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A Spotlight on Optogenetics
COLUMBIA SCIENCE REVIEW Volume 15 Issue II Spring 2019
EDITORIAL EDITOR-IN-CHIEF YOUNG JOON KIM CHIEF DESIGN OFFICER JOANNE WANG EDITORS SERENA CHENG, BENJAMIN GREENIELD, SARAH HO, ENOCH JIANG, CHERYL PAN, JANE PAN, JUAN VALENCIA, VICTORIA YANG ILLUSTRATORS CASEY LI, STEFANI SHOREIBAH, SIRENA KHANNA, MEGAN ZOU
MANAGING EDITOR ALICE SARDARIAN CHIEF ILLUSTRATOR EMILY WANG WRITERS LIZA CASELLA, ANNA CHRISTOU, SIRENA KHANNA, LINGHAO KONG, NAVIYA MAKHIJA, HARI NANTHAKUMAR, CLARE NIMURA, HANNAH PRENSKY, SEAN WANG, KYLE WARNER LAYOUT EDITOR AMANDA KLESTZICK
EXECUTIVE PRESIDENT ABHISHEK SHAH PUBLIC RELATIONS JACQUELINE ERLER SECRETARY JASON WANG ORGANIZATIONAL COMMITTEE MEMBERS TAMJEED AZAD, ADRIANA KULUSIC-HO, JULIENNE JEONG, CHANDLER MORRIS, SYLVIE SANDERS, JOANNE WANG, CINDY WANG, ANGELA ZHANG
VICE PRESIDENT SOPHIE BAIR TREASURER ADRIEN STEIN SPREAD SCIENCE DIRECTOR MAKENA BINKER COSEN SPREAD SCIENCE TEAM BRENDON CHOY, CHENOA BUNTS-ANDERSON, MAGGIE ZHONG, SOPHIE EGBUNIWE, NICHOLAS ZUMBA
The Executive Board represents the Columbia Science Review as an ABC-recognized Category B student organization at Columbia University
Cover illustrated by Emily Wang
Fair Use Notice Columbia Science Review is a student publication. The opinions represented are those of the writers. Columbia University is not responsible for the accuracy and contents of Columbia Science Review and is not liable for any claims based on the contents or views expressed herein. All editorial decisions regarding grammar, content, and layout are made by the Editorial Board. All queries and complaints should be directed to the Editor-In-Chief. This publication contains or may contain copyrighted material, the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of issues of scientific significance. We believe this constitutes a “fair use” of any such copyrighted material, as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, this publication is distributed without profit for research and educational purposes. If you wish to use copyrighted material from this publication for purposes of your own that go beyond “fair use,” you must obtain permission from the copyright owner.
SPRING 2019 LETTERS FROM THE EDITORS /
YOUNG JOON KIM & ALICE SARDARIAN
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COCKTAIL SCIENCE: ORGANOIDS, MEDUSAVIRUS & ORGAN DONATION
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SPOTLIGHT ON OPTOGENETICS /
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BACTERIAL BATTERIES /
CLARE NIMURA
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LINGHAO KONG
HONG KONG HOUSING CRISIS /
SEAN WANG
TRADITIONAL CHINESE MEDICINE /
SIRENA KHANNA
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LETTERS FROM Dear Reader, It is my pleasure to present to you the spring 2019 print issue of the Columbia Science Review. In this exciting issue, we present several articles exploring the scientific dialogue surrounding the brain, urban housing, alternative medicine, and energy storage. Sirena Khanna gives a detailed comparison between Traditional Chinese Medicine (TCM) and Western Medicine (WM) in “Finding the Yin and Yang in Healthcare,” which also includes all four of her wonderful, hand-drawn diagrams. In “A Spotlight on Optogenetics: The Science and Ethics that Surround It,” Clare Nimura then dives deep into the ethics of optogenetics, a cutting-edge neuroscience laboratory technique that utilizes light to stimulate the brain in specific ways. Sean Wang gives insight into the Hong Kong Housing Crisis with a thorough compilation of real estate and demographic statistics. Last, but not least, Linghao Kong gives a detailed rundown of the possibilities of storing and extracting energy from microbial systems. We hope that each one of these articles piques your interest and compels you to further read on these topics. In other news, I will be stepping down from my position as editor-in-chief this fall and our managing editor, Alice Sardarian, will be assuming leadership of the editorial board. Alice has gone above and beyond the call of duty in helping me juggle both the print and online components of our publication. She has introduced many innovations in our editorial team’s workflow and I am excited to see how she unfolds her vision for the Columbia Science Review this coming academic year. It has been a great honor to serve as the publication’s editor-in-chief this past year and I hope that our editors, journalists, illustrators, and layout staff continue to nurture your collective love for science. Warmly,
Young Joon Kim Editor-in-Chief
Dear Reader, Welcome to the spring issue of the Columbia Science Review! You are about to explore a multitude of topics that we hope will spark an interest in you. By going through this journal, you are helping us to fulfill one of our main goals, which is to promote scientific inquiry and literacy. It seems today, more than ever, science is at the forefront of countless critical issues. However, at times, scientific thought and its relevance seems to be neglected and undermined during substantial policy making. It is important that we base our understanding of the world on tangible evidence, shored up by extensive research. In order to do so, we must make science easily accessible to vast and diverse audiences. I’d like you to consider the integral role of science in expanding our understanding of our world, but also for fueling our activism. We hope you enjoy these articles and urge you to continue exploring topics in the STEM fields. We’re always looking for enthusiastic and passionate scientists and writers, so, if you find yourself curious about a topic and wish to contribute with an article, kindly reach out to us through our website. Happy reading,
Alice Sardarian Managing Editor
THE EDITORS
COCKTAIL SCIENCE
COLUMBIA SCIENCE REVIEW
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BRAINS
IN
A
DISH
Written by Young Joon Kim // Illustrated by Emily Wang
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rganoids, simplified, three-dimensional replicas of organs generated in vitro, offer scientists and physicians the opportunity to study complex tissues while preserving the structure and anatomy of the organ of interest. Organoids have been used to investigate the properties of the intestinal lining, tongue, and various other tissues. In August, the Muotri group at the University of California, San Diego, published the results of a study in which their laboratorygrown brain organoids exhibited simple brain waves characteristic of neural networks in mature human brains. Over the span of several months, the organoids, as if to mirror the natural development of real brains, spontaneously generated cellular networks with synchronized electrical activity and periodic release of both excitatory and inhibitory neurotransmitters [2]. The study results, published in Cell Stem Cell, offers insight into the development of neural complexity in the human context. Specifically, Muotri suggests that network formation may arise from a genetically programmed timeline. The more tantalizing implications of the study, however, revolve around the ethics of potentially creating a rudimentary consciousness as evidenced by the
organoids’ complex network behavior. For instance, if scientists could generate a cerebral organoid that could sense pain, would delivering noxious stimuli to such an organoid breach the ethical principles of research? Because organoid research is still infantile, Jean Lunshof, a bioethicist at Harvard University, reported to The New York Times that organoids “are in a completely different category” from real human brains and must not be treated as such. Nevertheless, with field’s rapid growth, scientists and ethicists will likely have to establish new guidelines for the creation and manipulation of brain organoids [1, 2]. Dr. Muotri hopes to embark on more exciting studies of these organoids in the coming years. In July, he sent a handful of his organoids in specialized containers to the International Space Station with NASA’s assistance to investigate the impact of zero-gravity growth. Similarly, his laboratory has developed a computer system that translates the electrical activity of the organoids into movement instructions of a robotic limb. The possibilities of inquiry beyond these two proposed projects are, of course, endless and the advent of brain organoids may help us answer some of the countless questions we have about the brain and its illnesses [2].
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medusavirus
Written by Sarah Ho // Illustrated by Emily Wang
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lthough it’s named after the terrifying Greek monster whose stare turns her victims into stone, at 260 nanometers, the Medusavirus doesn’t initially seem all that impressive. But, as scientists from the Tokyo University of Science and Kyoto University have discovered, the Medusavirus may actually help us understand how eukaryotic life formed from prokaryotic life [1, 2]. The conventional virus is fairly primitive and codes for less than 100 genes [3]. The reason that viruses do not need many genes is that they replicate by “hijacking” a eukaryotic host cell, using the host’s pre-existing proteins to reproduce [4]. However, in the past few decades, a new kind of virus has emerged called the giant virus, which is as large as some bacteria and has a genome that contains thousands of genes [3]. The Medusavirus, so named because its infiltration causes a species of amoebas to develop a hard, stone-like shell, falls into this category.
When researchers sequenced the Medusavirus’s genome, which is comprised of double-stranded DNA, they were surprised to find that it coded for a complete set of histones, which are proteins that allow DNA to stay coiled inside the nucleus, usually only found in eukaryotic cells [2]. Viruses normally don’t have histones because they don’t have enough DNA to necessitate them, nor do they have nuclei [2, 3]. Moreover, the sequencing also revealed genes for a primitive version of DNA polymerase, which helps build replicated strands of DNA [2]. After conducting an evolutionary analysis, the scientists concluded that the Medusavirus’s DNA polymerase could be the origin for the various DNA polymerases that eukaryotes employ [4]. While it was previously believed that viruses were merely degenerate offshoots of eukaryotic cells, with this new research, scientists are beginning to consider whether viruses instead played an integral role in the development of eukaryotic life.
A Potential Key to U n d e r s ta n d i n g E u k a r y o t i c
Life
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A NEW ERA OF O R GA N D O N AT I O N Written by Alice Sardarian // Illustrated by Casey Li
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rgan donation, transportation, and transplantation is a complex, yet critical, process, aiding about 80 patients a day [1]. Still, as many as 20 patients die each day awaiting transplants, where the average wait time is between one and six years [1]. This horrifying reality is due to the disposal of organs that are not of “high enough quality,” the overall lack of donors, the avoidance of riskier surgeries, and, primarily, inherent transportation complications [2]. The locations of patients in relation to those of their suitable donors impact both the availability and the viability of life-saving organs. The transportation of organs must be completed in an expeditious, yet safe, manner. It is primarily completed via ice box ground and, rarely, air delivery, which involves extensive costs and highly variable services. Organs have been frequently forgotten on planes or have become ischemic due to delays [3]. Additionally, a study found that the preservation of organs on ice, specifically hearts and lungs, led to the loss of 60% of the donated organs after 4 hours of contact [4]. Thus, it becomes evident that this mode of transportation is ineffective and limits the distance over which donations can occur. Recently, a revolutionary organ transportation occurred in Maryland. A team at the University of Maryland constructed a safe drone which successfully delivered a kidney to a patient who had been on an eight year waitlist. Though the drone only traversed three miles, the team believes they can improve the drone to travel “faster and farther,” reducing the loss of viable organs to travel time, and improving access to organs in regions that may not have a sufficient donor base [5]. Beating travel time is critical to maintaining organ viability. Altering the medium in which organs are stored during transport is also necessary. The Food and Drug Administration is currently reviewing a new organ transport container. TransMedics have developed portable Organ Care Systems (OCS) for thoracic organ transport, which mimic physiological processes
needed to keep organs functionally stable [6]. The OCS has the capacity to oxygenate and provide nutrients to the tissue, as well as constantly monitor the organ’s condition. The OCS and drone delivery technology offer new solutions to serious organ donation problems, addressing the most complicated transportation challenge. Thus, they prevent unnecessary deaths, overcome geographic disparity, and ensure that no organ goes to waste.
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// REFERENCES // BRAINS IN A DISH
[2] Zimmer, C. (2019, August 29). Organoids Are Not Brains. How Are They Making Brain Waves? The New York Times. Retrieved from https://www.nytimes. com/2019/08/29/science/organoids-brainalysson-muotri.html THE MEDUSA VIRUS [1] Yoshikawa, G., Blanc-Mathieu, R., Song, C., Kayama, Y., Mochizuki, T., Murata, K., ... & Takemura, M. (2019). Medusavirus, a novel large DNA virus discovered from hot spring water. Journal of Virology, JVI-02130. [2] Zhang, S. (2019, May 20). Beware the Medusavirus. Retrieved from https://www. theatlantic.com/science/archive/2019/03/ giant-medusavirus-hosts-turn-tostone/585289/ [3] Cepelewicz, J. (2018, March 5). New Giant Viruses Further Blur the Definition of Life. Retrieved from https://www. quantamagazine.org/new-giant-virusesfurther-blur-the-definition-oflife-20180305/ [4] Tokyo University of Science. (2019, May 1). New giant virus may help scientists better understand the emergence of complex life. Retrieved from https://phys.org/ news/2019-05-giant-virus-scientistsemergence-complex.html A NEW ERA OF ORGAN DONATION [1] Organ Donation Statistics. (2019). Retrieved from https://www.organdonor. gov/statistics-stories/statistics.html [2] Yasinski, E. (2016). When Donated Organs Go to Waste. Retrieved from https://www.theatlantic.com/health/ archive/2016/02/when-donated-organs-goto-waste/470838/ [3] Seiler, B. (2019). New Technology Could Help Expand Donor Access to Transplantation. Retrieved from https:// www.umms.org/ummc/news/2019/pioneeringbreakthrough-unmanned-aircraft
[4] Groundbreaking technology successfully rewarms large-scale tissues preserved at low temperatures. (2017). Retrieved from https://www.eurekalert.org/pub_ releases/2017-03/uom-gts022717.php [5] Zraick, K. (2019). Like ‘Uber for Organs’: Drone Delivers Kidney to Maryland Woman. Retrieved from https:// www.nytimes.com/2019/04/30/health/dronedelivers-kidney.html
OCKTAIL CIENCE
[1] Trujillo, C. A., Gao, R., Negraes, P. D., Gu, J., Buchanan, J., Preissl, S., … Muotri, A. R. (2019). Complex Oscillatory Waves Emerging from Cortical Organoids Model Early Human Brain Network Development. Cell Stem Cell, S1934590919303376. https://doi. org/10.1016/j.stem.2019.08.002
[6] TransMedics OCS™: Science that Mirrors Life. (n.d.). Retrieved from https://www. transmedics.com/ocs-hcp/
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A Spotlight on Optogenetics: The Science & Ethics that Surround It Written by Clare Nimura Illustrated by Emily Wang
W
hat if we had the power to alter someone’s thoughts with a flash of light? This idea sounds like the beginning of a dystopian novel, but the technology actually exists: it’s called optogenetics. This relatively new technique in neuroscience allows scientists to control individual neurons in the brain, turning them on or off to study their functions. Despite many recent advances and discoveries, the complex circuitry of the human
brain remains largely unknown. Optogenetics is an invaluable new tool with which to better understand the brain, and may even act as a therapy for mental health conditions and sensory impairments. It is already transforming the field of neuroscience, but at the same time, it opens up a wealth of new ethical risks. Controlling the mind with such extreme precision is a dangerous power, so it is crucial that we understand the mechanisms
behind optogenetics and its potential consequences to ensure that this incredible technology is being used safely and ethically. Optogenetics uses a combination of genetic engineering and light to control neurons in the brain [1]. Scientists use a virus to deliver certain genes to specific neurons. Once integrated into the host genome, these genes allow the neurons to produce light-sensitive proteins.
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What if we had the power to alter someone’s thoughts with a flash of light?
These proteins respond to specific wavelengths of light by opening or closing ion channels that turn the neuron “on” or “off.” In the most common model, blue light stimulates neurons, and yellow or green light deactivates them. These pulses of light can be delivered to neurons anywhere in the brain via surgically implanted fiber optic cables or electrodes. After activating a neuron, scientists can observe which neighboring neurons
are activated as well as the ultimate response in order to deduce the functions of specific pathways in the brain. One circuit of neurons could be integral to auditory processing, or another circuit could be implicated in neurological abnormalities that cause conditions like Parkinson’s Disease. Optogenetics opens a unique window into the brain’s neural connections, enhancing researchers’ abilities to develop effective treatments for brain disorders that affect so many today. However, as many recent studies have already hinted, the potential uses of optogenetics do not come without ethical concerns. In 2012, a research group at MIT successfully used optogenetics to manipulate the memory of a mouse [2]. The scientists first allowed a mouse with light-sensitive cells to explore the environment in Box A, allowing it to form a memory of the space. Then, they placed the same mouse in Box B and optogenetically activated its memory of Box A with a laser, while simultaneously giving the mouse a shock. The mouse linked its memory of Box A to the experience of getting a shock, falsely associating trauma with a harmless environment. When this mouse was placed back in Box A, it froze in fear, mistakenly remembering that it had been shocked there. This study induced fear: researchers manipulated the mouse to remember an experience that never happened. Many worry that similar memory implantation or manipulation could be the starting point for horrible, science-fiction-style brainwashing:
the idea of changing someone’s thoughts with just a flash of light lends itself to thoughts of far-fetched, dystopian scenarios. However, the invasive nature of optogenetics alone makes it unlikely that the technology could currently be exploited with malicious intent: it is impossible to stealthily perform procedures to change neurons in an individual’s brain without the subject noticing. What makes optogenetic technology particularly worrisome is that its extreme precision allows experimenters to alter whatever they choose in a very exact manner. At the moment, this danger is still mostly theoretical, though it may very well become a problem in the future. There are many ways to alter the brain, but optogenetics presents the ability to precisely induce almost anything, from a false memory to an artificial emotion to a seizure. Two obvious applications of optogenetics are in neuroscience, to explore brain circuitry, and in neurology, to treat brain disorders. It is unlikely, however, that optogenetics itself will become a standard treatment for psychiatric illnesses in the near future, as it is highly invasive and its long-term effects are yet unknown. More probably, the discoveries that scientists make about neural pathways in the brain will inform novel therapies for these illnesses. Numerous brain disorders, including depression, addiction, obsessive-compulsive disorder, and post-traumatic stress disorder, result from irregularities in the inhibition or activation of
COLUMBIA SCIENCE REVIEW neurons. Should optogenetics be used as a treatment, it may be possible to correct these abnormalities in the circuitry without directly impacting other areas of the brain, unlike drug treatments or surgery. But this is where the line blurs. The use of optogenetics as treatment begs us to consider to what extent we might alter an identity: no other technology can permanently alter or selectively activate specific elements of the brain with such extreme precision. In the past fifteen years, optogenetics has ushered in a new era in neuroscience, wherein researchers have begun understanding the inner workings of the brain on the scale of individual neurons. In August of 2015, the U.S. Food and Drug Administration approved the first trials for an optogenetics-based therapy which aims to restore light sensitivity to the retinas of patients with a form of blindness called retinitis pigmentosa [3]. In addition, numerous research investigations that utilize optogenetics are about to make the leap from animal research into clinical trials. One such study aims to help restore neural function to patients with Parkinson’s disease. While it may be years before optogenetics becomes part of routine clinical treatments, this technology is unquestionably an exciting frontier of neuroscience. There is still a long way to go before optogenetic techniques are used in humans, but many ethical concerns have already arisen. How do we ensure that physicians do not misuse this technology? Though optogenetics may appear to have the same risks as any other invasive brain procedure, the precise nature of the technology adds the risk of altering very specific functions of the brain, such as the generation of false memories or emotions. What if the power to edit consciousness falls into the wrong hands? This is a continuation of an age-old problem associated with any new and powerful technology: how and should we use it? For example, should optogenetics be used to erase
14 traumatic memories? These concerns are warranted and consequently will require proper regulations and ethical boundaries. Preserving mental liberty, integrity, and continuity before and after optogenetic treatment should be a primary concern. As optogenetics develops, it is imperative that we remain cognizant of the ethical issues that accompany this powerful technology so that it can be a positive and safe tool.
commons.wikimedia.org
Cages equipped with optogenetic LED commutators for in vivo rat studies on behavorial response to optogenetic stimulation. // REFERENCES // [1] Optogenetics. Retrieved from https://www.mpg.de/18011/ Optogenetics [2] Noonan, D. (2014, November 01). Meet the Two Scientists Who Implanted a False Memory into a Mouse. Retrieved from https://www.smithsonianmag.com/ innovation/meet-two-scientistswho-implanted-false-memorymouse-180953045/ [3] First human test of optogenetics highlights its clinical potential. Retrieved from https://www. scientifica.uk.com/neurowire/ first-human-test-of-optogeneticshighlights-its-clinical-potential
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Bacterial Batteries An introduction to the
principles & applications of
organic fuel cells Written by Linghao Kong Illustrated by Stefani Shoreibah
L
iving organisms have been harvesting energy to sustain themselves for billions of years. Only in the twentieth century, however, have humans been able to directly derive electrical energy from microbial life in systems known as organic fuel cells [1]. Organic fuel cells have the remarkable potential to efficiently generate energy from sources of waste and recent advancements may propel them to become a more mainstream source of energy, especially in the context of wastewater treatment. Organic fuel cells, also known as microbial fuel cells and biological fuel cells, are essentially systems that can convert chemical energy from macromolecules to electrical energy through oxidation-reduction reactions in living organisms [2, 3]. Organic fuel cells, whose basic setup is similar to Galvanic cells, are comprised of an anode,
a cathode, an ion exchange membrane between the two electrodes, and surrounding fluid around the electrodes. The microorganisms are located on the side of the ion exchange membrane with the anode [2, 3]. The conversion of chemical to electrical energy is achieved through the anaerobic cellular respiration of these microbes. During this process, the breakdown of organic molecules, such as glucose, generates free protons and electrons. Under anaerobic conditions, electrons are free to flow through the fuel cell circuit instead of becoming trapped by oxygen. Meanwhile, protons flow through the ion exchange membrane towards the cathode and reduce other compounds on the cathode side. The reduced compounds are known as oxidants. Electrons flow through the anode and deliver power to an output before ultimately
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returning to the cathode and completing the reduction process with the protons [2, 3]. The history of organic fuel cells began with their theorization in 1911 by Michael C. Potter, who observed that an electrical current could be generated with the decomposition of organic matter [4]. Though Potter’s research demonstrated how Escherichia coli could be used to generate an electric current, interest in organic fuel cells did not gain momentum until 1931, when Barnet Cohen was able to successfully link together half cells to generate a current of 0.2 milliamps [4, 5, 3]. Progress continued, but until developments in 1999, microbes being used for organic fuel cells were unable to directly transfer electrons to the anode to generate an electrical current. Consequently, these fuel cells were known as mediator microbial fuel cells because the microbes required chemicals to mediate electron transfer. The mediator chemicals, such as methyl viologen, humic acid, and thionine, accepted electrons from the microbes during cellular respiration, traversed the cellular membrane, and deposited the electrons into the anode [2]. However, these chemicals were almost always toxic and expensive [2]. Additionally, mediator chemicals required replacement and replenishment for continued use of the organic fuel cell, hampering their widespread use. Then, in 1999, Byung Hong Kim et al. showed that a type of bacterium, Shewanella putrefaciens, was able to transfer electrons from its cellular respiration cycle directly to the anode under specific conditions, thereby no longer requiring the need for mediator chemicals [6]. The discovery of these mediatorless organic fuel cells massively increased the applicability and accessibility of microbial fuel cells. Whether or not fueled by Kim’s finding, the number of publications about and amount of research into microbial fuel cells have been growing exponentially since around 2000, with about 1,000 publications and 28,000 citations for microbial fuel cells in 2015 alone from less than 50 publications and less than 500 citations in 2000 [1]. One of the greatest appeals of using organic fuel cells is their potential as a waste eliminator [2]. Because of the variety of microbes, such as bacteria or yeast, available to be used in organic fuel cells, the cells can metabolize a variety of molecules present in wastewater, including sugars, organic polymers, and organic acids. These microbial fuel cells can serve as both a step in the process of treating wastewater and a way to generate additional energy. Additionally, some forms of these fuel cells are able to produce hydrogen gas as a byproduct of their reactions, providing another source of renewable energy as well [7]. Fuel cells used in wastewater treatment are known as sediment microbial fuel cells [8, 9]. They are designed slightly differently than traditional organic fuel cells: rather than in solution, the anode and the microbes are housed within sediment itself, and the cathode is placed outside of the sediment in water. Wastewater is passed through the system and is
treated as a result of microbial metabolism, with energy generated in the process. While the energy generated from the system is not high, the use of sediment microbial fuel cells is still appealing due to their high longevity, low maintenance, and abilities to generate enough energy for low-power, wastewater monitoring sensors and to target specific contaminants with specific microbes [8, 9]. With further advancements, these sediment microbial fuel cells will be able to generate more power and further offset the energetic cost of purifying wastewater, moving past the current testing stage and into widespread use. However, there are currently significant drawbacks to widespread organic fuel cell use. First, there are limitations with the reactions involved with the cathode of the organic fuel cells. The reduction process occurring at the cathode is hampered by three major factors: activation losses, ohmic losses, and mass transport losses. Activation loss refers to the energy required from the system to overcome the activation energy barrier and reduce the oxidant. Ohmic loss refers to the energy lost in overcoming the intrinsic resistance to the flow of electrons and protons. Mass transport loss refers to the loss of energy needed to continually supply oxidants and remove products in order
“One of the greatest appeals of using organic fuel cells is their potential as a waste eliminator.” to provide enough oxidants for the reduction reaction [10]. Additionally, the total power output of organic fuel cells is low, preventing its use currently as a large scale generator of energy [11]. Combined, these drawbacks detract greatly from the potential total energy output that organic fuel cells theoretically achieve. There are many efforts underway to address these issues. Research on using catalysts at the cathode shows how the activation energy can be lowered to more easily reduce some oxidants, including platinum, gold, and even other microorganisms. The effect of cathode surface area on the efficiency of energy generation has also been investigated. It was found that greater cathode surface areas provide more locations for the oxidants to react, which in turn increases the power output. To address ohmic loss due to resistance, researchers are trying to optimize the travel path and distance between the anode and cathode, thereby reducing the amount of resistance experienced. Researchers are also attempting to optimize the thickness of the ion
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17 exchange membrane: while thinner membranes promote more proton exchange between the anode and cathode compartments, they are also easier for other compounds to cross. In order to minimize mass transport loss, researchers are looking into designing a cathode-housing compartment with a geometry intended to maximize efficient addition of oxidants and removal of products. Different designs and methods of introducing more oxidants to the cathode, such as a rotating cathode, are also being considered [10]. Despite these issues, organic fuel cells are being used in a variety of fields. Another ongoing application for organic fuel cells is powering remote biosensors, especially marine biosensors that monitor water temperature, salinity, and pressure. The organic fuel cells that power these biosensors are often known as benthic microbial fuel cells [12]. The installation of these fuel cells is achieved by lowering and positioning them into the marine sediment, which is already teeming with organic material and microbes that are capable of powering the fuel cells and can easily produce energy production from natural metabolic processes If the fuel cells are placed in areas of high marine productivity and high organic material influx, then they would need little, if any, maintenance due to the naturally occurring nutrient source [11, 12]. A less conventional application of organic fuel cells is in medicine. Because these fuel cells do not require batteries, they could potentially be used to power medical implants, especially pacemakers, for extended periods of time, possibly even without requiring periodic surgeries for replacements. These medical devices would acquire glucose from the bloodstream as a source of energy for the microbes and use oxygen as the final oxidant. However, due to health regulation standards and the fact that organic fuel cells, being powered by living organisms, are less consistent than batteries, these medical devices do not seem to be that feasible without significant improvements in performance and reliability [13]. Organic fuel cells are an exciting area of exploration for future energy production. They are useful in a variety of applications, such as providing power to biosensors with difficult accessibility, and are extremely attractive for use in wastewater treatment. While there are still significant issues that must be addressed in organic fuel cells, such as mass transport and ohmic loss, research is being done to investigate how to optimize fuel cell efficiency. In this increasingly environmentally conscious world, the applications and prevalence of organic fuel cells can, and should, only increase with further development.
[2] Alternative Energy. What are Microbial Fuel Cells. Retrieved from http://www.altenergy.org/renewables/ what-are-microbial-fuel-cells.html
// REFERENCES //
[13] Bettin, C. (2006). Applicability and Feasibility of Incorporating Microbial Fuel Cell Technology into Implantable Biomedical Devices. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=1 0.1.1.547.9833&rep=rep1&type=pdf
[1] Santoro, C., Arbizzani, C., Erable, B., Ieropoulos, I. (2017, July 15). Microbial fuel cells: From fundamentals to applications. A review. Retrieved from https://www.sciencedirect.com/science/article/ pii/S0378775317304159
[3] He, Z., Angenent, L.T. (2006, July 27). Application of Bacterial Biocathodes in Microbial Fuel Cells. Retrieved from http://www.envbiotech.de/ research/EA-biocath-final.pdf [4] Potter, M.C. (1911, September 14). Electrical effects accompanying the decomposition of organic compounds. Retrieved from https://royalsocietypublishing.org/ doi/abs/10.1098/rspb.1911.0073 [5] Arends, J.B.A., Verstraete, W. (2012, April 16). 100 years of microbial electricity production: three concepts for the future. Retrieved from https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3821677/
[6] Kim, B.H., Kim, H.J., Hyun, M.S., Park, D.H. (1999, April). Direct electrode reaction of Fe(III)reducing bacterium, Shewanella putrefaciens. Retrieved from https://ukm.pure.elsevier.com/en/ publications/direct-electrode-reaction-of-feiiireducing-bacterium-shewanella-
[7] Rozendal, R.A., Hamelers H.V.M., Euverink, G.J.W., Metz, S.J., Buisman, C.J.N. (2006, February 2). Principle and perspectives of hydrogen production through biocatalyzed electrolysis. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=1 0.1.1.459.4020&rep=rep1&type=pdf
[8] Xu, B., Ge, Z., He, Z. (2015, March 27). Sediment microbial fuel cells for wastewater treatment: challenges and opportunities. Retrieved from https:// pubs.rsc.org/en/content/articlelanding/2015/ew/ c5ew00020c#!divAbstract [9] Abbas, S. Z., Rafatullah, M., Ismail, N., & Syakir, M. I. (2017). A review on sediment microbial fuel cells as a new source of sustainable energy and heavy metal remediation: mechanisms and future prospective. Retrieved from https://onlinelibrary. wiley.com/doi/pdf/10.1002/er.3706 [10] Rismani-Yazdi, H., Carver, S. M., Christy, A. D., & Tuovinen, O. H. (2008). Cathodic limitations in microbial fuel cells: An overview. Retrieved from https://www.sciencedirect.com/science/article/pii/ S037877530800387X
[11] Ivars-Barcelรณ, F., Zuliani, A., Fallah, M., Mashkour, M., Rahimnejad, M., & Luque, R. (2018). Novel Applications of Microbial Fuel Cells in Sensors and Biosensors. Retrieved from https://www.mdpi. com/2076-3417/8/7/1184/htm [12] U.S. Naval Research Laboratory. Continuous Sustainable Power Supply Cell. Retrieved from https://www.nrl.navy.mil/techtransfer/availabletechnologies/energy/benthic-fuel-cell
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Written by Sean Wang Illustrated by Emily Wang
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n 2016, Hong Kong’s population had the longest life expectancies in the world for both men and women, at 81.3 and 87.3 years, respectively [2]. The city is touted as having accessible public transportation, health and wellness resources for the elderly, and universal health care for hospital treatment, among other benefits [2]. Despite the utopian image that Hong Kong presents, however, the city is plagued with poor housing conditions. With 7.5 million citizens, Hong Kong has a population density of roughly 7,000 people per square kilometer, with up to 25,000 people per square kilometer in some areas [11]. Despite this crowdedness, much of the city’s space is used for non-residential purposes, consequently raising rent prices and pushing some of the population towards homelessness. Because residents may be forced to live in poor housing conditions and to spend the majority of their salaries on housing, major health consequences appear, such as safety hazards and the increased spread of disease. Additionally, residents who cannot afford housing or are ineligible for public rental housing (PRH) live in smaller subdivided units (SDUs), which are not regulated and can lead to an increase of dangerous health and safety hazards. By assessing possible avenues by which the Hong Kong government can obtain land for residential development, opportunities to improve the housing conditions and the health of residents will open. Solving Hong Kong’s housing efforts will have to be a multi-pronged effort. Obtaining land for the government to build additional public rental units will help increase the current housing supply and limit rising housing prices [25].
HONG KONG’S CURRENT HOUSING STATUS In 2018, Hong Kong was named the least affordable housing market for the eighth year in a row by Demographia, an urban planning policy consultancy, which reviewed 293 metropolitan markets in nine countries in its annual housing affordability survey [7]. The study found that the “median price of a home in the city is 19.4 times the median annual pre-tax household income” [7]. This value may be somewhat misleading as it does not distinguish between private or public housing prices. For private housing, rentals comprise about 70 percent of the city’s average monthly household income, or 122 percent of the average individual’s salary [23]. As a result, housing costs, especially in the private market, pose a major financial stressor
COLUMBIA SCIENCE REVIEW for the average Hong Kong resident. Private housing currently accounts for over fifty percent of all Hong Kong housing, while public housing only makes up about forty-five percent (see Table 1). Privately owned housing is significantly more expensive than public rental housing; depending on territory, private housing ranges from 267-440 HK$/square meter, whereas public rental housing costs only 54-68 HK$/square meter (see Table 2). Because there is a major financial incentive to obtain public rental housing, the limitations to obtaining such housing pose problems for many Hong Kong residents.
20 housing ownership systems in Hong Kong—they are frequently forced to live in subdivided units or flats (SDU) [24]. In 2016, the average SDU held 2.26 people, and its average area of accommodation (essentially, walking or standing space) was 5.3 square meters, which was half or a third of the space in private housing or PRH [8]. Although the homeless population of Hong Kong is relatively small, the growth of this population has been high in recent years due to the unaffordability of housing. A report by a collective of community organizations in the Homeless Outreach Population Estimation (HOPE Hong Kong) details the status
TABLE 1: Percentage of population by type of housing in Hong Kong Public permanent housing
2007
2012
2017
48.2
46.6
44.7
Rental housing
30.1
29.7
29.0
Subsidized sale flats
18.2
16.8
15.7
Private permanent housing
51.1
52.9
54.6
0.6
0.6
0.7
Temporary housing
TABLE 2: Rent prices of public and private permanent housing separated by area of Hong Kong HK$ / m 2 (IFA) Rent of HA PRH flats (average monthly rent as at end March of the year)
2018
2008
2013
Hong Kong Island
43
50
61
Kowloon
45
55
68
New Territories
38
44
54
2008
Rent of private permanent housing
HK$ / m 2 (SA) 2013 2018
(average monthly rent of flats <70 m2 in the 1st quarter of the year Hong Kong Island
269
323
440
Kowloon
193
253
359
New Territories
140
189
267
While public rental housing (PRH) is a limited resource for which Hong Kong citizens must apply, the demand for housing has greatly exceeded its supply. According to the Hong Kong Housing Authority, “As of end-June 2018, there were about 150,600 general application for PRH” and “[the] average waiting time for general applicants was 5.3 years” [14]. While citizens wait for responses on PRH—or while some are unable to even apply due to external reasons such as having too high an income or family members that have applied for different
of the homeless in Hong Kong—commonly referred to as “street sleepers” [4]. From 2013 to 2014, the number of street sleepers grew by 51 percent, and between 2017 and 2018, the homeless population grew by 21.9 percent from 924 registered street sleepers to 1127 [5].
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PUBLIC HEALTH EFFECTS OF HOUSING INSTABILITY Housing instability has negative consequences on individuals. A review by the U.S.-based Center for Housing Policy found that “by providing families with greater residential stability, affordable housing can reduce stress and related adverse health outcomes... by freeing up family resources for nutritious food and health care expenditures” [26]. Furthermore, according to the same review, there “is some evidence to suggest that the stress associated with unaffordable housing can have significant adverse health consequences even if it does not lead to actual eviction, foreclosure, or a forced move,” such as a “greater likelihood of developing hypertension over a 10-year period” for “individuals who reported difficulties paying for basic expenses,” as well as “lower levels of psychological well-being and [a higher likeliness of ] seeing a doctor” for “individuals experiencing difficulty making their mortgage payments” [26]. By alleviating the stressors of unstable or unaffordable housing, residents can better avoid these negative health outcomes. Decreasing overcrowding can also reduce the spread of infectious diseases and life stressors. The World Health Organization reports that “inadequate shelter and overcrowding are major factors in the transmission of diseases with epidemic potential such as acute respiratory infections, meningitis, typhus, cholera, scabies, etc. Outbreaks of disease are more frequent and more severe when the population density is high” [27]. The Center for Housing Policy’s review found that overcrowding increases risk for infectious disease, including acute lower respiratory infections, and that those living in high-density housing are “more vulnerable to the negative psychological effects of daily stressors than those living in low-density homes” [26]. Finally, a number of hazards specific to SDUs can be mitigated as their necessity decreases with increased housing supplies and the appropriate rent control. Partition walls and additional floor materials exacerbate building stress, obstructing emergency escape routes and leading to citizens’ deaths and injuries [10]. In addition, not only do SDUs have potentially inadequate lighting and ventilation, but they also frequently have problems with water seepage, which risks the spread of fungi and bacteria, increased chemical emissions from building materials, and the attraction of diseasetransmitting rodents and cockroaches [10]. Thus, SDUs are an accessible measure for those who wait for PRH or are unable to access PRH; however, the poor regulation of their conditions poses major health risks for their residents. Increasing the
SPRING 2019 housing supply will make these SDUs less appealing for residents in Hong Kong; as a result, the usage of SDUs will hopefully go down, decreasing such health and safety dangers.
INCREASING HONG KONG’S LAND SUPPLY AS A SOLUTION One major solution proposed by the Hong Kong government has been reclaiming and repurposing the city’s land supply. While not a new solution, this method has been underutilized over the past decade. The Legislative Council of Hong Kong reported that from 1993 to 2016, the amount of “built-up land (e.g. land for residential business and infrastructure usage)” went up by 78 percent, but accounted for just 24 percent of total land available [11]. Between 1993 and 2000, the Hong Kong provided 7800 hectares of land for building use through land reclamation and rezoning, but only 900 hectares from 2009-2016—an 88 percent decrease [11]. While land appropriation is by no means a new solution, increasing the pace at which land is reclaimed will require an aggressive stance. At the helm of these efforts, Hong Kong’s Task Force on Land Supply has put forward eighteen different recommendations on sources of land for housing development [11]. Its current shortto-medium-term solutions include “developing brownfield sites, tapping into private agricultural land reserve in the New Territories, alternative uses of sites under private recreational leases, and relocation or consolidation of land-extensive recreational facilities” [18]. However, attempting to obtain private agricultural land could prove legally difficult and require strong cooperation between government and private parties [20]. Further, the repurposing of private recreational land such as the Fanling golf course could lead to public backlash as well as the possible destruction of historical buildings and mass tree felling [17, 21]. A mostly unacknowledged avenue for additional land is the acquisition of currently undeveloped or abandoned land. However, these are not listed as options (of any time scale) on the Task Force proposals, even those that are long-term and conceptual [18]. Rather, the Task Force’s emphasis is on further developing land that has been previously developed. Nonetheless, the benefits from unused land could prove to be a great boon to the city’s land supply. The Legislative Council especially
COLUMBIA SCIENCE REVIEW highlights potentially reclaiming of 3700 hectares of abandoned agricultural land in the New Territories of Hong Kong as a possible avenue for additional housing [11]. There are also an additional 841 square kilometers (84100 hectares) of “woodland, shrubland, grassland, or wetland” which comprises 88 percent of Hong Kong’s remaining undeveloped land, or roughly 66 percent of Hong Kong’s total land [11]. While there is little research available on the effort necessary to reform undeveloped areas into land for housing, the Hong Kong government should take notice of the large supply of non-builtup land that is currently available.
CONCLUSION To put this problem in perspective, the explicit problem of dangerous subdivided units is limited. Only about three percent of the Hong Kong population actually live in these units [22]. Nonetheless, Hong Kong’s current housing situation is dismal for those who lack the financial resources to obtain private housing or even public rental housing. Unsafe living conditions in subdivided units and homelessness are unacceptable standards and endanger those who must live in such circumstances. Additionally, spending so much of one’s income on housing leaves little money for a healthy and sustainable lifestyle. Consequently, the Hong Kong government must prioritize the affordability and supply of land. Land reclamation and rezoning appears to be an accessible solution for the Hong Kong government to undertake. Unfortunately, appropriating land for housing is a challenge given that it is often met with pushback from private parties. However, the Hong Kong government fails to acknowledge that there is a land supply available in natural non-built-up or abandoned land. Thus, the Hong Kong government may need to shift its focus to where land can be acquired rather than attempting to destroy city landmarks. Additionally, this action plan must be handled with context: the overall amount of usable and recoverable land is quite limited compared to the overall volume of land due to Hong Kong’s mountainous terrain. It is important to clarify that it can be difficult to directly predict how the Hong Kong housing market will respond to an increase in housing supply and if there will be a sufficiently large price decrease across the territories of Hong Kong. Nonetheless, the possible benefits of increasing housing supply, decreasing housing prices, and limiting the usage of SDUs would improve the overall health of Hong
22 Kong residents. In the grand scheme, improving the housing conditions and availability of housing in Hong Kong is only one piece of the puzzle to strengthening the health of the city. There are high levels of air pollution due to emissions from industry and traffic as well as insufficient prior environmental planning [1]. Tall buildings create “urban walls that are barriers to wind circulation and vistas in the city” as well as “wind tunnel effects and unsafe environments at street levels” [1]. Light and ventilation in highrise units are highly variable given positioning and physical proximity to other buildings. Future housing and zoning efforts will need to take into account these larger housing issues when preparing to build additional housing for Hong Kong residents. // REFERENCES // [1] What is TCM? Retrieved from https:// www.tcmworld.org/what-is-tcm/ [2] Eisen, Marty. (2016, February 16). Qi in Traditional Chinese Medicine. Retrieved from http://qi-encyclopedia. com/?article=Qi%20in%20Traditional%20 Chinese%20Medicine [3] Radical 84. Retrieved from https:// en.wikipedia.org/wiki/Radical_84 [1] Lau, S.S. (2011). Physical Environment of Tall Residential Buildings: The Case of Hong Kong. In: Yuen B., Yeh A. (eds) High-Rise Living in Asian Cities. Springer, Dordrecht. doi: https://doi. org/10.1007/978-90-481-9738-5_3 [2] Senthilingam, M. (2018, March 3). This Urban Population Is Leading the World in Life Expectancy. Retrieved from www.cnn. com/2018/03/02/health/hong-kong-worldlongest-life-expectancy-longevity-intl/ index.html [3] Population - Overview. (2018, October 19). Retrieved from www.censtatd.gov.hk/ hkstat/sub/so20.jsp [4] Ching, A. L. S., & Ching, C. (2013, August 21). Survey Report March 2014. CityYouth Empowerment Project Department of Applied Social Studies - City University of Hong Kong. Retrieved from www.soco. org.hk/publication/private_housing/ homeless research 2014_english.pdf [4] Siu, P. (2018, May 3). Surge in Hong Kong Homeless as Sky-High Rents Continue to Rise. Retrieved from www.scmp.com/news/ hong-kong/community/article/2144384/ number-registered-hong-kong-homelesssoars-sky-high-rents [5] Removed. [6] Hong Kong Takes Title for Least Affordable Housing for 8th Year. (2018, January 22). Retrieved from www.bloomberg. com/news/articles/2018-01-22/hongkong-takes-title-for-least-affordablehousing-for-8th-year [7] 2016 Population By-Census Thematic Report: Persons Living in Subdivided Units. (2018, January 18). Retrieved from
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23 www.info.gov.hk/gia/general/201801/18/ P2018011800595.htm [8] Statistical Highlights Housing. (2018, June 26). Retrieved from www. legco.gov.hk/research-publications/ english/1718issh32-subdivided-units-inhong-kong-20180626-e.pdf
analysis/prl.php [21] This calculation was made under the assumption that if 92,700 subdivided units exist in Hong Kong; on average, 2.25 people live in an SDU, that totals roughly 200,000.
[9] Chung, K. T. W. (2014). The issue of subdivided units in Hong Kong: licensing as a solution? (Outstanding Academic Papers by Students (OAPS)). Retrieved from City University of Hong Kong, CityU Institutional Repository.
[22] Liu, P., & Lam, J. (2018, August 21). Nearly half Hong Kong flats rent for more than US$2,550 a month. Retrieved from https://www.scmp.com/business/ article/2160554/nearly-half-hk-flatsrent-us2550-month-70-cent-medianhousehold-income
[10] Land Supply and Utilization in Hong Kong. (2018, April 30). Retrieved from www.legco.gov.hk/research-publications/ english/1718issh22-land-supply-andutilization-in-hong-kong-20180430-e.pdf
[23] Wong, A. (2017, November 13). How To Become Eligible For Public Housing In Hong Kong. Retrieved from https:// thenewsavvy.com/spend/property/becomeeligible-public-housing-hong-kong/
[11] Zhao, S. (2018, August 6). Number of people sleeping in McDonaldâ&#x20AC;&#x2122;s soars sixfold in five years. Retrieved from http:// www.scmp.com/news/hong-kong/community/ article/2158365/number-people-sleepinghong-kong-mcdonalds-branches
[24] Been, V., Gould Ellen, I., & Oâ&#x20AC;&#x2122;Regan, K. (2018, August 8). Supply Skepticism: Housing Supply and Affordability. Retrieved from furmancenter.org/files/ Supply_Skepticism_-_Final.pdf
[12] Housing in Figures 2018. (2018). Retrieved from www.thb.gov.hk/eng/psp/ publications/housing/HIF2018.pdf [13] Number of Application and Average Waiting Time for Public Rental Housing. (2018, November 11). Retrieved from www.housingauthority.gov.hk/en/aboutus/publications-and-statistics/prhapplications-average-waiting-time/index. html [14] Geography and Climate. Retrieved from www.censtatd.gov.hk/FileManager/ EN/Content_810/geog.pdf [15] Zhao, S. (2018, March 27). Four of 17 Proposals to Boost Land Supply Can Yield Results in Decade. Retrieved from www.scmp.com/news/hong-kong/ economy/article/2139183/four-17proposals-boost-hong-kongs-landsupply-new-homes-can [16] Task Force on Land Supply. (n.d.). Land Strategy Ongoing. Retrieved from https://www. landforhongkong.hk/en/demand_ supply/land_strategy_ongoing.php [17] Task Force on Land Supply. (n.d.). Supply Analysis. Retrieved from landforhongkong.hk/en/ supply_analysis/index.php [18] Task Force on Land Supply. (n.d.). Developing Brownfield Sites. Retrieved from landforhongkong.hk/en/supply_ analysis/brownfield.php [19] Tapping into the Private Agricultural Land Reserve in the New Territories. Retrieved from landforhongkong.hk/en/supply_ analysis/private_land.php [20] Alternative Uses of Sites under Private Recreational Leases Relocation or Consolidation of Land-Extensive Recreational Facilities. Retrieved from landforhongkong.hk/en/supply_
[25] Lubell, J., Crain, R., & Cohen, R. (2007, July). Framing the Issues the Positive Impacts of Affordable Housing on Health. Retrieved from https://pdfs.semanticscholar.org/0dbf/ ed563545d8b93877db82ee0634e68796ede7.pdf [26] What are the health risks related to overcrowding? (2016, August 29). Retrieved from http://www.who.int/ water_sanitation_health/emergencies/qa/ emergencies_qa9/en/
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THE YIN & G IN
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Written & Illustrated by Sirena Khanna
in h T
e r ealthca
raditional Chinese Medicine (TCM) is an ancient method of healing founded upon the idea of Qi. Qi, written as 气 and pronounced like the “chi” in “chia seeds,” means energy in Chinese [1]. In English, the word “energy” derives from words associated with force and vigor, but anyone who has taken general chemistry or physics knows that the concept of energy has much deeper underpinnings in nature itself. Energy simultaneously builds and destroys the universe; from the microscopic interactions between atoms in a water molecule, to the giant nuclear explosions that rocked the end of World War II, energy determines the order of life— for good or bad. In Chinese, the word for energy captures its fundamental role in everyday life. The character Qi (气) appears in the words for “gas” (气体), “air” (空 气), “odor” (气味), and “weather” (天气), among many others [2]. The character 气 is written using
the “air/gas” radical, so the idea of a disseminating energy is embedded in the way it is written, too [3]. The deeply-rooted and rich connotations of Qi elevate the idea of energy in the Chinese language to something more accurately translated as vital energy or life energy. Similarly to the matter-energy construct in physics, Qi in Chinese medicine explains what binds the universe together. Qi connects every dimension of life: physical, mental, and spiritual; as such, TCM practices focus on promoting and maintaining the flow of Qi in a person’s body, mind, and spirit. Being able to practice TCM relies on an understanding of Qi, and since there are many ways to qualify this energy, TCM practitioners need to be well-versed in recognizing its different aspects. The overarching classification system is known as yin and yang (阴阳); yin is associated with being hot, feminine, and light, while yang is associated with
* The character for Qi and the air/gas radical look the same in Simplified Chinese. In Traditional Chinese, however, the character for Qi is written as 氣, which is composed of the “air/gas” radical 气 and the “rice” radical 米, which can also signify vapor.
The Concourse of Traditional Chinese & Western Medicine 25
being cold, masculine, and heavy [4]. Good health, according to yin and yang, is a balance between these complementary forces. While yin and yang forms the basis of TCM and Chinese philosophy, this overarching dynamic can be further broken down into the Theory of Five Elements, in which certain elements represent yin and others embody yang [5, 1]. This theory also attributes a Qi to each of the five vital organs; for example, there are a Liver-Qi, a Kidney-Qi, and a Heart-Qi. Each organ-Qi is associated with one of the five elements: wood, fire, earth, metal, and water. According to yin-yang and the Theory of Five Elements, illnesses are a direct result of an imbalance in or excess of Qi. For example, depression is most commonly associated with an imbalance in LiverQi. When a patient seems depressed, a TCM practitioner might address their Liver-Qi stagnation through acupuncture and/or a prescription of herbal remedies. TCM texts, like Western Medicine textbooks, house a vast amount of information that help the practitioner devise a proper treatment. Some of these texts are thousands of years old, such as the 2,200 year old Huang Di Nei Jing [6]. Modern TCM texts compile empirical evidence not only from ancient TCM texts like Huang Di Nei Jing but also from modern TCM practices [7]. The Five Flavors Theory summarizes centuries of empirically determined herbal remedies. The theory classifies each herb under five different flavors and a temperature, either cold or hot [8]. There are five tastesâ&#x20AC;&#x201D; sweet, salty, sour, bitter, and acrid (spicy)â&#x20AC;&#x201D; each of which corresponds to an element in the Theory of Five Elements. Imbalances in LiverQi, for example, are treated with sour-tasting and cooling herbs because these herbs have relaxing and fluid-retaining properties. TCM posits that plants
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such as Aconitum (commonly known as aconite or monkshood) fall under this criteria, so Aconitum allegedly nourishes the liver and helps blood circulation [9]. Altogether, yin and yang and the Theory of Five Elements are used to classify the different qualities of Qi, and in doing so, these systems form the cornerstones of diagnosing and treating illnesses within TCM. To those brought up with Western Medicine (WM), the TCM system of diagnosis and treatment seems radically different.Is taste really a good indicator of medicinal effect? Does the TCM approach to Qi miss the mark completely? The relatively recent emphasis on evidence-based research has spurred studies into the efficacy of TCM. Although much of this research is in its infancy, the preliminary results show why the thousands years-old system of TCM works on a physiological to molecular level. In order to address Liver-Qi stagnation, researchers at the Beijing University of Chinese Medicine created a rat model of depression to study the biological basis of Liver-Qi dysfunction. In the study, the researchers identified three genes in the liver associated with depression; they also proved that treatment with the Chinese herb Si Ni Tang (scientifically known as Aconitum) helped improve depression-related behaviors in rats [10]. The specific mechanisms that alter the expression of these depression genes in the liver were not revealed, but, at the very least, this study confirms the relationship between liver dysfunction and depression. Another common area of interest is the role of Chinese herbs in treating diseases like diabetes and diseases of the nervous system, such as neuropathy. Neuropathy is a broad category of disorders caused by the degeneration of the nervous system. Peripheral neuropathy (PN), in particular, is a condition that results from damage to the peripheral nervous system. PN is a common complication of diabetes mellitus (DM) [11]. 60 to 70 percent of patients with diabetes also have neuropathy, a condition specifically referred to as diabetic peripheral neuropathy (DPN) [12]. In America, around 20 million people have DPN, and although the prevalence of DPN has not been measured in China, around 114 million people there have DM [13, 14]. Traditional Chinese Medicine (TCM) uses both acupuncture and herbal remedies to treat PN disorders such as DPN. In 2012, researchers at the Peking Union Medical College Hospital verified the use of Astragalus, Salvia, and yam in such treatment.
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In their study, they studied the effects of these herbs on Schwann cell myelination and neurotrophic factors, which are important players in maintaining and regenerating neurons [15]. Although the exact mechanisms of Astragalus, Salvia, and yam on the nervous system are unknown, the study nonetheless demonstrated that these Chinese medicines promote nerve repair and regeneration. Slowly but surely, evidence-based research is shedding light on the scientific basis of what has been known through trial and error in TCM for thousands of years. A promising example of the concourse of TCM and WM appeared in a 2017 study on the use of acupuncture in hospital emergency rooms [16]. The study, published in the Medical Journal of Australia, showed that acupuncture is an effective medication in treating acute pain for ankle sprains and lower back pain but that its analgesic effects take around an hour to manifest; however, once its full effects set in, the pain relief was comparable with that of pharmacotherapy. Although research into TCM is just beginning, the modernization of TCM is well underway. In the US, the National Center for Complementary and Alternative Medicine (also known as the National Center for Complementary and Integrative Health, or NCCIH) was established in 1998 “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care” [17]. The center has a budget around $120 million US dollars, an investment that speaks to the United States’ interest in pursuing integrative medicine [18]. On the international stage, in 2008, the World Health Organization (WHO) supported an international agreement called the Beijing Declaration that promotes the preservation of traditional medicine in national healthcare systems across the world [19]. This declaration is representative of the global impetus towards integrative medicine. In 2016, China further propelled the shift toward evidencebased research into TCM by passing new legislation that expanded its funding. As Article 8 of the Law of the People’s Republic of China on Traditional Chinese Medicine upholds, “The state supports TCM scientific research and technical development, encourages innovation in TCM science and technologies, shall popularize and apply TCM scientific and technological achievements, protect TCM intellectual property rights, and enhance TCM scientific and technical level” [20]. Overall, the legislative push towards researching TCM in a scientific setting bodes well for its integration into WM. In a yin and yang fashion, TCM and WM balance each other’s extremes. The use of randomized clinical trials and biomedical research can bring TCM up
to speed with WM modern standards, while TCM can teach WM the overarching, holistic approach of traditional medicine. An important application of this mutualistic relationship between TCM and WM is in pharmaceuticals. Pharmaceutical research often focuses on a reductionist method by singling out compounds from herbs to sell as drugs. However, the one-drug-one-disease philosophy is questionable [13]. Current research suggests that herbal medicine, including those from TCM, has synergistic effects, so individual active ingredients work together to create a greater effect and should not be isolated and prescribed on their own [21]. TCM can complement the rigid, sometimes narrowminded views in WM with a fluid, personalized treatment. For example, a Western doctor might prescribe vitamin supplements to someone with neuropathy if the doctor thinks the disease is caused by a vitamin deficiency [14]. In comparison, TCM practitioners treat the entire body with multiple herbal remedies in order to balance the flow of Qi. TCM’s holistic approach to disease explains why acupuncture is also a big part of treatment. Disease is a complex interaction of many biological systems, so the entire person— not just one type of molecule— should be treated. The best of both worlds would be a combination of WM and TCM [22]. Integrative medicine could yield the best diagnoses since it combines TCM pattern classifications alongside biomedical diagnoses. Many patients turn to TCM clinics for this reason: when WM had no cure, TCM was the next best option. Treating TCM as a last resort reveals the myopic attitude many people in the United States have toward alternative medicine. Yet, TCM might be able to treat certain diseases better than WM, and unfortunately patients only discover its virtue after going through everything WM has to offer. Moreover, TCM is rooted in preventative, non-invasive medicine, so the goal is to maintain balance in Qi before major diseases ensue. In this regard, TCM is not only more cost effective but also better for the patient’s health because it potentially prevents disease altogether. The main deterrent to TCM integration in WM is the lack of awareness and the stigma against Chinese medicine. Most insurance companies do not offer coverage for TCM acupuncture and herbal remedies due to safety and liability concerns; these concerns are mostly unfounded because licensed TCM practitioners must undergo rigorous training and obtain a formal license to practice medicine, just as WM doctors do, too [23]. But, as research continues to support TCM practices and as patients turn to alternative medicine, demand could carve out a new space for TCM in the Western healthcare market. As it turns out, through alternative medicine, WM and TCM have the potential to complement
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