth [11]. In addition, since BDNF is very important in mammalian adults, our research goal was to investigate whether BDNF changes depending on the mode of delivery.

In the water immersion group, high BDNF levels in the cord blood, but not in the mother’s blood, may contribute positively to the neurological development of the newborn. Moreover, Kodomori et al. showed in their animal study that maternal BDNF contributes to the neurological development of the fetus through uteroplacental passage. In our study, high BDNF levels were detected in the cord blood of rats in the water immersion group. In the perinatal period, the blood-brain barrier is immature because circulating BDNF may reflect the level of BDNF in the central nervous system, and circulating cortical BDNF levels are correlated, as has been reported. Again, in previous studies, conditions such as surgery, stress, birth, and hypotension that cause stress in the central nervous system have been found to cause changes in BDNF release. Accordingly, since hydrotherapy is a less painful and emotional form of delivery, higher BDNF values were obtained in our study group [18-20].

We also investigated the relationship between infant weight and BDNF levels and found only a weak link between maternal serum BDNF levels and infant weight. All the infants included in this study were term. In a recent animal experimental study [21], the relationship between infant sex and BDNF was investigated, and it was shown that BDNF content increased in the brains of both male and female rat pups 0 h after hypoxia and 4 h in serum; however, only males had increased brain BDNF levels 4 h after hypoxia. When we investigated the relationship between baby sex and BDNF levels, we did not find any difference in BDNF levels between the sexes. This may be due to the small number of patients. As this subject has been extensively researched and the importance of BDNF and other neurohormones is increasing, more long-term studies are needed.

Recent studies have investigated the use of serum BDNF levels in Alzheimer’s disease and as a biomarker of schizophrenia and depression. We aimed to examine serum BDNF levels because we believe that hydrotherapy has positive effects on maternal psychology and protects against the development of postpartum depression. As hydrotherapy has positive effects on maternal psychology and postpartum depression, we examined serum values [21-23].

Neurotrophic factors play crucial roles in neuroprotection. Neurotrophins promote survival and reduce apoptosis in many populations of neurons [14].

Limitations of the Study

The small number of participants in our study and the fact that we did not follow mothers and babies in the long term may be a limitation of our study.

Conclusions

In light of these studies, the neuroprotective effects of neurotrophins, especially BDNF, including anti-apoptotic axonal development of neurons, neurodevelopmental effects that have healing effects in some neurodegenerative diseases, and their positive effects in diseases such as autism and mental retardation, have increased the importance of BDNF in recent years. The relationship between BDNF, other delivery modes, and hydrotherapy has not been previously studied. Although we have shown in our study that hydrotherapy delivery may have a positive effect on BDNF levels, we believe that immersion in water contributes to the development of neurons in newborns by increasing BDNF levels. We hope that our study will encourage future research on this very important subject and will shed light on future studies on this very important subject.

Declarations

  1. Conflict of interest: Not applicable
  2. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
  3. Ethical approval: Ethical approval was received from the Zekai Tahir Burak Women’s Health Education and Research Hospital with the approval of the ethics committee (ethical approval statement: 58/2018).
  4. Consent to Participate: All participants provided written informed consent prior to their participation in the study in accordance with the tenets of the Declaration of Helsinki.
  5. Authors’ Contributions:
    Conceptualization: Rahime Bedir Findik
    Investigation: Rahime Bedir Findik, Ozlem Uzunlar, Esin Merve Erol Koc
    Methodology: Rahime Bedir Findik, Ozlem Uzunlar
    Resources: Rahime Bedik Findik, Ozlem Uzunlar, Esin Merve Erol Koc
    Validation: Rahime Bedir Findik, Ozlem Uzunlar
    Supervision: Yaprak Ustun
    Writing – original draft: Rahime Bedir Findik, Ozlem Uzunlar
    Writing – review & editing: Rahime Bedir Findik, Ozlem Uzunlar
    Formal analysis: Jale Karakaya, Gulsen Yilmaz, Fatma Meric Yilmaz Mert
    All authors have read and agreed to the submitted version of the manuscript.
    1. Data availability: Data are however available from the authors upon reasonable request and with permission from [third party name].

    Abbreviations

    BDNF: Brain-Derived Neurotrophic Factor; ELISA: Enzyme- Linked ImmunoSorbent Assay; OD: The Optical Density

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Evaluation of In Vitro Cell Viability and Cytokine Production by Mesenchymal Stem Cells Exposed to the Homeopathic Medicine Matricaria chamomilla D3

DOI: 10.31038/IJVB.2024823

Abstract

Chamomilla has long been recognized in traditional medicine for its established uses in herbal medicine and homeopathy. It is commonly recommended for treating respiratory, hepatic, gastrointestinal, and mental disorders. Additionally, it exhibits sedative, antiseptic, antiemetic, and anti-inflammatory properties and is frequently used to address issues related to teething in young patients. Despite its widespread use, scientific validation is essential to enhance the credibility of this medicine. In vitro studies offer a valuable approach for assessing the impact of homeopathic medicines on cellular functions, including cytotoxicity and cytokine secretion. Cell viability is typically evaluated through assays such as MTT, which measures cellular metabolic activity and provides insight into the proportion of viable cells following exposure to specific compounds. In the case of mesenchymal stem cells (MSCs) exposed to Matricaria chamomilla D3, the goal is to determine whether the homeopathic remedy affects cell survival or induces cytotoxicity. MSCs are known for secreting various cytokines that regulate inflammatory responses and promote tissue regeneration. Exposure to Matricaria chamomilla D3 may influence cytokine secretion, potentially altering the inflammatory response. This study evaluated the in vitro toxicity of injectable Chamomilla D3 in human mesenchymal stem cells, along with its potential anti-inflammatory effects, as evidenced by the reduction in the pro-inflammatory cytokine IL-8. The findings suggest that homeopathic Chamomilla D3 exhibits in vitro anti-inflammatory activity.

Keywords

Homeopathy, Vegetal, Complementary medicine

Introduction

Matricaria chamomilla, also known as chamomile, is a globally distributed plant [2]. It has a rich history in herbal medicine and homeopathy, with indications for treating various diseases [1]. Matricaria chamomilla is a versatile plant with multiple uses in folk medicine. It treats respiratory, hepatic, gastrointestinal, and mental alterations like stress and anxiety. It is also used as a sedative, antiseptic, and antiemetic, among others reported.

The phytochemistry, biological, and pharmacological properties of Matricaria chamomilla extracts are extensively characterized and systematically documented within herbal medicine. Its phytochemical composition encompasses over 120 bioactive compounds, including essential oils, terpenoids, and phenolic substances such as phenolic acids, flavonoids, and coumarins. These compounds impart a range of well-documented activities, including antioxidant, antibacterial, antifungal, antiparasitic, insecticidal, antidiabetic, anticancer, anti-inflammatory, antidepressant, antipyretic, anti-allergic, and analgesic effects [3].

According to the Homeopathic Medical Material, Matricaria chamomilla is indicated for various clinical manifestations such as irritability and hypersensitivity. Additionally, it may be relevant for treating otitis and diarrhea, especially in children, and for conditions associated with teething and gastrointestinal disturbances [4]. described effects such as anti-inflammatory and antispasmodic activities, among others, that support alleviating clinical symptoms. These effects may significantly improve the previously mentioned signs and symptoms [5].

The present study aimed to evaluate the anti-inflammatory activity of Matricaria chamomilla prepared according to the homeopathic pharmacopeia, specifically at a D3 potency and a concentration of 8 µL/mL. This evaluation focused on releasing the inflammatory cytokine Interleukin 8 (IL-8) and assessed the viability of healthy mesenchymal stem cells exposed to the medicine Matricaria chamomilla.

Materials and Methods

MTT Assay

The injectable homeopathic medicinal product Chamomilla D3 was tested on human mesenchymal stem cells (MSC) by the MTT test at a concentration of 8 µL/mL. Cell culture was performed in 75 cm2 flasks until reaching 80% confluence. Human mesenchymal stem cells in culture were trypsinized and distributed in a 96-well plate. After this process, the cells were incubated for 24 hours at 37°C in a 5% CO₂ environment. The test substance was prepared at 8 µL/mL and distributed into the designated wells. After 24-hour incubation, the culture medium was withdrawn and discarded. A volume of 50 μL of medium supplemented with 20% FBS was added, followed by 50 μL of medium containing the diluted test substance. The cells were incubated for an additional 48 hours in a CO₂ incubator, maintained at 5% CO₂ and a temperature of 37°C. After this period, the treatment medium was discarded, and 100 µL of the MTT solution was added to each well. The plate was covered with aluminum foil and incubated for 4 hours in an oven. Subsequently, MTT was removed, and 100 µL of DMSO was added to each well. The optical density was measured at 570 nm ± 10 nm using a plate reader. After this assay, the cytokine levels released upon exposure to the medicine were measured.

Cytokine Dosing

After reaching cellular confluence, cultured human mesenchymal stem cells were subjected to trypsinization and plated in 96-well plates. After 24 hours of incubation at 37°C with 5% CO₂, the culture medium was removed, and the wells were washed with PBS. Subsequently, 200 μg/mL of LPS (lipopolysaccharides from *Escherichia coli* O55: B5 – Sigma Aldrich), diluted in an antibiotic-free medium, was added in wells of positive control group and treatment group. Negative control group did not receive LPS, only culture medium. A subsequent incubation was performed for an additional 24 hours. Following the induction period of cellular inflammation with LPS, the medium was removed from the plate, and the wells were washed with PBS. The medicine was added at a final concentration of 8 μL/mL in treatment group. In negative and positive control groups, culture medium was added. The plate was then incubated for 24 hours under the previously described conditions.

After the treatment period, the supernatant was removed, and serum-free culture medium was added for 24 hours. The supernatant was collected for IL-8 analysis. IL-8 levels were measured using flow cytometry with the FACS VIA BD™ cytometer.

Results and Discussion

The present study assessed the cytotoxicity of the injectable homeopathic medicine Chamomilla D3 in human mesenchymal stem cells. The analysis revealed that, at the tested concentration, the material exhibited no cytotoxic potential (Table 1 and Figure 1).

Table 1: Cell viability obtained from the control and treated groups (Chamomilla 8 μl/mL) after MTT testing.

Cell viability(%)

Control

Chamomilla 8µl/mL
94

93

101

93
102

95

Figure 1: Cell viability (%) of the control and treated groups (Chamomilla 8 μl/mL): ns = no statistical difference.

Following the initial analysis, the release of the inflammation marker IL-8 by MSCs was evaluated both in response to LPS exposure and after treatment with the medicine. It was observed that LPS induced the release of IL-8, demonstrating its effectiveness in stimulating inflammation within the cell culture environment (see Figure 2). Additionally, cells previously “inflamed” by LPS were subsequently “treated” with the homeopathic medicine Chamomilla D3. The results demonstrated a significant reduction in the inflammation marker IL-8 following treatment. A similar pattern was observed in the control group, which consisted of cells maintained in a culture medium without LPS induction or Chamomilla D3 treatment (see Figure 2).

Figure 2: The results of the cytokine dosage test are presented in pg/mL for the following groups: the control group without LPS addition, the control group with LPS addition, and the treated group with Chamomilla at 8 μl/mL.

Homeopathy is frequently investigated due to its low likelihood of toxicity and minimal risk of causing side effects. According to Millstine [6], homeopathy can benefit the treatment of specific clinical conditions by potentially providing symptom relief.

Homeopathic Chamomilla is known for its anti-inflammatory effects, which can aid in treating various conditions [10]. Studies have demonstrated that the compounds in Chamomilla, such as flavonoids and terpenoids, possess properties that aid in reducing inflammation and alleviating related symptoms. As noted by Amsterdam [7], Chamomilla is also recognized for its calming and relaxing effects, which can contribute to alleviating stress and anxiety – factors often associated with inflammatory processes in the body.

Furthermore, regarding the anti-inflammatory properties of homeopathic Chamomilla, this article supports and validates the study by Scabello and Gardin [8], which examines injectable dynamized medicines available in Brazil. The authors noted that Chamomilla harmonizes the excessive action of the soul organization over the vital force, particularly within the digestive and menstrual spheres, and addresses general inflammation, per the principles of Anthroposophical Medicine.

In the homeopathic form, Chamomilla was identified as one of the ten most frequently used medicines for treating migraines, as highlighted and reviewed by Santos. Migraines are types of headaches that impair the patient’s quality of life.

Another property attributed to a medicine based on Matricaria chamomilla is its relaxation and analgesic effects. These effects were demonstrated in the study by Jyothis [9], which experimentally evaluated its impact on the central nervous system. As a result, a significant reduction in locomotor activity was observed, indicating muscle relaxation, analgesic effects, and anticonvulsant activity. Pinto [12] also reported relaxation effects in animals subjected to stress and depression.

The antibacterial and fungicidal actions of Matricaria chamomilla were emphasized in the study by, which explored its various aspects and properties. The study noted that its compounds impart sedative attributes, support digestion, and exhibit antimicrobial effects against bacteria and fungi [13].

Conclusion

The present study demonstrated the low in vitro toxicity of injectable Chamomilla D3 in human mesenchymal stem cells. Additionally, it suggested a potential anti-inflammatory action, as evidenced by a reduction in the levels of the pro-inflammatory cytokine IL-8. However, further studies are needed to confirm the homeopathic indications of its compounds in their homeopathic form and establish Chamomilla‘s in vivo anti-inflammatory activity.

References

  1. Reis LS, Pardo PE, Oba E, Kronka Sdo N, Frazatti-Gallina NM (2006) Matricaria chamomilla CH12 decreases handling stress in Nelore calves. J Vet Sci. [crossref]
  2. El Mihyaoui A, Esteves da Silva JCG, Charfi S, Candela Castillo ME, Lamarti A, Arnao MB (2022) Chamomile (Matricaria chamomilla L.): A Review of Ethnomedicinal Use, Phytochemistry and Pharmacological Uses. Life (Basel) [crossref]
  3. Santos ARF, da C, Cruz JH, de A, Guênes GMT, Oliveira Filho A Ade, Alves M ASG (2020) Matricaria chamomilla L: pharmacological properties. Archives Of Health Investigation, 8(12)
  4. Lathoud JA (2017) Studies of Homeopathic Materia Medica. Ed. Organon. 3rd edition. Sao Paulo.
  5. Fernanda Michel Tavares CANTO(a) Oswaldo de Castro COSTA NETO(a) Jéssica Muniz LOUREIRO(a) Guido Artemio MARAÑÓN-VÁSQUEZ(a) Daniele Masterson Tavares Pereira FERREIRA(b) Lucianne Cople MAIA(a) Matheus Melo PITHON(c) (2022) Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review. Oral Res. [crossref]
  6. Millstine D (2023, December) Homeopathy. MSD Manual.
  7. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J (2009) A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. [crossref]
  8. Scabello RT, Gardin NE (2015) Potentized injectable medicines available in Brazil: indications based on homotoxicology and possibilities of use according to anthroposophic medicine. Arte Med Ampl
  9. JYOTHIS, AB Ram. A Study on Analgesic activity of Matricaria chamomilla.
  10. Srivastava JK, Shankar E, Gupta S (2010) Chamomile: A herbal medicine of the past with bright future. Mol Med Report. [crossref]
  11. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J (2009) A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol.
  12. Pinto SAG, Bohland E, de Paula Coelho C, de Azevedo Morgulis MSF, Bonamin LV (2008) An animal model for the study of Chamomilla in stress and depression: pilot study. Homeopathy [crossref]
  13. Singh O, Khanam Z, Misra N, Srivastava MK (2011) Chamomile (Matricaria chamomilla L.): an overview. Pharmacognosy Reviews.

Existential Communication – Old Wine in New Skins?

DOI: 10.31038/PSYJ.2024644

Abstract

Background: The term existential communication did not emerge but recently in medical terminology. It refers to doctor-patient-communication comprising issues of mortality, fragility of human being, and associated rational and emotional coping.

Objective and methods: A literature search the term existential communication was carried out in PubMed. Moreover, from the results and the author`s long background of facilitating “breaking-bad-news” workshops for oncologists, features of an existential communication are demonstrated.

Results: A PubMed search resulted in only 8 papers from the last decade explicitly using the term existential communication. Hundreds of papers used existential in various other attributions – from existential aspects to existential yearnings. The term existential was rooted in various directions of predominantly German existential philosophy, which after National-Socialism resonated in the USA and catalyzed pioneering strategies of psycho- oncological support. Some training programs for existential communication have been established and share the principles of breaking-bad-news communication.

Conclusion: Existential communication describes more precisely than end-of-life (EOL) discussion a long-standing and teachable medical task which must not be neglected without compromising high quality patient care, in particular in oncology and palliative medicine. Existential communication is prerequisite to avoid burdening patients with very advanced cancers with futile tumor-specific treatments and detrimental adverse-effects. Existential communication is important for patients but may foster a deeper professional satisfaction of health care professionals (HCP).

Keywords

Medical communication, Cancer, Psycho-oncology palliative care, Spirituality end-of-life discussion

Im existentiellen Bereich sind Wahrheit und Kommunikation dasselbe.

In the existential realm truth and communication are identical (translation HK) Hannah Arendt, 1957 [1]

Introduction

Originally the term existential communication has been a central concept of the existential philosophy of Karl Jaspers (1883-1969) [2], a renowned German philosopher and psychiatrist. Nearly a century ago, he coined existential communication for a uniquely dyadic and non-hierarchical communication which enables both interlocutors to evolve their distinctive personhood, their existence. The term opposed the Daseins-communication (communication of being) of daily life inclusive clinical practice. Thus, Jaspers` philosophical construct of existential communication was not established for clinical practice and consequently did not enter medical terminology. Hence, in 1969 Swiss- American psychiatrist Elisabeth Kübler-Ross could finish her landmark book On death And Dying [3] without using the term existential, even if her end-of-life conversations with patients doubtlessly meet today´s understanding of existential communication. Neither can be found the term existential in Cicely Saunders paramount book of palliative medicine of 1978 [4]. However, this book outlined her concept of total pain, which soon should shape the understanding of palliative care of the World Health Organization (WHO) [5] and of international and national palliative care societies [6]. Since then, state-of-the-art care of patients with life-threatening disease embraces a spiritual dimension. Almost simultaneously with the term spiritual the term existential emerged in the Anglo-American medical literature, though. Unlike existential communication the single term existential had entered psychiatric literature of German language already in the first half of the 20th century. The German philosopher Martin Heidegger (1889- 1976) had influenced the psychiatric and respective psychotherapeutic Daseins-Analysis of Ludwig Binswanger [7] and Medard Boss [8], both Swiss psychiatrists and psycho-analysts. Moreover, Viktor Frankl, an Austrian psychiatrist of Vienna, who had established his scientific reputation with innovative concepts of care for suicidal individuals and patients with depression, i.e. patients facing an existential crisis, had outlined his Existence-analysis and Logotherapy since the mid- thirties [9]. But during the Nazi-Era humanistic psychiatric patient care influenced by psychoanalysis and existential philosophy was eradicated in Nazi-dominated Europe and many of the most eminent representatives of German oncology and psychiatry – for being Jews – were forced to emigrate or into murderous concentration camps. In regard to their Nazi-collaboration German medical organizations put under taboo and discouraged any deeper reflection of existential philosophical issues like responsibility, guilt, and shame after the defeat of the Nazi-regime for more than one generation. However, US-American psychiatrists explicitly referring to the above mentioned European philosophers and clinicians soon should introduce the term existential into a now Anglo-American medical literature. Viktor Frankl, who had survived four concentration camps, took an important role for this transatlantic loop of the term existential. He refined his meaning-centered Logotherapy and Existence-analysis reflecting his years of existential threat and the murdering of his family in concentration camps. Initially his concept did not resonate much in the scientific community of post war Austria and Germany, but he gained recognition as a visiting professor at Harvard and other US- universities and with the English translation [10] of his post war book, which has been sold in millions of copies. In a 1991 survey Man’s Search for Meaning was rated one of the ten most influential books in the US. Independently, Stanford psychiatrist Irvin Yalom developed his very influential Existential Psychotherapy [11] leaning on Viennese psycho- analytic concepts and European pre-war existential philosophy. Yalom´s resources-centered therapeutic approach has been modified for psycho- oncological support for patients with cancer: at Stanford psychiatrist David Spiegel established his Supportive-Expressive Psychotherapy [12,13], while William Breitbart – a child of Holocaust survivors, and explicitly referring to Viktor Frankl – developed his Meaning-Centered Psychotherapy [14] at New York´s Sloan-Kettering Cancer Center. Spiritual, existential and finally existential communication had entered literature of oncology and palliative medicine, even if the conceptual understanding of different authors diverge [15].

Methods and Materials

A literature search was conducted in Pubmed (accessed June 21,2024) using the search term existential communication which resulted in 834 references. These comprised both papers using the combined term or just the single term existential or communication. Thus, many references dealt with the vast fund of medical communication which was considered helpful for outlining principles of existential communication. Moreover, the author returned to his extensive experience from facilitating workshops for clinicians on “breaking-bad-news” [16] where modules of communication on death and dying and associated emotions regularly were appreciated most by the participants.

Results

The term existential communication emerged in medical literature only a decade ago and of the 834 references only 6 papers had existential communication in their titles, with 5 of them affiliated with the Denish University of Odense [17-22]. In addition, 2 papers used the term (or modified as existential conversation [23]) in their abstracts or texts [24]. Hundreds of papers employed existential attributively to describe illness experiences, suffering, crisis, loss, shock, aspects of relationships and core values, feelings of guilt, isolation, and yearning (Table 1).

Table 1: Attributive use of existential in medical literature.

existential anxiety

e. conflicts

e. guilt

e. outcome

e. struggle

e. aspects

e. constructs

e. impact

e. pain

e. suffering

e. beliefs

e. crisis

e. uncertainty

e. perspective

e. support

e. burden

e. decision making

e. insight

e. intervention

e. problems

e. survivorship

e. terror

e. care

e. determinator

e. isolation

e. quality

e. thoughts

e. challenges

e. dimension

e. issues

e. questions

e. threat

e. circumstances

e. distress

e. loneliness

e. reactions

e. values

e. communication

e. encounter

e. loss

e. relation

e. vulnerability

e. concern

e. experience

e. meaning

e. rupture

e. well-being

e. condition

e. fear

e. needs

e. shock

e. yearnings

The term existential is embedded into two concurrent concepts. The European Association of Palliative Care (EAPC) und papers adopting its definition use spiritual as a meta-concept which includes existential [6]. Irvin Yalom`s Existential Psychotherapy considers existential as overarching concept, though, which comprises spiritual and religious issues [11]. In the same manner Scandinavian study groups understand existential as a meta-concept, which includes spiritual issues [20]. They are backed by a sample survey of the Denish population, which showed that “the existential” serves well as an overarching construct potentially including secular, spiritual and religious domains of meaning [25]. Moreover, general practitioners of the secular Denish society felt more at ease with the term existential in comparison to spiritual. However, the structural differences of both meta-concepts do not interfere much in actual communication with severely ill patients, and both meta- concepts sometimes may be found in parallel use by the same authors, or existential, spiritual and religious aspects are pragmatically put side by side on a same level [20,26].

Elise Tarbi`s study group at Boston`s Dana-Farber Cancer Institute defines existential communication “as any discussion concerned with confronting mortality and the fragility of existence; in particular, relating to major themes of (1) time as a pressing boundary; (2) maintaining a coherent self; and (3) connecting with others” [24]. This definition is compatible with the one used by the Denish study group at Odense University: “a metaconcept that includes communication about broad existential aspects and potentially, but not mandatorily, communication about spiritual and religious aspects [20].

Why Existential Communication?

In oncological and palliative care existential communication means communication in and about an existential crisis. Coping with a crisis situation depends on communication. Thus, existential communication features both a diagnostic and a therapeutical dimension [27]. The concept of total pain [4] already underscores the importance of giving attention to existential suffering for adequate symptom control [24,28] and quality of life. Otherwise patients might run the risk of being labeled as “difficult” by medical care providers. Breitbart pointed out that he teaches his trainees that “whenever they encounter an angry patient with advanced cancer think existential guilt […]Anger and anxiety have the same etymological roots, and in fact angry typically comes from fear. The fear of loss; loss of love, hope, life. [..]. Clinically I see Existential Guilt manifest as either depression, shame, anger, or intense death anxiety” [29].

Patients with advanced cancer usually want to talk about existential issues with their doctors. But doctors often fail to recognize these wishes or feel time pressured or incompetent for a sensitive wording or consider these issues too private to address. Moreover, physicians with their training in the biomedical approach often focus on obtaining objective measures and fixing a problem. Confronted with problems that cannot be measured objectively and with no direct solutions at hand this approach is bound to reach deadlock [26]. On the other hand, HCPs who engage in communication about existential issues report higher professional meaning and satisfaction and personal depth. Early communication on death and dying with patients with advanced oncological diseases entails less futile and costly oncological treatments and detrimental adverse effects in the weeks before death. These patients have a better quality of life, spend fewer days in a hospital, are less frequently admitted to intensive care units and have a higher chance to die outside a hospital [30]. As the percentage of patients receiving futile oncological treatment in the last weeks of their life did not diminish in the last decade eminent US- American cancer centers pleaded for a better training of oncologists to communicate with patients on existential issues [31].

Principles and Practice of Existential Communication

Existential issues like finitude, mortality and meaning of life cannot be solved but require an individual positioning, acceptance and maybe a possible reevaluation. Patients with life-threatening illness may have a lot of physical and psychosocial problems, but in contrast, they share their existential condition with their HCPs – even if the latter sense less urgency for grappling with their existential issues. Thus, doctors and nurses, wo feel confident in providing medical expertise or advice, generally feel far more challenged when a patient addresses existential suffering. It is beneficial for HCP-teams to reflect personal values and existential beliefs. As a matter of fact, doctors who have been confronted with existential threats in their biography tend to be more attentive to their patients` existential concerns [2]. Spiegel`s concept of “detoxifying dying” in group therapy constructively confronts one´s own mortality when faced with death or imminent loss and can be helpful for HCP-teams [12]. Communication is not an end in itself. Medical communication should be beneficial in coping with severe illness: patients should experience: (1) a sense of resonance – having been seen, heard and understood; (2) a “solidarity of mortals” – an empathetic relationship respecting the remaining autonomy and dignity; (3) hope – an expectation that in severe illness and even with facing death positive experiences may be possible [27]. For Suchman “the feeling of being understood by another person is intrinsically therapeutic: it bridges the isolation of illness and restores the sense of connectedness that patients need to feel whole.” [32] Quite often physicians neglect the crucial elements of establishing a therapeutic relationship: respectful greeting, eye contact, attention and showing interest and empathy. Connection will fail, if doctors just have eye contact with the display of their digital tools for timesaving and simultaneous documentation of patient information. Empathy is not identical with professional friendliness.

As soon as a patient gets informed about a life-threatening disease existential issues intermingle with questions about therapeutic options and treatment schedules: “How much time will I have left? “Why me?” “I am trapped in a black pit”, “I can´t be a burden for my family”, or “oh gosh, that´s the end!” During the last three decades very useful protocols for “breaking bad news” communication have been evaluated, even if lack of adherence to them still is a problem in clinical reality [33,34]. Existential topics are rarely expressed explicitly in palliative care conversations [21]. They often sprinkle patient-caregiver contacts for physical or psycho-social symptom assessment, medical or nursing procedures, or are woven within practical conversations during medical rounds. Statements like “It´s enough!”, “please give me something to die” deal with death, others with issues of justice and guilt: “Why do I have to suffer like this?” Issues of existential loss – loss of self-esteem and identity – emerge in sighs like “I am just a burden”, “This isn´t me anymore!” Again, as in “breaking-bad-news” communications, it is of paramount importance for HCPs not only to grasp the literal content of those statements but also to identify and to primarily address their implicit and dominant emotional contents: uncertainty, fear, despair, anger, shame, feelings of worthlessness. That is how emotional resonance is achieved [16,32,35]. A clinical snippet may demonstrate this approach:

Patient: “This is no life any more.”

Physician responding to the literal message:

Oh no, we do everything to help you, you can rely on our palliative care expertise.Physician responding to the emotional message:

“You are really despaired.” Pause, and when the patient confirms non-verbally (nod, eye contact):

Please tell me what is haunting you most?

The response to the literal message implicitly devaluates the present illness experience while dodging the emotional issue as a “empathetic terminator” [32]. To minimize a risk of rebuff patients weave existential cues within conversations during medical care or nursing procedures. They sound the openness of HPCs for existential communications [22]. This may be underlined by another clinical snippet:

A 67-year-old woman presenting with ascites was diagnosed with advanced ovarian cancer. She is scheduled for a diagnostic laparotomy. When the experienced anesthesiologist sees her the day before surgery to explain his procedure he is puzzled by the welcome statement of that friendly lady: “I wonder about my future?” The senior doctor hesitates, then answers: “In my opinion, people don´t reflect enough about death.” The patient is startled. She just answers to the technical questions relevant for adequate anesthesia. She is too upset to sleep during the night before surgery.

The patient´s statement “I wonder about my future” doubtlessly is a distinct existential cue. The doctor perceives the emotional message of fear of death. He could address this emotion by labeling it: “Are you afraid to die soon?” However, the doctor flinched from dealing with the emotional issue und took refuge to a rational comment, schoolmasterly dodging the patient´s existential distress. Every existential crisis is charged with unpleasant emotions. Therefore, physicians may be tempted to side-step these emotions by moving quickly to the field of professional action competence with comments, giving advice, or hurriedly suggesting solutions. But it is crucial to take up the patients´ emotional cues first in order to advance to an existential communication. Moreover, HCPs should keep in mind that strong emotions hamper cognitive information processing. Nevertheless, before engaging in an existential communication HCPs should clarify, whether there are any interfering uncontrolled physical symptoms such as pain, thirst, or an urge to urinate. The above snippet demonstrates: Existential clues often hit the HCPs by surprise. They have to decide whether momentarily engaging in an existential communication is a feasible or wise option. Anyway the HCP should signify having registered the cue, maybe – concerning the above snippet by commenting: “That´s an important issue for you, but it makes sense to wait for the results of tomorrow`s operation.Or the consultant may request the patient´s consent to inform his responsible physician about a desire for a deeper communication, or may ask permission to pass a more specific religious topic to a chaplain.

Tarbi found that conversations with more discussion of prognosis also contained more discussion of existential topics [24]. But without showing a lack of courteous manners doctors often focused on strictly medical facts, failing to notice or ignoring the patient´s existential illness experience and strife for meaning and validation. “Courteous but not curious” is Agledahl`s [36] summary of analysis of doctor- patient encounters in a Norwegian teaching hospital. Whether patients open up to share their existential thoughts heavily depends on non-verbal and sensory elements of an encounter: whether a HCP is perceived both physically and relationally present. “The bodily sensation of presence and sensing seems to precede the verbal dimension of spiritual care and communication […] The patients use a sort of decoding in which they try to sense and decipher whether they will be accommodated, if they initiate a conversation about spiritual matters” [37]. Reciprocally HCPs have to decode the patients` non- verbal cues and keep in mind the most important principles of medical communication: (1) active listening – learning the illness experience; (2) asking questions – showing interest, and encouraging a narrative and its clarification; (3) perception – what and how does the patient communicate verbally and non-verbally. It is important to recognize that a patient is the single expert of his illness experience which he might share by answering to questions like:

“What burdens you most?”

“If you ponder on your illness, how much time do you think you have got to live?”

“When thoughts of death and dying come to your mind, do they cause fear or anxiety?”

“When you think about the rest of your life, what matters most for you?”

“Do you have a specific event or goal you would like to live?”

“When you think back, what did help you most in coping with your disease?”

“When you reflect on your life, what makes you really proud?”

I encourage this kind of “empathetic curiosity” which had been lacking in Agledahl`s study of patient-doctor encounters [36]. Addressing tabooed or anxiety-ridden issues reduces anxiety. Moreover, a simultaneous validation of coping efforts will diminish a patient´s sense of helplessness, hopelessness, and isolation and restore a sense of agency in spite of an advanced disease. Meanwhile, useful concepts of existential communication have been established [18,20,22]. In addition, established guidelines for “breaking bad news” in medicine and reviewed programs of communication skills training in oncology [34] comprise the principles of existential communication.

Conclusion

The recent term existential communication with its secular roots and associations excellently describes a long standing medical task which is crucial for state-of-the art patient care, especially in oncology and palliative medicine. In contrast to the common term end-of-life discussion existential communication semantically does not focus on the end of life but also on the life before. Existential communication also deals with maybe lifelong individual values and resources which impact treatment decisions. But on disease progression of advanced cancer oncologists often “skip over discussions of prognosis and jump to offering a new line of therapy” [31]. They struggle with “taking away hope” [38]. feel uncomfortable with existential issues, and biasedly believe that additional treatment will benefit the patient. That is why existential communications are to be actively scheduled in patient care and are particularly crucial when disease-modifying treatment is stopped. Existential issues of remaining life time and anxiety or confusion surrounding dying regularly emerge at this phase of an illness trajectory. At the same time therapeutic responsibility often changes which may structurally augment the patient´s suffering of having to leave behind loved ones. A patient`s complicit encouragement of his oncologist to offer additional treatment sometimes is motivated by the patient´s fear that otherwise his medical life-line will be cut. Therefore, an early integration of palliative care specialists into the oncological care team is important. Moreover, patients may feel very relieved when oncologists empathetically explain, that with stopping a futile treatment survival will not be shorter but quality of life will be better because adverse effects will cease.

Acknowledgment

The author thanks Matthias Demandt, MD,. for constructive comments on early versions of the manuscript

Competing Interest

The author declares that he has no competing interests.

Funding Information

The author did not receive external funding.

The author did not receive external assistance with data collection, analysis, and manuscript preparation

Ethical Declaration

This study did not involve human participants or animal subjects.

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Tobacco Pandemic: Challenges and Responses

DOI: 10.31038/CST.2024943

Abstract

Smoking is the leading cause of preventable death worldwide. Its toxicity affects every organ. It is a risk factor or aggravating cause of many diseases: cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, HIV infection and tuberculosis, and is a major source of environmental pollution. The socio-economic costs of smoking, already exorbitant, are likely to become unsustainable by 2050 for all countries, particularly low- and middle-income countries. Twenty years after the adoption and implementation of the WHO Framework Convention on Tobacco Control (FCTC), this article aims to take stock of the situation regarding tobacco use and tobacco control. All countries and international health agencies must be involved in the fight against the tobacco pandemic. It is more important than ever to strengthen tobacco control policies, particularly by helping people to stop smoking, to curb the pandemic and its devastating consequences.

Keywords

Smoking, Smoking-related diseases, Tobacco control, Smoking cessation, Public-health

Introduction

Currently more than 20% of the world’s population were smokers. Smoking remains a global health issue despite the gradual reduction in its prevalence. It is responsible for more than 8 million deaths a year worldwide [1]. The toxicity of tobacco products affects every organ in the body, and it is a direct cause, adjuvant and aggravating factor in many diseases: cancer, cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, HIV infection, tuberculosis, environmental health risks, all of which affect all countries, particularly low- and middle-income countries [2]. The prevalence and mortality of these diseases are set to rise sharply by 2050, entailing very high socio- economic costs. Twenty years after the adoption and implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), this article takes stock of the impact of this pandemic and the state of tobacco control, highlighting the necessity to intensify efforts to combat smoking.

Smoking: A Preventable Killer

Smoking is a chronic disease causing many illnesses. It is the leading preventable cause of death. Smoking cessation is associated with an improvement in life expectancy and quality of life, the greater the earlier the cessation, but even after the age of 60 it is associated with an increase in life expectancy [3].

Cancer

In 2022, there will be 20 million new cases and 9.7 million deaths from cancer. It is estimated that there will be more than 35 million new cases of cancer in 2050, an increase of 77% compared with 2022, particularly in low- and middle-income countries, where cancer mortality will double [4].

Smoking is associated with an increased risk of most cancers.The harmful effects of smoking are exacerbated by other factors (alcohol abuse, malnutrition, viral infections, air pollution) [3,4]. Smoking is the main cause of lung cancer (12.4% of all new cancer cases and 18.7% of all cancer deaths). The prevalence of this cancer is increasing in all countries and its incidence could rise by 47% between 2020 and 2040 [4].

The risk of cancer decreases with the length of time smokers have quit [3]. In Korea, a retrospective cohort study of 3 million smokers aged 30 years and older showed that the risk of cancer decreased after 10 years of smoking cessation (HR=0.83 ; 95% CI: 0.80-0.86) compared with continued smoking. The reduction in the risk of lung cancer is more pronounced for quitting before the age of 50 (HR=0.43; 95% CI: 0.35-0.53) compared with quitting at the age of 50 or older (HR=0.61 ; 95% CI: 0.56-0.66). Smoking cessation also reduces the risk of perioperative complications from excisional surgery and the risk of recurrence after cure, it increases life expectancy and quality of life in patients treated for cancer [5].

Cardiovascular Disease

Nearly two million deaths per year are attributable to smoking- related cardiovascular diseases, and the socioeconomic costs of these diseases will rise sharply by 2050 [6].

In high-income countries, tobacco-related cardiovascular mortality is tending to decrease among men, but is increasing among women. In France, for example, the incidence of myocardial infarction before the age of 65 increased by 50% in women (16% in men) between 2005 and 2014. For the same level of smoking, women have a 25% higher risk of coronary heart disease than men [7]. Almost 75% of deaths from cardiovascular disease occur in developing countries, where people have less access to primary health care, screening and early treatment of these diseases.

Mortality from coronary heart disease is reduced by 35% after 2 to 4 years of smoking cessation and by 50% after 10 years. Smoking cessation helps prevent coronary heart disease in young people, where smoking is the main cause. Quitting also reduces the risk of death or reintervention after coronary artery bypass graft surgery or angioplasty, stroke, abdominal aortic aneurysm and obliterative arteritis of the lower limbs [3,7].

Chronic Obstructive Pulmonary Disease

COPD is the fourth leading cause of death worldwide (4.7% of annual mortality), affecting 10.3% of the world’s population, and its prevalence is expected to increase by more than 20% by 2050 [6]. The socioeconomic costs of smoking are increasing, particularly in low- and middle-income countries [8].

Tobacco smoke is the main risk factor for COPD, and women are more susceptible than men [9]. Smoking accelerates the decline in lung function, which is a source of disability. It increases the frequency of exacerbations, leading to death and hospitalisation, and the development of cardiovascular, metabolic and cancer-related comorbidities [9].

Stopping smoking is associated with a reduction in patient-reported symptoms of chronic bronchitis within one to two months. It slows the decline in lung function (FEV1) in COPD patients and reduces the risk of respiratory infections, exacerbations, hospitalisations, death and smoking-related co-morbidities [3,9].

Diabetes

In 2021, 10.5% of adults aged 19-75 worldwide had diabetes mellitus; 90% of them lived in an emerging country. Diabetes will cause 6.7 million deaths. By 2045, 12.2% of adults will have diabetes, and the explosion in the number of cases, in which smoking is a key factor, will place a socioeconomic burden on all countries [10]. The prevalence of smoking is 20.8% in patients with type 2 diabetes and 10-30% in those with type 1 diabetes [11].

Smoking increases insulin resistance, the risk of prediabetes and diabetes in the general population, and gestational diabetes. Diabetic smokers have a 48% excess risk of premature death from all causes and a 36% excess risk of cardiovascular mortality. Smoking increases the risk of macroangiopathy and microangiopathy, hospitalisation for infections, cancer and depression [10,11].

In people with diabetes, smoking cessation reduces the risk of premature mortality, cardiovascular disease and progression of microangiopathy lesions. It also reduces the risk of cancer, hospitalisation for infections and maternal-foetal complications in gestational diabetes. Finally, it facilitates glycaemic control and reduces symptoms of anxiety and depression [11].

HIV Infection

Worldwide, 39 million people are living with HIV ; 630,000 die and 1.3 million are newly infected each year [12]. Antiretroviral therapy (ART) has significantly reduced AIDS-related mortality, but the proportion of deaths from non-AIDS-related causes has increased, mainly due to smoking, which is twice as common as in the general population [13].

HIV-infected smokers have lower CD4 cell counts, higher HIV viral loads and lower self-reported quality of life than HIV-positive non-smokers. Their risk of dying from cardiovascular disease, cancer or bacterial pneumonia is twice as high and with equivalent ART, smokers have a life expectancy 12 years less than non-smokers. [14].

Smoking cessation among people living with HIV is associated with a reduction in all-cause and smoking-related mortality compared with compared with continuous smokers. Stopping smoking reduces the risk of cardiovascular disease, bacterial pneumonia, COPD and cancer, especially lung cancer [13]. WHO recommends that smoking cessation interventions be integrated into HIV care [12].

Tuberculosis

In 2023, tuberculosis (TB) was no longer among the top ten causes of death worldwide, but it still caused 1.3 million deaths. Nearly 8 million new cases of TB were diagnosed: 410,000 people developed a multidrug resistant or resistant to rifampicin TB [15].

More than 80% of TB case and 90% of TB deaths occur in developing countries. The main drivers of the TB epidemic are the spread of HIV and drug-resistant TB, but smoking is responsible for 17.6% of TB case and 15.2% of deaths in high-burden countries [16]. Smoking, whether active or passive, triples the risk of tuberculosis infection and disease, particularly severe and infectious lung disease, forms resistant to anti-tuberculosis drugs, mortality and disease recurrence, and treatment failure [16].

Smoking cessation among smokers with TB is associated with better treatment adherence, higher cure rates, lower mortality and fewer relapses [16]. WHO recommends that TB and tobacco control should be tackled simultaneously to end the TB epidemic, which is one of the United Nations Sustainable Development Goals [17].

Environmental Health Risks

The WHO estimates that 12.6 million deaths worldwide (23% of all deaths) are attributable to the environment; 75% of pollution-related deaths occur in developing countries. Every year, tobacco production, processing and transport emit 84 million tonnes of CO2, contributing to global warming [18].

Air pollution and passive smoking are responsible for 35% of all cases of bronchopulmonary disease worldwide [18] Cigarette smoking produces toxic substances in mainstream smoke (inhaled by the smoker), second-hand smoke (burning of the glowing end of the cigarette), third-hand smoke (deposition of tobacco residue on surfaces) and cigarette butts [19].

The toxic gases and particles produced (polycyclic aromatic hydrocarbons (PAHs), nitrosamines, aldehydes, ketones, alcohols, phenols, PM2.5 and PM10 microparticles) cause lung cancer, COPD, respiratory infections and allergies, as well as cardiovascular, metabolic (type 2 diabetes, thyroid dysfunction), intestinal and mental diseases [20]. These facts are a justification for tobacco control and smoking cessation.

Tobacco Control and Smoking Cessation

Financial Implications of Smoking

A report from the World Health Organization (WHO) estimates that the annual economic cost of smoking worldwide, including health expenditure, lost productivity, is approximately $1.4 trillion (1.8% of the annual global gross domestic product) and in the USA, the economic cost of smoking is nearly $300 billion a year. [20]. Of this amount, 40% affects developing countries. In France, despite a decline in smoking prevalence, the social cost of smoking is estimated at €156 billion annually, representing an annual cost of €2,300 per inhabitant, regardless of smoking status [21]. In Belgium, this cost reaches €20 billion per year and €2,000 per inhabitant per year [22].

Globally, at least 70% of tobacco consumption occurs in low- and middle-income countries. In addition to the morbidity and mortality associated with tobacco use, the cultivation, processing, and disposal of tobacco products pose environmental risks, including atmospheric pollution, global warming, and changes to ecosystems. These challenges impede the economic development of these countries.

Modalities of Tobacco Control

All forms of tobacco use are detrimental to health and well- being. Only a comprehensive, global approach to tobacco control, encompassing regulation of production, marketing and smoking cessation, can effectively safeguard individuals and the environment from the adverse effects of tobacco use.

The WHO Framework Convention on Tobacco Control (FCTC) – A Legal Framework for Tobacco Control

Adopted in 2003 and implemented in 2005, it has been ratified by 183 countries, representing 90% of the world’s population [21]. Its objectives are “to protect present and future generations from the health, social, environmental and economic consequences of tobacco use and exposure to tobacco smoke by providing a framework for the implementation of tobacco control measures by Parties at the national, regional and international levels, with a view to achieving sustained and substantial reductions in the prevalence of tobacco use and exposure to tobacco smoke”.

It has led to the implementation of tobacco control measures: (1) demand reduction (increasing tobacco price and restricting its availability, banning all forms of tobacco advertising, informing and warning the public, providing cessation services); (2) supply reduction (combating illicit trade, banning sales to minors, unit sales, vending machines); (3) evaluation, scientific and technical cooperation on tobacco control.

These measures have already led to a reduction in the prevalence of smoking worldwide, but the devastating effects will only be felt in the long term.

Strengthening Tobacco Control

Tobacco control needs to be continuously strengthened to meet new challenges [1]. For example, banning the sale of all new tobacco products (nicotine pearls and pouchs, disposable vaping products and non-tobacco flavors, the use of menthol) and restricting the places where tobacco is consumed (health units, urban and outdoor areas) will make it possible to reduce the trade and consumption of tobacco. Plain packaging must become the rule, the sale of tobacco products must be strictly regulated and fighting illicit trafficking must be stepped up. Finally, the policy of increasing tobacco prices must be pursued relentlessly. Taken together, these measures will denormalize the image of smokers and smoking [18,21].

The Protection of Young People is a Priority

Smoking often starts in adolescence, and young people are a prime target for the tobacco industry. Their brains are more vulnerable to the effects of psychoactive substances such as nicotine. The prevalence of smoking peaks between the ages of 25 and 35, and tobacco addiction makes it difficult to quit [1].

The promotion of a tobacco-free lifestyle from an early age is based on: (1) the strict application of tobacco control measures (regular and consistent increases in tobacco prices, bans on the sale of tobacco to minors and on new tobacco products: nicotine pearls and pouchs, disposable vaping devices, smoke-free schools, universities and transport); (2) parental information and smoke-free homes; (3) educational initiatives in schools aimed at strengthening young people’s psychosocial skills and critical thinking are effective [24]. All these measures contribute denormalizing tobacco use, preventing smoking and, more generally, addictive behaviour [24,25].

Various actors are involved in preventing smoking (tobacco, cancer, respiratory associations, etc.). In 2024, the theme of World No Tobacco Day was ‘Protecting children from tobacco industry interference’, which raised awareness of the tobacco industry’s harmful influence on young people [26]. Many countries are working towards a ‘tobacco-free adult generation’ in the next decade [22].

Helping People to Stop Smoking

Strategies to Help People Quit

The provision of smoking cessation services is explicitly included in the FCTC (Art. 14) [23]. Smoking cessation is the only way to reduce the morbidity and mortality associated with tobacco use.

Smoking cessation is part of the treatment of diseases related to tobacco use. Health professionals must be involved in this intervention, using evidence-based non-medication strategies (counselling to quit, cognitive behavioral therapy) [26] and medication strategies (nicotine replacement therapy, bupropion, varenicline) [28].

Medications to help people stop smoking are not widely available in low- and middle-income countries because of their high cost and the lack of trained prescribers. Only a public health framework that takes into account the specific characteristics of these countries and based on the denormalization of smoking, the training of health professionals in smoking cessation and the provision of smoking cessation medications by international health authorities, will enable them to implement effective tobacco control [29].

Strategies for Harm Reduction?

There is no threshold of consumption below which smoking is safe [30]. However, can strategies be proposed to reduce risks and harms associated with smoking?

Tobacco companies offer products that deliver nicotine without burning tobacco (heated tobacco, snus, nicotine pearls and pouchs), promising an alternative to traditional cigarettes. These products may reduce the harmful effects associated with smoke inhalation (lung cancer, COPD), but they maintain nicotine dependence, they are not free of toxicity and therefore not credible proposals [31].

The electronic cigarette (e-cig.) vaporizes a nicotine-containing liquid that is much less toxic than tobacco smoke, making it a potential tool for reducing the risks of smoking when used exclusively, although there are uncertainties about the safety of long-term use. Recent studies [28,32] show that e-cig. can help people to quit smoking; further studies are needed to determine whether this benefit applies to smokers in developing countries [33]. The increasing use of e-cigarettes by young people, especially disposable (puff) and high-nicotine devices (JUUL), could lead to nicotine addiction and subsequent cigarette smoking [34], which has led many countries [35] and the WHO to propose measures to prevent e-cig. use by young people [36].

Conclusion

Twenty years after the implementation of the FCTC, every country in the world is affected by the tobacco pandemic, the leading cause of preventable death. Tobacco control in all its forms remains a major public health challenge because of its health, socioeconomic and environmental consequences. More than ever, health professionals need to be involved in smoking prevention initiatives and in helping people to quit.

Contribution to the Article

All authors contributed to the writing and correction of this article.

Conflict of Interest

The authors declare that they have no conflict of interest.

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