x - 38 Louis Sheehan

While peyote and other plant hallucinogens had been used in shamanistic rites for centuries, the modern era of hallucinogenic research began in April 1943. At Sandoz Laboratories in Basel, Switzerland, chemist Albert Hofmann accidentally dosed himself with LSD, a rye ergot fungus he had been working with, and suddenly saw the world through kaleidoscope eyes.

That first acid trip sparked an explosion in experimentation by psychiatrists, intellectuals, artists, spiritual seekers, and even Nobel Prize–winning scientists including physicist Richard Feynman and Francis Crick, who reportedly admitted before he died in 2004 that he had visualized the double-helix structure of DNA while under the influence of LSD. In the heady postwar years, hundreds of promising studies were conducted in the United States, Canada, and Europe on the use of LSD and other psychedelics, like peyote, to treat such psychiatric maladies as schizophrenia, autism, drug addiction, alcoholism, and chronic depression. “People don’t realize today how valuable these studies were and how enthusiastic the reception was within psychiatry, which was then locked in a rigid Freudian orthodoxy,” Grob says. “Investigators were getting very rapid, positive, and transformative changes in patients.”

By the early 1960s more than 1,000 studies on LSD and other hallucinogens discussing the experiences of 40,000 patients had been published in reputable medical journals. “It was a medicine of remarkable power,” Stanislav Grof says. The Czech-born psychiatrist conducted dozens of government-sanctioned LSD experiments in the ’50s, ’60s, and early ’70s on heroin addicts, alcoholics, and terminal cancer patients in his native Prague and later at the Maryland Psychiatric Research Center, a mental health facility in Catonsville, Maryland, where he was chief of psychiatric research.

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“The results were quite impressive, particularly in some of those categories that are very resistant to treatment, such as heroin addiction,” recalls Grof, who is now 76. “It could also frequently relieve pain, even pain that didn’t respond to narcotics. I found the studies with cancer patients to be the most moving, to see how their attitudes toward death changed.”

During the 1950s and early ’60s, research in Canada by psychiatrists Abram Hoffer and Humphry Osmond using mescaline and LSD on patients with severe alcohol addictions became the stuff of legend (pdf). “Alcoholics Anonymous believed many alcoholics don’t do well until they become deeply motivated by ‘hitting bottom,’” says Hoffer, who at 90 still sees patients. “We thought we could use a whip to frighten alcoholics and drive them away from a desire to drink by giving them a bad trip. After giving it to five patients, we realized that instead of hitting bottom, they were having a beneficial, pleasurable experience. It opened their minds, they developed some insights, and they began to see things they never had seen before,” which made them more receptive to psychotherapy.

This prompted Osmond to coin the term psychedelic (from the Greek, meaning “mind manifesting”) to describe the drugs’ capacity for mental enrichment. When combined with talk therapy, just one or two daylong LSD sessions blunted the desire to drink, even in alcoholics written off as hopeless. Psychedelics became part of treatment in Saskatchewan’s five treatment centers and were administered in 100- to 800-microgram doses—many times the strength of a street dose and potent enough to conjure up visions. In follow-ups two and three years later, researchers found that more than half the patients—and, in some instances, up to 90 percent—remained sober, according to Erika Dyck, a medical historian at the University of Alberta in Edmonton and author of an upcoming book on psychedelic psychiatry. Many patients said the sessions saved their lives.

But these potent potions soon became a symbol of the dark side of the ’60s counterculture. Unhinged people on bad acid trips who had taken bootleg or adulterated street drugs began showing up in emergency rooms in the throes of severe panic attacks or psychotic breakdowns. Psychedelics, and LSD in particular, were held responsible for suicides, permanent brain damage, and cult thrill killings. In response to the hysteria, Sandoz stopped supplying researchers with LSD in 1965; a year later the drug was outlawed in the United States, and by 1972 legitimate scientific research had ground to a halt.

Lack of scientific standards in many of the early studies compounded the problem. Often the reports were based on anecdotal evidence, or the studies failed to give any participants dummy pills as a basis for comparison. Nor were the tests blinded. In a blinded test, researchers don’t know whether they are giving patients the drug being tested or fake medicine. That is an important control; other–wise, personal biases and expectations can muddy test results.

At the time, though, Charles Grob thought the setbacks were only temporary. After hearing a lecture by Grof in the 1970s about his studies with the terminally ill, he decided that pursuing this line of research was what he wanted to do with his life. “His research was inspiring,” Grob recalls. “The hospice movement hadn’t occurred yet, and these patients were often pushed off into a corner of a sterile hospital. But when I told my father, he said no one would listen to me unless I had credentials.”

Grob headed back to college, earned his medical degree in 1979, and, after completing a child psychiatry fellowship, began teaching at Johns Hopkins Hospital in 1984. “Almost overnight, the field had gone into deep hibernation,” he recalls. Still, he never gave up on the drugs’ tantalizing potential. When UCLA wooed him away from the University of California at Irvine in 1993, where he was teaching and practicing after leaving Johns Hopkins, he told his future boss about his secret passion. “I hope I’m not too crazy for you,” Grob told him.

The research climate was changing once again. In 1990 Rick Strassman, a psychiatrist at the University of New Mexico in Albu–querque, got federal clearance to do the first psychedelic studies on humans in nearly two decades. Several factors helped pry open the regulatory doors, Strassman says. The countercultural excesses were a dim memory, a new regime at the FDA was more open, the little-known psychedelic he proposed to test—DMT—didn’t have the baggage of LSD, and he was persistent. “It took two years,” Strassman says. “They never said no, so I thought until they did, I would continue working on getting approval.”

Over the next five years, he injected 65 healthy adult volunteers with DMT (dimethyltryptamine), a powerful hallucinogen derived from plants that induces a trancelike state. Many of the subjects, all of whom had taken psychedelics before, reported having out-of-body and near-death experiences and felt the sessions were among the most intense episodes of their lives.

Not long after, Grob witnessed the salutary effects of psychedelics when he was invited by a colleague to do a privately funded investigation of the emotional health of people who regularly ingested these substances as part of their religion. In the summer of 1993, he traveled to Manaus, Brazil, a major port city in the Amazon rain forest, to study members of the Centro Espirita Beneficente União do Vegetal (UDV) church. Founded in Brazil in 1961, the 8,000-member religion mixes traditional Christianity with indigenous beliefs. Central to the UDV rituals is drinking ayahuasca, a tea brewed from two plants that grow in the Amazon basin. One contains DMT; the other contains an alkaloid that prevents DMT from being degraded in the stomach. Grob did a psychiatric and neuropsychological inventory comparing 15 long-term users of ayahuasca with 15 matched controls and found the church members were physiologically and psychologically healthier. They were more cheerful, confident, relaxed, even-tempered, and orderly and scored better on memory and concentration tests—and there was no evidence of deterioration of their personalities or their mental acuity.

    So much emotion is tied up with this research that it often gets in the way of critically analyzing the risks.

When Grob quizzed them about their personal lives, many UDV members described themselves as angry, impulsive reprobates hell-bent on self-destruction before they entered the church. Some had unsavory histories of violence and spousal abuse and were severely alcoholic or addicted to drugs. “I was amazed because these were responsible, high-functioning pillars of the community,” Grob recalls. “They all unequivocally credited ayahuasca, when taken in the controlled setting of the church, as the catalyst for their evolution into upstanding citizens.”

Emboldened by Strassman’s success, Grob applied to the FDA for permission to test MDMA on dying cancer patients. The agency insisted that safety studies be completed first on 18 healthy volunteers to ensure that the drug didn’t trigger damaging side effects. In 1994 he administered the first dose of MDMA to a test subject. But after completing the pilot study, he abandoned the drug in favor of the less controversial psilocybin. After Grob made the switch, the FDA gave him the go-ahead, and he recruited his first terminal cancer patient in 2004.

But the real turning point was a 2006 Johns Hopkins study using psilocybin in 36 healthy adults who were spiritually inclined but had never done psychedelics. They all received both psilocybin and an amphetamine-like compound (Ritalin), which has some psychoactive effects, such as increasing heart rate and increasing concentration. Some received psilocybin first; others received Ritalin first. In follow-up interviews two months later, four out of five said that the psilocybin experience had improved their well-being and satisfaction with life, about 70 percent rated the experience as among the most spiritually significant events of their lives, and nearly 70 percent called it one of the most personally meaningful events, comparable to the birth of a first child or the death of a parent. These beneficial effects persisted more than a year, when the volunteers were interviewed again.

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“Many of these people had a genuine mystical experience, which was transformative in a profound way,” says Roland Griffiths, a behavioral psychopharmacologist at the Johns Hopkins University School of Medicine and the study’s lead investigator. Especially significant was the experiment’s rigorous design, which proved that this type of research can be safely done under scientifically standardized conditions. Perhaps even more important, Herbert Kleber says, is that Griffiths is new to the field and “not a true believer.”

What are the drugs doing to create such powerful effects? At the chemical level, psilocybin, LSD, and DMT—which are classified as tryptamines—are structurally similar to serotonin, a powerful chemical messenger that expedites the transmission of nerve signals in the brain. Tryptamines work by mimicking the action of serotonin, which is responsible for controlling an array of functions, including mood, sexual desires, sleep cycles, memory, and appetite. MDMA is a phenethylamine; it taps into the neuronal reservoirs of the key brain chemicals serotonin, dopamine, and norepinephrine (adrenaline), boosting their levels in the brain. Mescaline, although it is classified as a phenethylamine, works more like LSD or DMT.

While no one knows why psychedelics exert powerful positive effects or why they transform perceptions, progress in brain imaging has allowed researchers to discover where these drugs act in the brain. Extensive animal studies and PET scans on humans reveal that tryptamines such as psilocybin stimulate an array of brain structures: the prefrontal cortex, which is the center of executive functioning; limbic regions such as the amygdala that govern our emotional life and the formation of memories; the striatum, which plays a role in cognitive functions; and the thalamus.

Scientists suspect that one of the key areas especially affected is the thalamus, a walnut-size structure at the base of the brain that is the gateway for sensory information—taste, touch, vision, and hearing. The thalamus normally acts as a filter, winnowing out extraneous sensory information before relaying data to the cerebral cortex, the seat of memory, attention, language, and consciousness. Under psychedelics, the sensory overload may overwhelm the thalamus, leading to delusions, hallucinations, thought disturbances, feelings of persecution, and loss of coherent ego experiences.

“The cortex basically takes all the information coming in and synthesizes it into reality,” says David E. Nichols, a professor of medicinal chemistry at Purdue University in West Lafayette, Indiana, who has done animal research on hallucinogens. “When you alter that circuitry, you’re essentially changing your perception of reality.”

That’s why scientists stress the importance of taking these powerful substances in a pleasant and well-supervised environment, rather than in the uncontrolled settings of recreational drug use. Psychedelics amplify whatever is going on around you and within you, Nichols says. “Taken in haste, without proper regard for their effects and in chaotic conditions, the effects can be really awful and frightening. But with the proper preparation, in a proper setting, with the right controls, the experience can be wonderful.”

Annie Levy, a participant in Grob’s study, agrees. The 54-year-old neuropsychologist underwent her psilocybin session at UCLA last May, shortly after her ovarian cancer had come roaring back in spite of two rounds of intensive chemotherapy. Overwhelmed by dread, Levy says she was “plagued by obsessive thoughts that I would suffer horribly while going through the dying process.”

A few days before her treatment, Levy says, “I had felt somewhat anxious about participating in the study, but meeting the treatment team helped calm my fears.” And once the psychedelic took hold, her despair disappeared. She was able to come to terms with her eventual death, concentrate on all the joy in her life, and stop ruminating about all the awful things that might happen in the future. The drug’s influence endured for about six months. “I wish I could go in for another session,” Levy says, “like a booster.”

Despite such glowing testimonials, some researchers worry about the potential for serious psychic damage if these compounds are used by hundreds of therapists on thousands of patients, instead of by a small cadre of dedicated scientists testing carefully screened volunteers in tightly controlled situations. “The idea of turning [these drugs] loose makes me uncomfortable,” says University of Utah pharmacologist Glen Hanson, who is also director of the Utah Addiction Center there. “Before we make them available by prescription, there needs to be compelling evidence that they’re unique and that a large population would derive substantial benefit.”

Eventually, though, this research may lead to more precisely targeted therapeutics for the disorders psychedelics seem to help, such as OCD and other compulsive ills, like bulimia and anorexia. In animal studies, repeated dosages of psilocybin diminish the number of 2A serotonin receptors, which dampens their expression. This is a process known as downregulation.

“We suspect that physiologically, this is what happened in the OCD study—that psilocybin downregulates the activity of these receptors,” says Franz X. Vollenweider, a psychiatrist and neuroscientist at the Psychiatric University Hospital in Zurich, Switzerland, who conducted many of the imaging studies and has done psychedelic research for more than a decade. “We’ve done a lot of basic research,” he adds. “Now we want to use the tools we’ve developed to see what is going on in real patients. If we could convincingly demonstrate hallucinogens alter these receptors, then we can find other compounds that have similar mechanisms but are less frightening.”

Will these studies finally open the door to acceptance? David Nichols says psychedelics researchers keep a low profile “because everyone lives in fear that some administrator will kill their project.” Roland Griffiths of Johns Hopkins, for example, who has been doing pharmacological research for more than three decades, never had a project scrutinized as thoroughly by his institution’s review board and the FDA as his 2006 psilocybin study was. Throughout the study he worried that negative publicity might halt the research.

Charles Grob is more hopeful. “Sure, it’s been Sisyphean because of the cultural stigmas, and it has taken years to go even little baby steps,” he says. “But people are making dramatic progress working with the hardest cases. We’re on the threshold of opening up an exciting new field.”

So you are an unapologetic procrastinator, running fast and furious up to the deadline and, often, right past it. It is not that you choose to turn work in late but rather that you have no choice, you say? Now there is mathematical proof to back up your story.

Plotted on a graph, the speed of a procrastinator’s work is a straight line, rising as the deadline gets closer. Based on this observation, computer science professor Michael Bender of Stony Brook University in New York used the line to calculate the time it might take a real-life procrastinator to complete a series of tasks using a variety of common strategies, especially focusing on the most important (but not necessarily the most imminent) deadline first. His analysis, published in the Journal of Scheduling, showed that no strategies guarantee that procrastinators will meet all deadlines. Because procrastinators wait to work, when an unexpected assignment becomes a new priority—thanks to, say, a sick coworker—the model procrastinator has no slack time and blows the deadline. “To meet all their deadlines,” Bender says, “procrastinators have to be able to see the future perfectly.”

But they do not need a crystal ball, says Timothy Pychyl, a psychologist at Carleton University in Ottawa, Ontario. They need discipline. “Procrastination happens because you’re disorganized, not very dutiful, and probably impulsive,” he says.

The common bedbug (Cimex lectularius) is the best adapted to human environments. It is found in temperate climates throughout the world and lives off the blood of humans. Other species include Cimex hemipterus, found in tropical regions (as well as Florida), which also infests poultry and bats, and Leptocimex boueti, found in the tropics of West Africa and South America, which infests bats and humans. Cimex pilosellus and Cimex pipistrella primarily infest bats, while Haematosiphon inodora, a species of North America, primarily infests poultry.

Oeciacus, while not strictly a bedbug, is a closely related genus primarily affecting birds.

Adult bedbugs are a reddish brown, flattened, oval, and wingless, with microscopic hairs that give them a banded appearance. A common misconception is that they are not visible to the naked eye. Adults grow to 4 to 5 mm (one-eighth to three-sixteenths of an inch) in length and do not move quickly enough to escape the notice of an attentive observer. Newly hatched nymphs are translucent, lighter in color and continue to become browner and moult as they reach maturity. When it comes to size, they are often compared to lentils or appleseeds.

Bedbugs are generally active only at dawn, with a peak attack period about an hour before sunrise. They may attempt to feed at other times, however, given the opportunity, and have been observed to feed at any time of the day. Attracted by warmth and the presence of carbon dioxide, the bug pierces the skin of its host with two hollow tubes. With one tube it injects its saliva, which contains anticoagulants and anesthetics, while with the other it withdraws the blood of its host. After feeding for about five minutes, the bug returns to its hiding place. The bites cannot usually be felt until some minutes or hours later, as a dermatological reaction to the injected agents, and the first inclination of a bite usually comes from the desire to scratch the bite site.

Although bedbugs can live for a year or as much as 18 months without feeding, they typically seek blood every five to ten days. Bedbugs that go dormant for lack of food often live longer than a year, well-fed specimens typically live six to nine months. Low infestations may be difficult to detect, and it is not unusual for the victim not to even realize they have bedbugs early on. Patterns of bites in a row or a cluster are typical as they may be disturbed while feeding. Bites may be found in a variety of places on the body.

Bedbugs may be erroneously associated with filth in the mistaken notion that this attracts them. However, severe infestations are often associated with poor housekeeping and clutter. Bedbugs are attracted by exhaled carbon dioxide and body heat, not by dirt, and they feed on blood, not waste. In short, the cleanliness of their environments has effect on the control of bedbugs but, unlike cockroaches, does not have a direct effect on bedbugs as they feed on their hosts and not on waste. Good housekeeping in association with proper preparation and mechanical removal by vacuuming will certainly assist in control.

All bedbugs mate via a process termed traumatic insemination.  Instead of inserting their genitalia into the female's reproductive tract as is typical in copulation, males instead pierce females with hypodermic genitalia and ejaculate into the body cavity. This form of mating is thought to have evolved as a way for males to overcome female mating resistance. Traumatic insemination imposes a cost on females in terms of physical damage and increased risk of infection. To reduce these costs females have evolved internal and external "paragenital" structurescollectively known as the “spermalege”. Within the True Bugs (Heteroptera) traumatic insemination occurs in the Prostemmatinae (Nabidae) and the Cimicoidea (Anthocoridae, Plokiophilidae, Lyctocoridae, Polyctenidae and Cimicidae), and has recently been discovered in the plant bug genus Coridromius (Miridae).

Remarkably, in the genus Afrocimex both males and females possess functional external paragenitalia, and males have been found with copulatory scars and the ejaculate of other males in their haemolymph. There is a widespread misbelief that males inseminated by other males will in turn pass the sperm of both themselves and their assailants onto females with whom they mate. While it is true that males are known to mate with and inject sperm into other males, there is however no evidence to suggest that this sperm ever fertilizes females inseminated by the victims of such acts.

Female bedbugs can lay up to five eggs in a day and 500 during a lifetime. The eggs are visible to the naked eye measuring 1 mm in length (approx. two grains of salt) and are a milky-white tone. The eggs hatch in one to two weeks. The hatchlings begin feeding immediately. They pass through five molting stages before they reach maturity. They must feed once during each of these stages.

At room temperature, it takes about five weeks for a bedbug to pass from hatching to maturity. They become reproductively active only at maturity.

In most observed cases a small, hard, swollen, white welt may develop at the site of each bedbug bite. This is often surrounded by a slightly raised red bump and is usually accompanied by severe itching that lasts for several hours to days. Welts do not have a red spot in the center such as is characteristic of flea bites. In other cases, it is observed that welts first appear upon the inccessant scratching that is triggered by the bite, and seem like a mosquito bite that increases in size upon scratching. Later, however, the welts subside but tend not to disappear like those from mosquitos, and persist for up to several weeks. This usually depends on the person's skin type, environment and the species of bug.

Some individuals respond to bed bug infestations and their bites with anxiety, stress, and insomnia.  Individuals may also get skin infections and scars from scratching the bedbug bite locations.

Most patients who are placed on systemic corticosteroids to treat the itching and burning often associated with bed bug bites find that the lesions are poorly responsive to this method of treatment. Antihistamines have been found to reduce itching in some cases, but they do not affect the appearance and duration of the lesions. Topical corticosteroids, such as hydrocortisone, have been reported to expediently resolve the lesions and decrease the associated itching.

Bed bugs seem to possess all of the necessary prerequisites for being capable of passing diseases from one host to another, but there have been no known cases of bed bugs passing disease from host to host. There are at least twenty-seven known pathogens (some estimates are as high as forty-one) that are capable of living inside a bed bug or on its mouthparts. Extensive testing has been done in laboratory settings that also conclude that bed bugs are unlikely to pass disease from one person to another.  Therefore bedbugs are less dangerous than some more common insects such as the flea. However, transmission of trypanosomiasis (Chagas disease) or hepatitis B might be possible in appropriate settings.

The salivary fluid injected by bed bugs typically causes the skin to become irritated and inflamed, although individuals can differ in their sensitivity. Anaphylactoid reactions produced by the injection of serum and other nonspecific proteins are observed and there is the possibility that the saliva of the bedbugs may cause anaphylactic shock in a small percentage of people. It is also possible that sustained feeding by bedbugs may lead to anemia. It is also important to watch for and treat any secondary bacterial infection.

Notes of Louis Sheehan

Bedbugs were originally brought to the United States by the early colonists. They thrive in places with high occupancies such as hotels. Bedbugs were believed to be altogether eradicated 50 years ago in the United States and elsewhere with the widespread use of DDT. Some theories are now suggesting that they never really left. One recent theory about the reappearance of bedbugs has to deal with geographic epicenters where the bedbugs are believed to center from. During the investigations of these epicenters, they found two locations where they discovered the apparent epicenters. They are located at poultry facilities in Arkansas and Texas. It was determined that the workers in these facilities were the main spreaders of these bedbugs and carrying them to their places of residence and elsewhere after leaving work.Bedbug populations in the United States have increased by 500 percent in the past few years. It is still uncertain exactly what has caused the resurgence of these bedbugs, but most believe it has to do with the increase in international travel and the use of new pest-control methods that do not affect bedbugs. In the last few years, the use of baits instead of insecticide sprays is believed to have contributed to the increase.

As previously stated, bedbugs were all but eradicated from North America during the 1940s and 50s. However, bedbug cases have been on the rise recently, not only in North America, but all across the world. Prior to the mid twentieth century, bed bugs were very common. According to a report by the UK Ministry of Health, in 1933 there were many areas where all the houses were infested with bedbugs to an extent. Since the mid 90's, the reports of bed bug cases have been on the rise. Figures from one London borough show the numbers of reported bedbug infestations doubling each year during the period from 1995 to 2001. The rise in bedbug infestations has been hard to track due to the fact that bedbugs are not an easily identifiable problem. Most of the reports are collected from various pest-control companies, local authorities, and hotel chains. Therefore, the problem may be more severe than we currently believe it to be. Several reasons have been noted for the cause of the recent bedbug resurgence but the main two are the recent increase in international travel and the use of less noxious pesticides.

The most-cited reason for the dramatic rise in bed bug cases world wide is due to the increase in international travel in recent decades. In 1999, four separate infestations throughout the United Kingdom alerted people to the possibility of an increase in the world wide bedbug population, facilitated by international travel and trade. However, there is evidence of a previous cycle of bed bug infestations in the United Kingdom. The Institution of Environmental Health Officers maintained statistics for bed bug infestations, data collected from reports and inspections. In the period 1985-1986, the Institution of Environmental Health Officers reported treating 7,771 infestations in England and Wales, and 6,179 infestations in 1986-1987. There were also reports of infestations in Belfast and Scotland.

New York City has been riddled with bedbug infestations since the turn of the century. Bedbugs have found their ways into hotels, schools, and even hospital maternity wards. Jeffrey Eisenberg, the owner of Pest Away Exterminating on the Upper West Side claims his company receives 125 calls a week now as compared to only a few just 5 years ago. In 2004, New York City had 377 bedbug violations. However, from July to November of 2005, a 5-month span, there were 449 violations reported in the city, an alarming increase in infestations over a short period of time. A large number of international travelers visit New York each day, and exterminators and entomology experts place most of the blame on them.

Since 1999, infestations have been reported in the United Kingdom, Germany, Spain, Australia, Canada, and the United States. Two separate studies in Tuscany, Italy provide further proof of the resurgence of bedbugs in relation with international travel. In case 1, during the summer of 2003 a seven year old boy developed a number of papulae on his lower legs which caused severe itching. His parents suspected insects in the boy’s room and upon searching found several in the folds of the mattresses on the young boy’s bed. Two specimens were identified as C. lectularius and the room was treated with an insecticide to rid the room of the bedbug infestation. The house the boy was living in had not experienced a bedbug infestation before. However, one month before the infestation, two family friends had traveled by plane from Nepal to stay with the family for ten days. This is a good indication for the transfer of bedbugs due to international travel. Case 2 involves a forty-eight year old man traveling by car to Pisa, Italy from Prague, Czech Republic in June of 2003 and staying in a rented house with three friends. After several days, the man noticed several bullous eruptions on his upper and lower extremities all arranged in linear clusters of three. The man found several insects in his room and after identification the insects were identified as C. lectularius. The rent house was well kept and had never had a bedbug infestation. However, a group of Germans had rented the house a few weeks before the Czech group arrived. This too was a good indicator of bedbug spread by international travel.

Due to the widespread use of potent insecticides such as DDT, bedbugs were nearly eradicated. However, many of these strong insecticides have been banned from use in the United States are being replaced with weaker insecticides such as pyrethroids. The problem with the weaker insecticides is that many bedbugs have grown resistant to them. A study at the University of Kentucky randomly collected bedbugs from across the entire United States. These “wild” bedbugs were up to several thousands of times more resistant to pyrethroids than the laboratory bedbugs. Another problem with current insecticide use is that the broad-spectrum insecticide sprays for cockroach and ants that are no longer used had a collateral impact on bedbug infestations. Recently, the switch has been made to bait insecticides which have proven effective for cockroaches but have allowed bedbugs to escape the indirect treatment.

The number of bedbug infestations have risen significantly since the turn of the century. The National Pest Management Association reported a 71% increase in bedbug calls between 2000 and 2005. The Steritech Group, a pest management company out of Charlotte, North Carolina, claimed that 25% of the 700 hotels they surveyed between 2002 and 2006 needed bedbug treatment. In 2003, a brother and sister staying at a Motel 6 in Chicago were awarded $372,000 in punitive damages after being attacked by bedbugs during their stay. These are only a few of the reported cases since the turn of the 21st century.

There are several means by which dwellings can become infested with bedbugs. People can often acquire bedbugs at hotels, motels, and bed-and-breakfasts, as a result of increased domestic and international tourism, and bring them back to their homes in their luggage. They also can pick them up by inadvertently bringing infested furniture or used clothing to their household. If someone is in a place that is severely infested, bedbugs may actually crawl onto and be carried by people's clothing, although this is atypical behavior — except in the case of severe infestations, bedbugs are not usually carried from place to place by people on clothing they are currently wearing. Finally, bedbugs may travel between units in multi-unit dwellings (such as condominiums and apartment buildings), after being originally brought into the building by one of the above routes. This spread between units is dependent in part on the degree of infestation, on the material used to partition units (concrete is a more effective barrier to the spread of the infestation), and whether infested items are dragged through common areas while being disposed of, resulting in the shedding of bedbugs and bedbug eggs while being dragged. In some exceptional cases, the detection of bedbug hiding places can be aided by the use of dogs that have been trained to signal finding the insects by their scent much as dogs are trained to find drugs or explosives. A trained team (dog and handler) can detect and pinpoint a bedbug infestation within minutes. This is a fairly costly service that is not used in the majority of cases, but can be very useful in difficult cases.

The numerical size of a bedbug infestation is to some degree variable, as it is a function of the elapsed time from the initial infestation. With regards to the elapsed time from the initial infestation, even a single female bedbug brought into a home has a potential for reproduction, with its resulting offspring then breeding, resulting in a geometric progression of population expansion if control is not undertaken. Sometimes people are not aware of the insects, and do not notice the bites. The visible bedbug infestation does not represent the infestation as a whole, as there may be infestations elsewhere in a home. However, the insects do have a tendency to stay close to their hosts (hence the name "bed" bugs).

[edit] Common location of infestations

Blood-fed Cimex lectularius

Blood-fed Cimex lectularius

Bedbugs travel easily and quickly along pipes and boards, and their bodies are very flat, which allows them to hide in tiny crevices. In the daytime, they tend to stay out of the light, preferring to remain hidden in such places as mattress seams, mattress interiors, bed frames, nearby furniture, carpeting, baseboards, inner walls, tiny wood holes, or bedroom clutter. Bedbugs can be found on their own, but more often congregate in groups. Bedbugs are capable of travelling as far as 100 feet to feed, but usually remain close to the host in bedrooms or on sofas where people may sleep.

Bedbugs are known for being elusive, transient, and nocturnal, making them difficult to detect. While individuals have the option of contacting a pest control professional to determine if a bedbug infestation exists, there are several do-it-yourself methods that may work equally well.

The presence of bedbugs may be confirmed through identification of the insects collected or by a pattern of bites. Though bites can occur singularly, they often follow a distinctive linear pattern marking the paths of blood vessels running close to the surface of the skin. The common bite pattern of three bites close to each other has garnered the macabre coloquialism "breakfast, lunch, dinner."

A technique for catching bedbugs in the act is to have a light source accessible from bed and to turn it on at about an hour before dawn, which is usually the time when bedbugs are most active. A flashlight is recommended instead of room lights, as the act of getting out of bed will cause any bedbugs present to scatter. If you awaken during the night, leave your lights off but use your flashlight to inspect your mattress. Bedbugs are fairly fast in their movements, about equal to the speed of ants. They may be slowed down if engorged.

Glue traps placed in strategic areas around the home, (sometimes used in conjunction with heating pads, or balloons filled with exhaled breath, thus offering the carbon dioxide that bedbugs look for) may be used to trap and thus detect bedbugs. This method has varied reports of success. There are also commercial traps like "flea" traps whose effectiveness is questionable except perhaps as a means of detection. Perhaps the easiest trapping method is to place double-sided carpet tape in long strips near or around the bed and check the strips after a day or more.

With the widespread use of DDT in the 1940s and '50s, bedbugs all but disappeared from North America in the mid-twentieth century. Infestations remained common in many other parts of the world, however, and in recent years have begun to rebound in North America. Reappearance of bedbugs in North America has presented new challenges for pest control without DDT and similarly banned agents.

Another reason for their increase is that pest control services more often nowadays use low toxicity gel-based pesticides for control of cockroaches, the most common pest in structures, instead of residual sprays. When residual sprays meant to kill other insects were commonly being used, they resulted in a collateral insecticidal effect on potential bedbug infestations; the gel-based insecticides primarily used nowadays do not have any effect on bedbugs, as they are incapable of feeding on these baits.

The National Pest Management Association, a US advocacy group for pest management professionals (PMPs) conducted a "proactive bed bug public relations campaign" in 2005 and 2006, resulting in increased media coverage of bedbug stories and an increase in business for PCOs, possibly distorting the scale of the increase in bedbug infestations.

If it is necessary to live with bedbugs in the short term, it is possible to create makeshift temporary barriers around a bed. Although bedbugs cannot fly or jump, they have been observed climbing a higher surface in order to then fall to a lower one, such as climbing a wall in order to fall onto a bed. That having been said, barrier strategies nevertheless often have beneficial effects: an elevated bed, for example, can be protected by applying double-sided sticky tape (carpet tape) around each leg, or by keeping each leg on a plastic furniture block in a tray of water. Bed frames can be effectively rid of adult bedbugs and eggs by use of steam or, used with caution, by spraying rubbing alcohol on any visible bugs (although this is not a permanent treatment). Small steam cleaners are available and are very effective for this local treatment. A suspect mattress can be protected by wrapping it in a painter's disposable plastic drop cloth, neatly sealing shut all the seams with packing tape, and putting it on a protected bed after a final visual inspection. Bedding can be sanitized by a 120 °F (49 °C) laundry dryer. Once sanitized, bedding should not be allowed to drape to the floor. An effective way to quarantine a protected bed is to store sanitized sleeping clothes in the bed during the day, and bathing before entering the bed.

Food-grade diatomaceous earth (DE) can be sprinked under mattresses, along baseboards and on the edges of bookshelves where bed bugs hide. Food-grade DE, although harmless to mammals, including common house pets and humans, is a virtual death sentence for bed bugs. DE is a drying agent and is actually used in many dry pet foods to keep the kibble dry and fresh.

The DE particles abrade the bed bug, essentially dehydrating it of water and lipids. DE can be purchased online, in some health food stores, and in most plant stores. Neem oil (mentioned below) can be added to the DE (1 cup DE to 20 drops neem oil) in a plastic bag before sprinking it around. Other essential oils that can be added are juniper oil, eucalyptus oil, jlang jlang oil, rosemary oil and tea tree oil. The bed bugs hate the smell of the oils, and for those who don't and pass through, they will eventually be killed by the DE itself. Use 20 drops of each essential oil mentioned for each cup of DE.

Alternative treatments that may actually work better and be more comfortable than wrapping bedding in plastic that would cause sweating would be to encase your mattress and box springs in impermeable bed bug bite proof encasements after a treatment for an infestation. There are many products on the market but only some products have been laboratory tested to be bed bug bite proof. Make sure to check to see that the product you are considering is more than an allergy encasement, but is bed bug bite proof.

Vermin and pets may complicate a barrier strategy. Bedbugs prefer human hosts, but will resort to other warm-blooded hosts if humans are not available, and some species can live up to eighteen months without feeding at all. A co-infestation of mice can provide an auxiliary food source to keep bedbugs established for longer. Likewise, a house cat or human guest might easily defeat a barrier by sitting on a protected bed. Such considerations should be part of any barrier strategy.

BBC1 aired a television program entitled "The One Show" about the growth of bed bug infestations in London. In the program a pest control officer claimed that the use of insecticides alone was no longer an effective method to control bed bugs as they had developed a resistance to most if not all insecticides that might be used legally in the UK. He stated that insecticide use in conjunction to freezing bed bugs was the only effective control. All items of clothing and upholstery (including curtains) in the affected household had to be deep-frozen for at least 3 days in giant freezers to ensure complete eradication. The exact temperature at which bed bugs must be frozen was not mentioned.

Another method that might be useful in controlling bed bugs is the use of neem oil. It can be sprayed on carpets, curtains and mattresses. Neem oil is made from the leaves and bark of the neem tree native to India. It has been used safely for thousands of years in India both as a natural, effective insect repellent and it is antibacterial. It has recently received US Food and Drug Administration approval for external use. It is also possible to incorporate neem oil into certain types of mattress. Such mattresses are currently being manufactured by a German company.

[edit] Travel Tips

Since most bedbugs are carried by travellers through contact with beds and hotel rooms of infected locations, following are some tips for those travelling to hotels that might be at risk.

1) First look at the room to seek potential hiding places for bedbugs, such as carpet edges, mattress seams, pillow case linings, bedboards, wall trim or other tiny crack-like places bedbugs might hide. 2) Next, look specifically at the mattress seams for signs of bedbug activity: droppings, eggs, bloodstains or even bedbugs themselves, hiding in tiny folds and seam lines. 3) As mentioned, keep a flashlight nearby when sleeping, to immediately observe activity during the night without having to get up out of bed, thus giving bedbugs time to hide in safety. 4) Never leave your clothing laying on the bed, or any location of possible infestation (as mentioned above). Instead, use hangers or hooks capable of keeping all cloth distant from the floor or bed. 5) Close your suitcase, travel bag, when you're not using it. This way, during the night the bugs may move over top of your luggage with greater difficulty to get inside. 6) Elevate your luggage off the floor to tables or chairs. These may also be hiding places, but less likely. 7) Keep any bedbug you find (intact if possible) to show the hotel owner. 8) If you have a bad feeling about a location, trust your instinct. Look carefully for possible activity, or change locations.

The Texas A&M Center for Urban and Structural Entomology and the University of Arkansas Department of Entomology have been collaborating to study bed bugs on a genetic level in the hopes to shed light on the their recent resurgence. By studying the genetic variation within bed bug populations, researchers can gain insight into insecticide resistance and insect dispersal. Researchers have two theories as to how bed bug resurgence has occurred in the United States. One theory is that the source of current bed bug populations is from other countries without bed bug pesticides that have made their way through air travel, and another theory is that the surviving bed bug populations were forced to switch hosts to birds, such as poultry, and bats. Since bed bugs have undergone a huge resurgence in poultry populations since the 1970s, theory two seems likely.

The theory that the surviving bed bug populations were forced to switch hosts to birds is also supported by the research done at Texas A&M and the University of Arkansas. In a recent study, researchers subjected 136 adult bed bugs from 22 sampled populations from nine U.S. states, Australia, and Canada to genetic analysis. Their finding concluded that the bed bug populations were never completely eradicated from the United States as there was no evidence of a genetic bottleneck in either the mitochondrial or nuclear DNA of the bed bugs. Researchers suspect that resistant populations of bed bugs have slowly been propagating in poultry facilities, and have made their way back to human hosts via the poultry workers.

Other research is being conducted at Texas A&M and Virginia Tech to be able to use bed bugs in forensic science. Researchers are working on, and have been successful at, isolating and characterizing human DNA taken from bed bug blood meals. One advantage that bed bugs have over other blood feeders being used in forensics is that they do not remain on the host, and instead remain in close proximity to the crime scene. Therefore bed bugs could potentially provide crucial evidence linking the suspect to the crime scene. Researchers are able to identify what hosts are being fed upon, and are taking further steps to be able to identify the individual by genotyping, and to predict the duration from the time of feeding to recovery of viable DNA.

Zhou Enlai (simplified Chinese: 周恩来; traditional Chinese: 周恩來; pinyin: Zhōu Ēnlái; Wade-Giles: Chou En-lai) (March 5, 1898 – January 8, 1976) was the first Premier of the People's Republic of China, serving from 1949 until his death in January 1976. Zhou was instrumental in the Communist Party's rise to power, and subsequently in the construction of the Chinese economy and reformation of Chinese society.

A skilled and able diplomat, Zhou served as the Chinese foreign minister from 1949 to 1958. Advocating peaceful coexistence with the West, he participated in the 1954 Geneva Conference and helped orchestrate Richard Nixon's 1972 visit to China. Due to his expertise, Zhou was largely able to survive the purges of high-level Chinese Communist Party officials during the Cultural Revolution. His attempts at mitigating the Red Guard's damage and his efforts to protect others from their wrath made him immensely popular in the Revolution's later stages.

As Mao Zedong's health began to decline in 1971 and 1972, Zhou and the Gang of Four struggled internally over leadership of China. Zhou's health was also failing however, and he died eight months before Mao on January 8, 1976. The massive public outpouring of grief in Beijing turned to anger towards the Gang of Four, leading to the Tiananmen Incident. Deng Xiaoping, Zhou's ally and successor as Premier, was able to outmaneuver the Gang of Four politically and eventually take Mao's place as Paramount Leader.

He is also remembered for saying, when asked for his assessment of the 1789 French Revolution, "It is too early to say"

Zhou Enlai was born to a well-educated couple in 1898 or 1899[2] in Zhejiang, and spent most of his early years in Huai'an, Jiangsu. His education included the Chinese Classics and, later, the prestigious Tianjin Middle School. From there, he studied at Waseda and Nippon universities in Japan, and later attended Nankai University in Tianjin.

Zhou first came to national prominence as an activist during the May Fourth Movement. He had enrolled as a student in the literature department of Nankai University, which enabled him to visit the campus, but he never attended classes. He became one of the organizers of the Tianjin Students Union, whose avowed aim was “to struggle against the warlords and against imperialism, and to save China from extinction." Zhou became the editor of the student union’s newspaper, Tianjin Student. In September, he founded the Awareness Society with twelve men and eight women. Fifteen year old Deng Yingchao, Enlai’s future wife, was one of the founding female members. (They were married on August 8, 1925). Zhou was instrumental in the merger between the all male Tianjin Students Union and the all female Women’s Patriotic Association.

In January 1920, the police raided the printing press and arrested several members of the Awareness Society. Enlai led a group of students to protest the arrests, and was himself arrested along with 28 others. After the trial in July, they were found guilty of a minor offense and released. An attempt was made by the Comintern to induct Zhou into the Communist Party of China, but although he was studying Marxism he remained uncommitted. Instead of being selected to go to Moscow for training, he was chosen to go to France as a student organizer. Deng Yingchao was left in charge of the Awareness Society in his absence.

[edit] French "studies" and the European years

On November 7, 1920, Zhou Enlai and 196 other Chinese students sailed from Shanghai for Marseilles, France. At Marseilles they were met by a member of the Sino-French Education Committee and boarded a train to Paris. Almost as soon as he arrived Zhou became embroiled in a wrangle between the students and the education authorities running the “work and study” program. The students were supposed to work in factories part time and attend class part time. Because of corruption and graft in the Education Committee, however, the students were not paid. As a result they simply provided cheap labour for the French factory owners and received very little education in return. Zhou wrote to newspapers back in China denouncing the committee and the corrupt government officials.

Zhou traveled to Britain in January; he applied for and was accepted as a student at Edinburgh University. But the university term didn’t start until October so he returned to France, moving in with Liu Tsingyang and Zhang Shenfu, who were setting up a Communist cell. Zhou joined the group and was entrusted with political and organizational work. There is some controversy over the date Zhou joined the Communist Party of China. For secrecy reasons members did not carry membership cards. Zhou himself wrote "autumn, 1922" at a verification carried out at the Party's Seventh Congress in 1945.

There were 2,000 Chinese students in France, some 200 each in Belgium and England and between 300 and 400 in Germany. For the next four years Zhou was the chief recruiter, organizer and coordinator of activities of the Socialist Youth League. He traveled constantly between Belgium, Germany and France, safely conveying party members through Berlin to entrain for Moscow, to be taught the art of revolution.

[edit] The First United Front

Zhou returned to China as a seasoned party organizer in 1924. He was appointed Director of the CCP Guangdong Military Affairs Department, Director of Training at the National Revolutionary Army Political Training Department and Acting Director of the Whampoa Military Academy's Political Department. The latter role made Zhou political commissar of the 1st Division, 1st Corp during the Eastern Campaign of 1925.[3] At the end of that successful campaign, he was named CCP Secretary of Guangdong Province, one of the highest jobs in the party. A year later, at the age of 28 or 29, Zhou Enlai was elected to the CCP Politburo and placed in charge of military affairs.

Zhou Enlai (middle) and his wife Deng Yingchao with American journalist Edgar Snow, approx. 1938.

Zhou Enlai (middle) and his wife Deng Yingchao with American journalist Edgar Snow, approx. 1938.

In January 1924 Sun Yat-sen had officially proclaimed an alliance between the Kuomintang and the Communists, and a plan for a military expedition to unify China and destroy the warlords. The Whampoa Military Academy was set up in March to train officers for the armies that would march against the warlords. Russian ships unloaded crates of weapons at the Guangzhou docks. Comintern advisers from Moscow joined Sun’s entourage. In October, shortly after he arrived back from Europe, Zhou Enlai was appointed Director of the political department at the Whampoa Military Academy in Guangzhou.[4]

Zhou soon realized the Kuomintang was riddled with intrigue. The powerful right wing of the Kuomintang was bitterly opposed to the Communist alliance. Zhou was convinced that the CCP, in order to survive must have an army of its own. "The Kuomintang is a coalition of treacherous warlords" he told his friend Nie Rongzhen, recently arrived from Moscow and named a vice director of the academy. Together they set about to organize a nucleus of officer cadets who were CCP members and who would follow the principles of Karl Marx. For a while they met no hindrance, not even from Chiang Kai-Shek, the director of the academy.

Sun Yat-sen died on 12 March 1925. No sooner was Sun dead than trouble broke out in Guangzhou. A warlord named Chen Chiungming made a bid to take the city and province. The East Expedition, led by Zhou, was organized as a military offensive against Chen. Using the disciplined core of CCP cadets they met with resounding success. Zhou was promoted to head Whampoa’s martial law bureau. Zhou quickly crushed an attempted coup by another warlord within the city. Chen Chiungming once again took the field in October 1925. Once again Zhou defeated him and this time captured the important city of Shantou on the South China coast. Zhou was appointed special commissioner of Shantou and surrounding region. Zhou began to build up a party branch in Shantou whose membership he would keep secret.

On 8 August 1925, he and Deng Yingchao were finally married after a long-distance courtship of nearly five years. The couple remained childless, but adopted many orphaned children of "revolutionary martyrs"; one of the more famous was future Premier Li Peng.

After Sun's death the Kuomintang was run by a triumvirate composed of Chiang Kai-Shek, Liao Zhongkai and Wang Jingwei, but in August 1925 Liao (father of Liao Chengzhi and grandfather to Liao Hui, both prominent PRC politicians), was murdered by Nationalist agents. Chiang Kai-shek used this murder to declare martial law and consolidate right wing control of the Nationalists. On 18 March 1926, while Mikhail Borodin, the Russian comintern advisor to the United Front, was in Shanghai. Chiang created a further incident to usurp power over the communists. The commander and crew of a Kuomintang gunboat was arrested at the Whampoa docks (see Zhongshan Warship Incident). This was followed by raids on the First Army Headquarters and Whampoa Military Academy. Altogether 65 communists were arrested, including Nie Rongzhen. A state of emergency was declared and curfews were imposed. Zhou had just returned from Shantou and was also detained for 48 hours. On his release he confronted Chiang and accused him of undermining the United Front but Chiang argued that he was only breaking up a plot by the communists. When Borodin returned from Shanghai he believed Chiang’s version and rebuked Zhou. At Chiang's request Borodin turned over a list of all the members of the CCP who were also members of the Kuomintang. The only omissions from this list were the members Zhou had secretly recruited. Chiang dismissed all the rest of the CCP officers from the First Army. Wang Jingwei, considered too sympathetic to the communists, was persuaded to leave on a “study tour” in Europe. Zhou Enlai was relieved of all his duties associated with the First United front, effectively giving complete control of the United Front to Chiang Kai-Shek.

[edit] From Shanghai to Yan'an

Zhou Enlai in 1940

Zhou Enlai in 1940

After the Northern Expedition began, he worked as a labour agitator. In 1926, he organized a general strike in Shanghai, opening the city to the Kuomintang. When the Kuomintang broke with the Communists, Zhou managed to escape the white terror. Zhou attended a July 1927 meeting with Zhu De, He Long, Ye Jianying, Liu Bocheng, – all future marshals of the army – and Mao to decide a response to Chiang’s blood purge. Their move was the Nanchang Uprising, led by Liu and Zhou.[5]

After that attempt failed, Zhou left China for the Soviet Union to attend the Chinese Communist Party's 6th National Party Congress in Moscow, in June-July 1928.[6] He was elected Director of the Central Committee Organization Department; his ally, Li Lisan took over propaganda work. Zhou finally returned to China, after more than a year away, in 1929.

In Shanghai, Zhou began to disagree with the timing of Li Lisan's strategy of favoring rich peasants and concentrating military forces for attacks on urban centers sometime in early 1930. Zhou did not openly break with these more orthodox notions, and even tried to implement them later, in 1931, in Jiangxi. [7]

Zhou moved to the Jiangxi base area and shook up the propaganda-oriented approach to revolution by demanding that the armed forces under communist control actually be used to expand the base, rather than just to control and defend it. In December 1931, he replaced Mao as Secretary of the 1st Front Army with Xiang Ying, and made himself political commissar of the Red Army, in place of Mao. Liu Bocheng, Lin Biao and Peng Dehuai all criticized Mao's tactics at the August 1932 Ningdu Conference. [8] Under Zhou, the Red Army defeated four attacks by Chiang Kai-shek's Nationalist troops.[9] Only when the Nationalists were forced to change their tactics did Zhou endorse withdrawal. Zhou Enlai was thus one of the major beneficiaries of the 1931-34 side-lining of Mao Zedong, Deng Xiaoping, Tan Zhenlin, Deng Zihui, Lu Dingyi and Xiao Qingguang.

In early 1933, Bo Gu arrived with German Comintern adviser Otto Braun (a/k/a Li De) and took control of party affairs. Zhou at this time, apparently with strong support from party and military colleagues, undertook to reorganize and standardize the Red Army. The results were the structure that led the communists to victory:

    Leaders Unit Designation

    Lin Biao, Nie Rongzhen     1st Corps

    Peng Dehuai, Yang Shangkun    3rd Corps

    Xiao Qingguang       7th Corps

    Xiao Ke   8th Corps

    Liu Binghui      9th Corps

    Fang Zhimin    10th Corps