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For context, that’s more than the entire economic output of many countries! And Bezos doesn’t seem to be slowing down his selling, with Forbes.com reporting $5.1 billion in sales over the course of a few weeks in early 2021! [WSW Logo]( [Divider] A note from the Editor: Wall Street Wizardry is dedicated to providing readers like you with unique opportunities. The message below from one of our business associates is one we believe you should take a serious look at. [divider] Plastic pollution is one of the defining legacies of our modern way of life, but it is now so widespread it is even finding its way into fruit and vegetables as they grow. M Microplastics have infiltrated every part of the planet. They have been found buried in Antarctic sea ice, within the guts of marine animals inhabiting the deepest ocean trenches, and in drinking water around the world. Plastic pollution has been found on beaches of remote, uninhabited islands and it shows up in sea water samples across the planet. One study estimated that there are around 24.4 trillion fragments of microplastics in the upper regions of the world's oceans. But they aren't just ubiquitous in water – they are spread widely in soils on land too and can even end up in the food we eat. Unwittingly, we may be consuming tiny fragments of plastic with almost every bite we take. In 2022, analysis by the Environmental Working Group, an environmental non-profit, found that sewage sludge has contaminated almost 20 million acres (80,937sq km) of US cropland with per- and polyfluoroalkyl substances (PFAS), often called "forever chemicals", which are commonly found in plastic products and do not break down under normal environmental conditions. Sewage sludge is the byproduct left behind after municipal wastewater is cleaned. As it is expensive to dispose of and rich in nutrients, sludge is commonly used as organic fertiliser in the US and Europe. In the latter, this is in part due to EU directives promoting a circular waste economy. An estimated 8-10 million tonnes of sewage sludge is produced in Europe each year, and roughly 40% of this is spread on farmland. Due to this practice, European farmland could be the biggest global reservoir of microplastics, according to a study by researchers at Cardiff University. This means between 31,000 and 42,000 tonnes of microplastics, or 86 trillion to 710 trillion microplastic particles, contaminate European farmland each year. Spreading sewage sludge, or bio-solids, onto fields is common practice in many parts of the world (Credit: RJ Sangosti/The Denver Post/Getty Images) Spreading sewage sludge, or bio-solids, onto fields is common practice in many parts of the world (Credit: RJ Sangosti/The Denver Post/Getty Images) The researchers found that up to 650 million microplastic particles, measuring between 1mm and 5mm (0.04in-0.2in), entered one wastewater treatment plant in south Wales, in the UK, every day. All these particles ended up in the sewage sludge, making up roughly 1% of the total weight, rather than being released with the clean water. The number of microplastics that end up on farmland "is probably an underestimation," says Catherine Wilson, one of the study's co-authors and deputy director of the Hydro-environmental Research Centre at Cardiff University. "Microplastics are everywhere and [often] so tiny that we can't see them." SENSORY OVERLOAD From the microplastics sprayed on farmland to the noxious odours released by sewage plants and the noise harming marine life, pollutants are seeping into every aspect of our existence. Sensory Overload explores the impact of pollution on all our senses and the long-term harm it is inflicting on humans and the natural world. Read some of the other stories from the series here: The underwater sounds that can kill And microplastics can stay there for a long time too. One recent study by soil scientists at Philipps-University Marburg found microplastics up to 90cm (35in) below the surface on two agricultural fields where sewage sludge had last been applied 34 years ago. Ploughing also caused the plastic to spread into areas where the sludge had not been applied. The microplastics' concentration on farmland soils in Europe is similar to the amount found in ocean surface waters, says James Lofty, the lead author of the Cardiff study and a PhD research student at the Hydro-environmental Research Centre. The UK has some of the highest concentrations of microplastics in Europe, with between 500 and 1,000 microplastic particles are spread on farmland there each year, according to Wilson and Lofty's research. As well as creating a large reservoir of microplastics on land, the practice of using sewage sludge as fertiliser is also exacerbating the plastics crisis in our oceans, adds Lofty. Eventually the microplastics will end up in waterways, as rain washes the top layer of soil into rivers or washes them into groundwater. "The major source of [plastic] contamination in our rivers and oceans is from runoff," he says. There’s a new market segment exploding right before our eyes. I'm not talking about crypto. Not 5G. Not artificial intelligence or electric vehicles. Ironically, the mainstream media is covering it… but the financial news isn’t. A report by the UK's Environment Agency, which was subsequently revealed by the environmental campaign group Greenpeace, found that sewage waste destined for English farmland was contaminated with pollutants including dioxins and polycyclic aromatic hydrocarbons at "levels that may present a risk to human health". A 2020 experiment by Kansas University agronomist Mary Beth Kirkham found that plastic serves as a vector for plant uptake of toxic chemicals such as cadmium. "In the plants where cadmium was in the soil with plastic, the wheat leaves had much, much more cadmium than in the plants that grew without plastic in the soil," Kirkham said at the time. Research also shows that microplastics can stunt the growth of earthworms and cause them to lose weight. The reasons for this weight loss aren't fully understood, but one theory is that microplastics may obstructs earthworms' digestive tracts, limiting their ability to absorb nutrients and so limiting their growth. This has a negative impact on the wider environment, too, the researchers say, as earthworms play a vital role in maintaining soil health. Their burrowing activity aerates the soil, prevents erosion, improves water drainage and recycles nutrients. Plastic particles can also contaminate food crops directly. A 2020 study found microplastics and nanoplastics in fruit and vegetables sold by supermarkets and in produce sold by local sellers in Catania in Sicily, Italy. Apples were the most contaminated fruit, and carrots had the highest levels of microplastics among the sampled vegetables. According to research by Willie Peijnenburg, professor of environmental toxicology and biodiversity at Leiden University in the Netherlands, crops absorb nanoplastic particles – minuscule fragments measuring between 1-100nm in size, or about 1,000 to 100 times smaller than a human blood cell – from surrounding water and soil through tiny cracks in their roots. Analysis revealed that most of the plastics accumulated in the plant roots, with only a very small amount travelling up to the shoots. "Concentrations in the leaves are well below 1%," says Peijnenburg. For leafy vegetables such as lettuces and cabbage, the concentrations of plastic would likely then be relatively low, but for root vegetables such as carrots, radishes and turnips, the risk of consuming microplastics would be greater, he warns. Another study by Peijnenburg and his colleagues found that in both lettuce and wheat, the concentration of microplastics was 10 times lower than in the surrounding soil. "We found that only the smallest particles are taken up by the plants and the big ones are not," says Peijnenburg. This is reassuring, says Peijnenburg. However, many microplastics will slowly degrade and break down into nanoparticles, providing a "good source for plant uptake," he adds. It will take decades before plastics are fully removed from the environment – Willie Peijnenburg The uptake of the plastic particles did not seem to stunt the growth of the crops, according to Peijnenburg's research. But what effect this accumulation of plastic in our food has on our own health is less clear. Further research is needed to understand this, says Peijnenburg, especially as the problem will only get bigger. "It will take decades before plastics are fully removed from the environment," he says. "Even if the risk is currently not very high, it's not a good idea to have persistent chemicals [on farmland]. They will pile up and then they might form a risk." Health impacts While the impact of ingesting plastics on human health is not yet fully understood, there is already some research that suggests it could be harmful. Studies show that chemicals added during the production of plastics can disrupt the endocrine system and the hormones that regulate our growth and development. Chemicals found in plastic have been linked to a range of other health problems including cancer, heart disease and poor foetal development. High levels of ingested microplastics may also cause cell damage which could lead to inflammation and allergic reactions, according to analysis by researchers at the University of Hull, in the UK. The researchers reviewed 17 previous studies which looked at the toxicological impact of microplastics on human cells. The analysis compared the amount of microplastics that caused damage to cells in laboratory tests with the levels ingested by people through drinking water, seafood and salt. It found that the amounts being ingested approached those that could trigger cell death, but could also cause immune responses, including allergic reactions, damage to cell walls, and oxidative stress. It’s [an entirely new sector]( in the market… And Jeff Bezos has stepped down from Amazon CEO… Sold his Amazon shares… To finance THIS new project… This could be your lucky second chance if you missed out on Amazon… [Click here to see the company Jeff Bezos is investing in NOW]( Women are routinely dismissed when they report symptoms of urinary tract infections, though the consequences can be severe. F For Melissa Wairimu, a video editor in Nairobi, the symptoms started at the age of 21. She was having to urinate constantly, and it burned when she did. Her back hurt as well. A urine culture test diagnosed her with a urinary tract infection (UTI). "I didn't even know there was something called a UTI at that point," Wairimu says. She was prescribed a broad-spectrum antibiotic for seven days, and told to drink plenty of water to flush things out. But the symptoms kept coming back, sometimes stronger. The pain in Wairimu’s back spread to her abdomen. She felt tired constantly, yet it was uncomfortable to lie down. “You have that prickly feeling that you have to go to the washroom,” she explains. It would keep her awake. And the inability to sleep worsened the fatigue, which made it hard to keep to her tight work schedule. Wairimu feels that her doctors didn’t listen. She was told that her UTIs might be caused by sex – though she wasn’t having sex. Doctors seemed in a hurry to make assumptions and prescribe different antibiotics, yet these didn’t resolve the problem. One antibiotic even caused seizures. Wairimu is sympathetic to the six doctors she saw over the years, who she believes didn’t have enough training on recurrent UTIs. So she had to search out her own information, trawling through the internet and resonating with stories of people in similar situations. This led her to the patient advocacy group Live UTI Free, where she now works. Wairimu began tweaking her diet and doing a lot of trial and error to see what would keep her symptoms at bay. Four years on, the problem is still lurking, but the symptoms are more manageable. Visiting doctor after doctor. Not being taken seriously. Getting prescribed treatments that work only in the short term, if at all. These are the shared experiences of Wairimu and others experiencing "complicated UTIs" – defined as those that carry a higher risk of treatment failure – with an estimated 250,000 cases per year in the US alone. Many patients, clinicians and researchers alike are frustrated that there hasn’t been more progress in combatting both regular UTIs and these trickier forms, but they are holding out hope for change. Most research on urinary tract infections relies on laboratory mice. Some experts are questioning this, because mice aren't naturally susceptible to this disease (Credit: Alamy) Most research on urinary tract infections relies on laboratory mice. Some experts are questioning this, because mice aren't naturally susceptible to this disease (Credit: Alamy) Poorly understood The symptoms of a UTI include pain or burning while urinating, frequent or sudden pressure to urinate, passing urine that is cloudy, bloody or smelly, pain in the back or lower abdomen and fever or chills. Typically, this is caused by E. coli. Many other bacteria can also be culprits, but there’s limited research on these – and even on rarer strains of E.coli, according to Jennifer Rohn, who heads the Centre for Urological Biology at University College London, UK. A UTI can then cause cystitis, or inflammation of the bladder, explains Chris Harding, a urologist at Freeman Hospital and Newcastle University in the UK. There are other types of UTIs, but cystitis is the most common. UTIs in general are extremely common, affecting at least half of women at some stage in their lives. They’re especially frequent among young, sexually active women and post-menopausal women, Rohn says. Genetics, hormones, and anatomy all come into play. Women and girls are especially affected because they have shorter urethras than men, and thus bacteria can reach the bladder more easily. While UTIs are classified as an infectious disease, they’re not contagious. However, the bacteria responsible can be transmitted from person to person during sex. But men can get UTIs, especially when they’re older. In care homes, UTIs are the most common type of infection. Globally, UTIs affect an estimated 150 million people every year, but this already-pervasive issue is bound to become even more common as the world continues to age. "It’s a very large reason why elderly people end up in hospital," Rohn explains. Because UTIs are common and usually uncomplicated, many medical providers dismiss them as a normal part of being a woman. But that risks trivialising the more severe cases, which are numerous. One estimate is that, like Wairimu, 25% of women with at least one UTI will go on to have recurrent UTIs: at least two in six months, or three a year. Many have even more. As well as recurrent UTIs, there’s increasing awareness of chronic UTIs – sometimes referred to as long-term or embedded UTIs. Essentially, some people live with symptoms constantly. Yet there’s almost no official recognition of this condition. Diagnosing a urinary tract infection is not always straightforward (Credit: Getty Images) Diagnosing a urinary tract infection is not always straightforward (Credit: Getty Images) Even relatively straightforward UTIs get missed as often as they get spotted. The typical methods for diagnosing UTIs are dipstick testing of urine and mid-stream urine cultures, but these aren’t sensitive enough to be reliable. In contrast, newer-generation molecular tests are almost too sensitive, picking up any pathogen even if it isn’t linked to the problem. They’re also expensive. Does cranberry juice work for cystitis? Many people believe that drinking cranberry juice or taking capsules of its extract can help to alleviate the symptoms of cystitis. However, the evidence for the efficacy of this treatment is sparse and difficult to interpret. While some studies have found that cranberry products were beneficial – particularly in preventing new episodes from occurring in women with recurrent cystitis – in others cranberry juice had no effect. Read more from BBC Future about whether cranberry juice can stop cystitis. Urine testing is "cheap as chips," in Rohn’s words, but often misleading. The urine culture test – which involves growing the bacteria from a urine sample in the laboratory – was developed in the 1950s with pregnant women who had kidney infections. In other words, a standard test for UTIs derives from outdated research that wasn’t even UTI-specific. "If you rely on urine cultures to make a diagnosis, you might miss around half of all UTIs," Harding says. As with testing, medical education on UTIs remains out of date. Harding learned as a medical student that the bladder was a sterile environment. This popular misconception has led to confusion over how to interpret evidence of bacteria in the bladder. To this day, Rohn lectures medical students who believe, incorrectly, that urine is sterile. While researchers are aware of the inadequacy of the tests, "it’s not filtered down into clinical practice", says Carolyn Andrew, a director of the Chronic Urinary Tract Infection Campaign (CUTIC), a patient advocacy group in the UK that is calling for clinical guidelines related to chronic UTIs. Like many long-term sufferers of UTIs, Andrew was misdiagnosed at first. The retired lecturer was on a road trip when she became desperate for the loo, where she started feeling a burning sensation. Eventually "I was literally weeing every 15 minutes". The UTI tests came back negative, and Andrew was diagnosed with interstitial cystitis (IC), or bladder pain syndrome. The treatments for IC were painful and made things worse. The following year, when she saw a specialist, she was finally treated for chronic UTIs. "Thank god someone is listening to me," she remembers thinking. It would take nearly four years of antibiotics to clear up the embedded infection, but Andrew remains grateful. Andrew believes that a diagnosis based on symptoms rather than ineffective tests would have given her some answers earlier on. Rohn points out that symptom-based diagnosis is especially common-sense for people with repeat UTIs, as they can recognise their own bodily indicators. "Maybe we can start taking women and their symptoms more seriously," Rohn hopes. (Read more from BBC Future about the inequality in how women are treated for pain.) Some people have found that certain foods, such as chocolate, seem to trigger episides of cystitis (Credit: Alamy) Some people have found that certain foods, such as chocolate, seem to trigger episides of cystitis (Credit: Alamy) Stigma and neglect Rohn believes that a "perfect storm" of perceptions explains why UTIs have been so neglected: "It’s a woman’s disease. It also affects the elderly. And it’s down there," she says. "There probably still is a level of shame attached," says Andrew. Especially for older people or people from certain communities with taboos around discussing bladder issues, it can be hard to mention the symptoms. "Particularly in Africa, there’s not much talk about it," says Wairimu. “It’s hush hush.” There is undeniably a gendered element as well. "Women are told they’re dirty," Andrew fumes. "One of the most upsetting things about this is that a lot of women are told that their hygiene habits are unacceptable and that they’ve caused it themselves." Many people with complicated UTIs have had similar experiences of being misdiagnosed, talked down to, or gaslit. They are often told that their symptoms are all in their heads. Some are even shouted at by their doctors. "It’s also perceived as being very minor," Rohn notes. Because UTIs aren’t typically fatal, they don’t attract the same levels of funding and attention as other infections. But UTIs can lead to death via sepsis or kidney infection. "People don’t realise that bacterial infections are very dangerous if they aren’t treated properly," she says. These infections can be not only dangerous, but also deeply damaging the personal and professional lives of those affected. Andrew lived with constant pain and pressure on her bladder before she was finally treated for a chronic UTI. In her work with CUTIC, she’s seen people so desperate that they ask to have their bladders removed. And as challenging as UTI cases can be in adults, the challenges are magnified when treating children. For example, symptoms are often ambiguous in very young children, and getting an uncontaminated urine sample can be a challenge. Some parents who come to CUTIC report that children as young as three are experiencing UTIs. The antibiotic dilemma For those lucky enough to be accurately diagnosed with a UTI, treatment can be a minefield. In Kenya, antibiotics were prescribed almost indiscriminately for Wairimu. In the UK, the standard course of antibiotics for treating UTIs in women lasts three days. For men, whose cases are automatically considered complicated, the default period is seven days. The disparity is frustrating for some. Rohn believes that the standard three-day period, with the limited slate of antibiotics on offer, isn’t enough for many women. A key reason for the limited treatment duration is concern over antimicrobial resistance. This is justified, but too often a preoccupation with antimicrobial stewardship neglects people who are suffering, Rohn argues. "Stewardship’s not meant to stop treatment. It’s meant to stop inappropriate treatment." One paradox is that insufficient first-line treatment of UTIs can turn these infections chronic or recurrent, with tenacious bacteria hiding within biofilms. In these cases, ultimately more antibiotics may be required. For recurrent UTIs, patients are often treated with longer courses of antibiotics. This happened to Andrew, who dipped between private and public healthcare before she found relief. Many others wouldn’t have the resources or the education level to persist in seeking better care. Many people believe cranberry juice can help treat cystitis, but the evidence is extremely murky (Credit: Alamy) Many people believe cranberry juice can help treat cystitis, but the evidence is extremely murky (Credit: Alamy) Prospects for change A number of efforts are underway to improve diagnosis and treatment of UTIs. In response to antibiotics losing their power, researchers are trying to repurpose existing drugs or increase their penetration into the tissues where they’re needed. Last year, pharmaceutical company GSK also reported promising test results for a new oral antibiotic. If approved, it would be the first one developed in over two decades to treat uncomplicated UTIs. Given the enormous problem of drug-resistant superbugs, alternatives to antibiotics are needed as well. Harding offers patients vaginal oestrogen supplementation as one non-antibiotic option, but there are promising signs that antiseptics might also work. In March 2022 , together with colleagues from across the UK, Harding published the results of a study examining the effects of a urinary antiseptic on patients who were experiencing, on average, seven UTIs a year. Unlike antibiotics, antiseptics are usually applied outside the body – though both work to inhibit the growth of microbes. With this method, patients were instructed to take oral methenamine hippurate twice a day for 18 months. The idea is that the antiseptic salts turn into formaldehyde at the end of the kidney filtration process, killing off the bacteria that cause UTIs. The research found that the antiseptic administered to the study group left them essentially no worse off than the control group, who received antibiotics. Harding hopes that the results will lead to methenamine being recommended in British and European clinical guidelines as a preventive measure for people with recurrent UTIs. Several vaccines against UTIs are also in development. They’re furthest along in the UK, but even there are generally not accessible. “We’re excited by the opportunities presented by UTI vaccines for our patients but at this stage they all require further studies before we can make them widely available,” says Rajvinder Khasriya, who leads the UK’s only NHS clinic dedicated to chronic and recurrent UTI infections, where Andrew finally found relief. Basic research also has an important role in illuminating the urinary tract. Rohn says that “mouse models have reigned supreme” in UTI research for many years, despite mice having different urinary functions to humans. Unlike humans, mice don’t store urine for a long time. Nor do they even get UTIs naturally. Rather than relying solely on mouse-based models, Rohn and colleagues have designed a 3D model of a human bladder that can mimic the stretch and flow of the real organ, and be programmed with actual urine. "It’s quite exciting now being in a time when human modelling is entering a renaissance," Rohn enthuses. In the meantime, a greater awareness of UTIs – and willingness to take them seriously – could go some way to alleviating the suffering of women like Wairimu and Andrew, who have had to struggle for years to find answers. [divider] [WSW footer logo]( You are receiving this e-mail because you have expressed an interest in the Financial Education niche on one of our landing pages or sign-up forms on our website. If you {EMAIL} received this e-mail in error and would like to report spam, simply send an email to abuse@wallstreetwizardry.com. You’ll receive a response within 24 hours. 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