A First in Medicine: Personalized Gene Editing Saves Infant with Rare Genetic Disorder

Musunuru et al. Patient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease. New England Journal of Medicine, May 2025.

A recent groundbreaking study reported that researchers have successfully developed and delivered a personalized gene-editing therapy to treat an infant diagnosed with a life-threatening genetic disorder called carbamoyl phosphate synthetase 1 (CPS1) deficiency. This case marks the first time such a therapy—customized for a single patient—has been safely and effectively administered using CRISPR technology. CPS1 deficiency is a rare and serious condition that prevents the body from properly breaking down byproducts from protein metabolism, leading to toxic ammonia buildup. This can cause severe damage to the brain and liver, and treatment options are limited, usually involving a restrictive diet and eventual liver transplant. Researchers recently developed a CRISPR-based therapy targeting the defective gene in the baby’s liver cells. The gene editing was restricted to non-reproductive cells, ensuring that changes remained within the treated individual and were not passed to future generations. The therapy was administered in two doses—a low initial dose at six months, followed by a higher one. Positive results appeared quickly. The infant began tolerating more protein in the diet, and the need for medications to control ammonia levels was reduced. Critically, the child endured common illnesses, like a cold and a gastrointestinal infection, without experiencing the dangerous complications typically associated with CPS1 deficiency. This case demonstrates not only the promise of gene editing for treating rare genetic disorders but also the potential for rapid, patient-specific therapies. According to the experts, the platform used for this treatment is adaptable and could pave the way for personalized therapies for a broad range of conditions. While more work is needed, the team remains cautiously optimistic about the child’s continued progress.

What Language Disorders Reveal About Chatbots

Watanabe et al. Comparison of Large Language Model with Aphasia. Advanced Science, May 2025.

Artificial intelligence (AI) tools, especially large language model (LLM)-based agents like ChatGPT and LLaMA, are becoming more integrated into everyday life due to their outstanding fluency in generating text. However, these systems often produce confident yet incorrect information, which can mislead users unfamiliar with the subject matter. In a recent study, researchers have reported that this behavior is strikingly similar to a human language disorder called Wernicke’s aphasia. In this condition, individuals speak fluently but often produce confusing or meaningless statements. The research team explored this similarity using a method called energy landscape analysis, originally developed in physics and later adapted for neuroscience. This method visualizes how brain states or internal signal patterns in AI systems behave. They compared brain activity from individuals with various types of aphasia to the internal signal patterns of LLMs. The study found surprising similarities, particularly in how information is processed and how signals move within the systems. In both cases—human aphasia and AI models—signal patterns can become chaotic or overly rigid, leading to incoherent output. This discovery offers potential advancements in two fields. For neuroscience, it could provide new diagnostic tools for identifying and monitoring aphasia based on brain activity rather than just speech symptoms. For AI development, understanding these internal patterns might help engineers design systems that manage knowledge more flexibly and accurately. While the researchers caution against over-interpreting the results—emphasizing that AI doesn’t have brain damage—they suggest that these internal similarities could guide the creation of more reliable and intelligent AI in the future. Ultimately, this interdisciplinary insight may improve both medical diagnostics and the trustworthiness of AI tools.

Billions of Children Might Face Unprecedented Climate Extremes

Grant et al. Global emergence of unprecedented lifetime exposure to climate extremes. Nature, May 2025.

Climate scientists reveal that millions of today’s children will face unprecedented lifetime exposure to extreme climate events if current global climate policies remain unchanged. Under a high-emissions scenario leading to a 3.5°C rise in global temperatures by 2100, 92% of children born in 2020—around 111 million—are expected to endure record-breaking heatwaves during their lifetimes. In contrast, limiting global warming to the 1.5°C target set by the Paris Agreement could protect 49 million of these children from such exposure. When including all children aged 5 to 18 today, 1.5 billion would be affected under the 3.5°C scenario. However, if warming is limited to 1.5°C, 654 million of them could be spared these extreme impacts. The study shows that children—particularly those in tropical regions and low-income countries—will face far greater climate risks than any previous generation. Those in the most socioeconomically vulnerable communities are likely to suffer the worst effects. The researchers used demographic data and climate models to assess the generational exposure to six types of climate extremes: heatwaves, droughts, crop failures, wildfires, tropical cyclones, and river floods. Their findings reveal a significant intergenerational injustice. For example, under a 1.5°C warming limit, 52% of children born in 2020 would still face unprecedented heatwave exposure, compared to just 16% of those born in 1960. This highlights the urgent need for global climate action. With global warming currently on track to exceed 2.7°C, the study urges world leaders to commit to more ambitious emissions reductions. The message is clear: urgent and equitable climate action is essential to safeguard the futures of today’s youth.

Faithfulness means living in accordance with the covenant one made with God in pre-eternity. When a believer declares their faith, they are, in that moment, giving their word to God. It is as though they have taken an oath and entered into a binding agreement with Him. True faithfulness lies in fulfilling the terms of this commitment to the letter, living in a way that never breaks that solemn vow.

The declaration of faith is an affirmation that there is no true one worthy of worship and no rightful recipient of devotion other than God. As a reflection of this faithfulness, one must embody this belief not only in thought and emotion but also through speech and action. While a person’s faith, contentment, submission, and trust in God reveal their inward—or theoretical—loyalty, it is through conduct, behavior, and acts of worship that practical faithfulness is made visible. In this sense, faithfulness is not merely an internal bond with God—it is also a commitment to obey His commands and refrain from what He has forbidden.

Faith is, at its core, an inner acceptance. If a person fails to translate the demands of faith into action, they fall into a state of internal contradiction. One who proclaims belief through the declaration of divine oneness yet lives in opposition to God’s commandments is not upholding the requirements of faithfulness. In fact, such behavior amounts to breaking the very promise they made—a breach of the covenant they entered into.

A believer is someone who stands by their word. Once a promise is made, it must be honored—regardless of the cost. This is the example we see in the noble Companions: they pledged unwavering support to the Messenger of God (peace and blessings be upon him), and never deviated, even by an inch, from that promise. They upheld their word even at the cost of their lives. For salvation lies in truthfulness—in being upright in one’s state, speech, and conduct; in being completely and consistently sincere.

Human beings may be endowed with various potentials and distinctive qualities. Yet above all such attributes, the greatest honor a person can attain is servanthood to God. The very purpose of creation—for both humans and jinn—is to come to know and recognize God and to devote oneself to His worship. This purpose can also be described through its spiritual dimensions: faith, divine knowledge (ma‘rifah), love of God (mahabbah), and the joy of spiritual intimacy (dhawq rūhānī).

Throughout the Qur’an, God at times addresses humanity with the words “Yā ‘ibādī”—“O My servants.” In this address, we can sense His affection, compassion, and mercy for His creation. From another perspective, it may be understood as, “O My faithful bondsmen!” For us—weak and fallible beings who often stumble and falter in sin—such a divine call offers immense comfort and profound hope.

What is required of us, as servants of God, is to remain firmly anchored in this perspective and to reject anything that may obstruct or weaken it—just as one would cast away the accursed devil. God Almighty, who created the human being from clay, also endowed them with the capacity to ascend to the horizons of heart and spirit, to be honored with faith, spiritual knowledge, and divine love, and to attain closeness to Him. There are latent seeds within every soul—when nurtured and allowed to flourish, they enable one to become a close and intimate companion of God. This, indeed, is the station we should strive to attain.

For believers devoted to the path of faith, faithfulness holds special significance. Remaining unwavering in their loyalty to the Prophetic way—without straying even by so much as a hair’s breadth—is of the utmost importance. The truly faithful servants of God not only base their worship and devotion entirely on His command—they also tie their very existence in this world to serving His religion. So long as they have the opportunity to serve Islam, life holds value and meaning for them. But when they feel there is no longer anything more they can contribute, the light of the Hereafter begins to shine more brightly before their eyes. At that point, they can say with ease and serenity:

“O God, if my duty in this world has come to an end, then take me into Your presence.”

In saying this, they are not asking for anything that contradicts the destiny God has written for His servants. Rather, they are expressing a longing to be released from their earthly post and reunited with the Divine.

In this regard, Prophet Joseph (peace be upon him) stands as a beautiful example. At the very moment he was reunited with his parents, had become a figure of authority in Egypt, saw the religion he had shared begin to take root in people’s hearts, and witnessed consciences turning toward him—when he had reached the peak of worldly blessings and possessed all that a person might desire for happiness—he turned to God with this heartfelt plea:

“Let me die as a believer, and join me with the righteous.” (Surah Yusuf, 12:101)

If a person feels there is no meaningful duty left for them to fulfill in the service of faith, they may begin to long for release from this worldly life. This, too, is an expression of faithfulness.

Faithful servants of God never tie their worship or service to any worldly gain. They see ranks, titles, positions, and public recognition as spiritually perilous. They have no desire to be admired, to be seen everywhere, or to be fondly remembered by others. In fact, they tremble at the thought that even the slightest trace of such worldly ambition might creep into their devotion—fearing it could result in spiritual loss in the Hereafter. Their motto is simple and sincere:

“O God, if I can no longer serve Your religion, do not let me live even a moment longer!”

It is, of course, natural and desirable for a person to be remembered kindly after their death—to be known for the goodness they left behind and to be honored with prayers and supplications. Who would not wish for people to say:

“May God be eternally pleased with them—for they strove tirelessly to uphold the religion, rendered great services, raised righteous generations, and left behind ongoing charities that continue to add to their book of good deeds. May God grant them His forgiveness and mercy, gladden them with Paradise, and grant them nearness to the Prophet.”

All of this is a beautiful legacy, and we believe such remembrance will benefit a person in the Hereafter. Indeed, the Qur’an tells us that Prophet Abraham (peace be upon him), who is presented as a model for all believers, once prayed:

“Grant me a good name among later generations.” (Surah al-Shu‘arā, 26:84)

However, if someone like us, in this worldly life, grounds their servanthood in recognition and praise, it can no longer be considered sincere. Such an outlook is incompatible with true devotion, genuine servanthood, or authentic faithfulness.

In summary, a faithful believer should strive to spend every moment—every minute, every second, every breath—living for their Lord. Every matter should be connected to God, and every task carried out in His name. They must endure the burdens of this world for His sake, live for Him, sit for Him, rise for Him, and do everything solely for His sake. And if the thought of living for their own sake ever arises, they should be able to present their resignation from life itself before God.

Pursuing worldly ambitions, managing ventures for personal gain, involving oneself in activities believed to offer material or spiritual returns, or seeking public acclaim—all of this stands in direct contradiction to true faithfulness. In fact, such inclinations can rightfully be described as satanic. A person who lives for God cannot at the same time serve the aims of Satan.

If one fails to do the things that bring God’s pleasure, what value is there in receiving worldly praise or being exalted by others? If their efforts were driven by the desire for recognition, they will be held accountable in the Hereafter for those very accolades:

“Tell us—were you truly as they said you were?”

And if the answer is no, they will be cast down in disgrace.

If a person cannot be a true servant, faithful to God, then holding prominent positions, overseeing institutions, or becoming someone widely admired is not a success—it is a loss. And if, like worldly people, they internalize and embrace the praise spoken about them, they will find themselves suffering one loss after another on the path where they had hoped to win.

Leonardo da Vinci envisioned machines that run continuously and designed self-feeding mechanisms, which he presented in his drawings in the Codex Atlanticus [1]. From the perspective of today’s advanced technologies, such ideas may no longer seem impossible to many people, but at that time, they were considered far from reality by many. It is impressive to see how these ideas, which were just dreams in the past, have become concrete realities through the advancement of science and technology. 

Today, various studies have been carried out on renewable energy sources and a significant part of them have been implemented. In this direction, recent research on diamond batteries has shown that they can be considered as a viable alternative energy source in cases where commonly used batteries are insufficient. Diamond batteries are viewed as one of the sustainable solutions to the energy challenges faced by batteries used in medical devices (such as pacemakers and brain pacemakers, and others) [2]. 

Batteries used in medical devices are among the components that improve people’s quality of life, but they are usually lithium-ion or silver-zinc based, producing energy through chemical reactions and eventually depleting. This situation causes patients to undergo surgical interventions to replace the batteries. Diamond batteries can potentially eliminate this need, making it possible for patients to rely on a single, lifelong battery. 

Diamond batteries are a technology that operates using radioactive isotopes and can provide energy for hundreds or even thousands of years. During beta decay, beta particles (electrons) emitted from the nuclei of radioactive isotopes are absorbed by the surrounding semiconductor materials, generating an electric current. This enables diamond batteries to produce uninterrupted energy [3]. 

In addition to being long-lasting, diamond batteries have many other advantages, too. Nano-diamond structures are well tolerated by the human body and do not contain toxic substances. Beta radiation is at a level that does not harm human tissues and can be completely isolated thanks to nano-diamond coatings [4]. Although the use of diamond batteries in medical devices is still under development, in the near future, battery replacements for implants placed in the human body may no longer be necessary [5]. 

Diamond battery technology is not limited to solely batteries used in medical devices but has a wide range of applications, ranging from space exploration to nuclear waste management. With the development of this technology, it may be possible to see radical changes in energy storage systems even in daily life. 

The diamond battery is a good example of how much bountifully the world has been created. It falls on us to do the research and discover all of these riches that have been generously provided for us.

References

1. Birkbeck, University of London (n.d.) Exploring Leonardo da Vinci’s perpetual motion machines. Google Arts & Culture. https://artsandculture.google.com/story/exploring-leonardo-da-vinci-s-perpetual-motion-machines-birkbeck-university-of-london/TAUx_A38LTONJQ?hl=en (Accessed: 28.01.2025).
2. University of Bristol (2024) Diamond battery media release, University of Bristol News. https://www.bristol.ac.uk/news/2024/december/diamond-battery-media-release.html (Accessed: 28.01.2025).
3. ProQuest – The Conversion of Radiation Energy to Electric Current – The Nano Diamond Battery, https://www.proquest.com/docview/2758662526?fromopenview=true&pq-origsite=gscholar&sourcetype=Scholarly%20Journals (Accessed:29.01.2025).
4. Liu, H., Li, P., Jin, C. and Zhang, Y. (2019) “Design and analysis of a novel vibration-driven electromagnetic energy harvester with high efficiency’, Journal of Bionic Engineering”. 16(5), pp. 921-934. https://www.sciencedirect.com/science/article/pii/S2095177919301467(Accessed: 29.01.2025).
5. https://www.bristol.ac.uk/news/2024/december/diamond-battery-media-release.html

Being barely enough while overcoming all challenges
Desires pulling me in all directions
The first and the last advice in all of this
I have a job to do

Receiving accolades or battered with hatred
Regardless, I will change it, I will save it
At the 11th hour, never a dull moment 
It’s never enough
I have a job to do

Collecting almosts all the way to the top
Running, panting, almost giving up
While grabbing, dragging, shouldering nonstop
And tumbling over the final mark
‘cuz I have a job to do

Any minute now the journey can end 
Or everything can be snatched
Yet, I can’t stop here, I can’t rest
My dream, my passion, my love
I have a job to do

Throughout history, metals have held profound significance, shaping civilizations and symbolizing strength, resilience, justice, and divine provision. Sacred texts from across traditions reflect this importance, highlighting humanity’s relationship with metals like gold, silver, copper, and iron. The Old Testament, for instance, refers to iron and copper in mining and craftsmanship (e.g., Job 28:2), portraying the ingenuity of early metallurgical practices. The New Testament often uses gold and silver metaphorically, symbolizing wealth and spiritual lessons, while iron appears in the context of Roman military dominance. Similarly, the Qur’an emphasizes the significance of metals, dedicating an entire chapter—Surah Al-Hadid (Iron)—to explore the material and spiritual dimensions of iron. This chapter, “iron”ically, aligns with the atomic number of iron, which is 26. This connection is often interpreted symbolically to illustrate the Qur’an’s numerical and structural harmony rather than as direct scientific evidence [1]. Can such a connection between metals and sacred texts uncover a timeless narrative of innovation, faith, and the harmonious interplay between material resources and spiritual wisdom?

A divine gift to humanity

Holy Scriptures highlight the significance of iron in several verses. In the Old Testament, the verse “A land where the rocks are iron and you can dig copper out of the hills” (Deuteronomy 8:9) offers a remarkable insight into the understanding of metals during that period. Copper is described as being “dug from ore,” reflecting its extraction through mining and smelting, which was a well-established practice. In contrast, iron is referred to as “rocks,” a phrasing that aligns with the historical context (3300–1200 BCE) when iron was primarily sourced from meteoric material.

Iron is referred to in the Qur’an as follows (Al-Hadid 57:25): “Assuredly, We have sent Our Messengers with manifest truths (and clear proofs of their being Messengers), and We have sent down with them the Book and the Balance so that (relations among) humankind may live by equity. And We have sent down iron, in which is stern might and benefits for humankind, so that God may mark out those who help (the cause of) God and His Messengers, though they do not see Him. Surely God is All-Strong, All-Glorious with irresistible might.”

This verse conveys a dual message: iron as a resource of strength and utility and as a test of humanity’s ability to uphold justice. Its being “sent down” is both metaphorical, emphasizing its value as a divine provision, and literal, as modern science confirms its extraterrestrial origins. Scientists affirm that iron was formed in the cores of massive stars through nuclear fusion and later distributed across the universe via supernovae explosions. These celestial events brought iron to Earth, embedding it in the planet’s crust and even delivering it through meteoric impacts. This celestial journey reflects the Qur’anic portrayal of iron as a material uniquely provided for human benefit.

The descent of iron refers to its arrival on Earth during its formation via celestial processes like meteorite impacts. This process is scientifically understood as both a one-time event during Earth’s early development and an ongoing occurrence through sporadic meteorite showers. For more scientific and theological interpretations of iron’s celestial origins, see the reference by Dr. Eker.

Iron’s role in human civilization

Iron has been indispensable in shaping human history. Its use marked the transition from the Bronze Age to the Iron Age, revolutionizing agriculture, warfare, and infrastructure. Unlike metals like gold and silver, which are found in their native forms, iron is typically bound within ores, requiring advanced extraction techniques. This necessity reflects its value, and the ingenuity required to harness it.

The Qur’an acknowledges iron’s transformative role in civilization, particularly in the story of Dhul-Qarnayn in Surah Al-Kahf (18:96). Dhul-Qarnayn constructed an immense barrier using blocks of iron heated to glowing temperatures and bound with molten copper. This narrative highlights the sophistication of ancient metallurgical practices, which involved achieving high temperatures and carefully managing the properties of metals. The technique described mirrors the principles of modern semi-solid metalworking, where materials are heated to optimal states for shaping and bonding of dissimilar materials.

Prophet David’s mastery over iron

Another striking reference to iron in the Qur’an is found in Surah Saba (34:10): “And We made iron pliable for him.” This verse refers to Prophet David, who, by divine favor, was granted the ability to shape iron with ease. In an era when working with iron required immense effort, this gift was extraordinary. The ability to make iron pliable suggests a mastery of metallurgy far beyond the tools and techniques available at the time. It underscores both the practicality of iron and the divine facilitation granted to David in fulfilling his mission as a leader and protector. In parallel, verses in the Bible (Chronicles 22:3 and 29:2) indicate that Prophet David amassed substantial quantities of iron and other materials for the temple’s construction, demonstrating his role in organizing and supplying resources.

Historically, early ironworking was limited by the rudimentary furnaces of the time, which could not reach iron’s high melting point of 1,538°C. Instead, artisans relied on heating iron to a malleable state for shaping and combining it with other metals. The Qur’anic depiction of David’s skill thus points to a profound understanding of material science and a divinely inspired ability to harness it for good.

Prophet David’s era indeed aligns with the historical transition from the Copper Age to the Iron Age, as supported by archaeological findings, Biblical accounts, and Divine Texts. The Qur’an’s emphasis on his mastery of ironworking symbolizes this shift, portraying it as a divinely guided advancement in technology and human civilization. This harmony between historical evidence and sacred texts reinforces the idea that Prophet David played a key role in bridging these two transformative ages.

Iron’s transformative properties

What sets iron apart from other metals is its remarkable property of allotropy, allowing it to exist in different crystal structures depending on temperature and pressure. This unique characteristic enables iron to undergo phase transformations that enhance its strength, ductility, and hardness. When combined with carbon, iron forms steel, a material celebrated for its unparalleled versatility and resilience. The addition of other elements like nickel, chromium, and molybdenum further refines steel’s properties, enabling its use in everything from infrastructure to aerospace technology.

The Qur’an’s emphasis on iron’s strength and utility aligns with its material role in human progress. Its capacity to be shaped, alloyed, and tailored to specific needs has made it the backbone of technological advancement. From ancient tools to modern skyscrapers, iron has continuously empowered humanity to reach new heights of innovation.

The balance between might and morality

Beyond its physical properties, the Qur’an associates iron with justice and balance. In Surah Al-Hadid (57:25), the mention of the “Book” and the “Balance” alongside iron underscores this association. The balance represents the ethical framework guiding humanity, while iron symbolizes the strength to uphold justice. Together, they form a blueprint for societal harmony.

This emphasis on balance also mirrors the technical principles governing iron and steel. In modern metallurgy, the “equilibrium diagram” is a foundational reference in iron base production. This diagram maps the relationships between variables such as carbon content and temperature, defining the equilibrium states (e.g., ferrite, pearlite, or austenite) that yield optimal material properties. By maintaining this equilibrium, metallurgists create materials with the ideal balance of strength, ductility, and hardness, essential for diverse applications.

The symbolic and technical significance of balance aligns seamlessly here. Just as the equilibrium diagram guides metallurgists in achieving structural harmony in materials, the Qur’anic emphasis on balance calls upon humanity to seek ethical equilibrium in its use of power and resources.

In conclusion, the examination of iron within sacred texts reveals a profound interplay between divine wisdom, human ingenuity, and the material world. From the Old Testament’s descriptions of early metallurgy to the Qur’an’s dedicated Surah Al-Hadid, iron is consistently presented as a divinely provided resource of immense value. This value transcends mere material utility, encompassing spiritual and ethical dimensions. The Qur’an’s emphasis on iron’s being “sent down,” now corroborated by scientific understanding of its extraterrestrial origins, underscores its unique significance. The narratives of Prophet David’s mastery over iron and Dhul-Qarnayn’s use of it in constructing a formidable barrier highlight the advanced metallurgical knowledge and divinely inspired abilities associated with this metal. Furthermore, the Qur’an’s connection of iron with justice and balance resonates with the technical principles of modern metallurgy, where achieving equilibrium is crucial for optimizing material properties. This convergence of scriptural narratives, historical evidence, and scientific understanding reinforces the idea that iron is not merely a metal but a testament to divine wisdom, a catalyst for human advancement, and a symbol of the crucial balance between might and morality.

Note

For a deeper exploration of this numerical harmony, please refer to “Numerical Codes and Gematrical Mysteries in the Qur’an,” by Toprak in The Fountain.

References

• Colacino, Alessandro. Microstructural Evolution of Iron Meteorites. Thesis, University of Naples Federico II, 2020.
• Kamil Ezgin, “Iron Oxide Nanoparticles and Surah Iron (Hadeed),” The Fountain, Issue 74, March-April 2010.
• Noah Weaver, “Metals Have Character Too!” The Fountain, Issue 113, September-October 2016.
• Nuh Gedik, “Supernova Explosion and a Miracle of The Qur’an” – The Fountain, Issue 54, April-June 2006.
• Pense, Alan W. “Iron Through the Ages.” Materials Characterization, Vol. 45, 2001, pp. 1–20.
• Scott, David A. Metallography and Microstructure of Ancient and Historic Metals. Getty Conservation Institute, 1991.
• Sefik Hikmet Toprak, “Numerical Codes and Gematrical Mysteries in the Qur’an,” The Fountain, Issue 105, May-June 2015.
• Shahack-Gross, Ruth, et al. “Metalworking at Megiddo During the Late Bronze and Iron Ages.” Journal of Near Eastern Studies, Vol. 76, no. 1, 2017, pp. 53–74.
• Tylecote, R. F. A History of Metallurgy. 2nd ed., Maney Publishing for the Institute of Materials, 1992.
• Vander Voort, George. Metallography of Iron-Nickel Meteorites. Vac Aero International, 2018.
• Wertime, Theodore A. “The Beginnings of Metallurgy: A New Look.” Science, vol. 182, no. 4115, 1973, pp. 875–887.
• Yamauchi, Edwin. Metallurgy in the Biblical World, Department of History, Miami University, Oxford, OH 45056. Published in PSCF, Vol. 45, December 1993, pp. 252-259.
• Zeki Eker, “‘Demiri Biz İndirdik’ Mealindeki Âyetin Yorumu Üzerine,” Katre International Human Studies Journal, Issue 14, December 2022.

One evening, as the last light of dusk faded over the Grand Canyon, I found myself in the company of a friend, walking toward the dock that spanned the Colorado River. Our plan was to visit the Havasupai Falls, and we had no other choice but to board a small rowing boat to cross. Yet as we neared the dock, my friend hesitated, a shadow of anxiety crossing his face.

“I can’t,” he whispered, almost to himself. “I’m afraid it’ll sink.”

I tried to reassure him. “Think of it this way: there are thousands of boats here on the water, night and day. How many do you think sink each year?”

He paused, calculating. “Maybe one or two,” he conceded, “or perhaps none at all.”

“Then,” I said, “out of all those days in the year, why worry about the slim chance that something might go wrong tonight?”

Still, he hesitated. So, I gently urged him further, “Let’s think about life itself. We’re each given a set span of years, yet any day might be our last. How does this small risk compare to life’s uncertainties?”

He came to his senses, and though his hands still trembled, he allowed me to guide him aboard. Once seated on the small wooden bench, he looked out at the gentle sway of the dark water and held tight to the edge, as if his life depended on it. I leaned in close, choosing my words with care. “Listen, my friend,” I said, “fear is a gift, a sense given to us not to imprison life but to protect it. The Creator gave it to preserve us, not to make us captives of groundless anxieties. Life wasn’t meant to be burdensome, filled with dread, nor to be an endless fight against the shadows of what be.”

He listened, his gaze fixed on the faint stars reflected in the water. I continued, “If there’s a chance, a real risk—say one in two, three, or even five—then yes, caution is wise. It’s a fear that warns, a precaution that has value. But to dwell on a chance as faint as one in twenty, thirty, or forty, that’s not caution; that’s giving fear the reins. When fear is left unchecked like that, it twists life into a form of torment.”

He released his grip slightly and nodded, his expression shifting from one of fear to quiet acceptance. As the boat glided forward, it seemed that the weight on his heart lifted, the once-paralyzing fear replaced by a newfound calm. The night stretched on, cool and quiet, as we sailed across the Colorado River, each of us more at peace than before.

Life is meant to be lived

Just as our rowing boat glided quietly along the waters that evening, the truth settled in: life is meant to be lived, not constrained by irrational fears. Stepping off the boat, the realization dawned on my friend that fear, while an instinctual safeguard, can become a burden when unchecked. This wisdom echoed in the simple observation that we should fear what is reasonable to fear—grounded, tangible threats—not distant shadows.

Some fears are, in fact, rational. Those who avoid cigarettes consider the well-known risks of heart disease and death. Many refrain from sweets or red meat, well aware of links to serious illnesses such as diabetes, cancer, or stroke. Fear of speeding, a key cause of car accidents, is similarly grounded in solid reasoning. But when we step back to examine society’s most widespread fears, an interesting contradiction emerges. Among the most common fears—like spiders, heights, or snakes—their actual threat to our lives pales in comparison to more mundane risks, like heart disease or cancer.

Phobias

Consider arachnophobia, the most common fear of all. In reality, only about six people die from spider venom in the United States each year, yet this is a prevalent terror. The probabilities are not on the side of these fears: there’s a better chance of surviving a shark attack than falling prey to a spider’s bite. Similarly, the fear of flying—statistically safer than driving—is far more common than fear of heart disease, even though it’s the leading cause of death. Fear, then, can misguide us away from real dangers toward distant, unlikely scenarios, ensnaring us in what we cannot easily control.

Individuals with agoraphobia, for example, face a particular challenge, as their condition severely limits their quality of life. During the recent pandemic, many could finally empathize with those trapped in their homes by this fear. Similarly, the claustrophobic will avoid enclosed spaces, even critical medical scans that might save their lives. These conditions highlight the hidden impact of irrational fears, quietly reshaping lives in ways most of us will never see.

Some say the only phobia with practical value is mysophobia—the fear of germs—especially since the pandemic intensified our awareness of bacteria and viruses lurking around us. Those with this phobia avoid handshakes, public restrooms, and even loved ones in social settings. Mysophobia can lead to excessive handwashing, avoiding physical touch, and constant sanitation, often disrupting daily life.

Curiously, a different phobia also deserves mention—trypophobia, the fear of clustered holes. Although it does not align with any logical threat, it can evoke a visceral reaction of disgust and anxiety, from a honeycomb or lotus pod to the pebbled surface of a sidewalk. This curious phobia is widespread, yet cancer phobia ranks lower. And, finally, at twelfth place, sits the fear of death itself.

We fear things that are unlikely to hurt us; spiders, snakes, and heights. You may find many of these fears ridiculous. Some people experience panic attacks in open spaces or when encountering dogs or lightning. Others fear elevators and flying. These fears can severely disrupt people’s lives. Yet, in nearly all cases, the fears themselves are not the direct cause of death. Although the most common cause of death is heart disease, it is not in the top twelve among fears. Cancer, the second most common cause of death, is the eleventh most feared thing. In addition, while aerophobia—the fear of flying—is sometimes linked to the fourth leading cause of death, which is “accidents” (unintentional injuries), this association is misleading. Only about 1000 people die while flying yearly, which is the odds of approximately 1 in 11 million compared with 1.24 million who die in ground-traffic accidents. The odds of being killed in a car crash are approximately 1 in 5,000. However, most people feel safe in their cars, not on a plane. Fear is an emotion, and facts do not easily tame emotions. Individuals with claustrophobia may refuse to get an MRI even if the procedure is essential for diagnosing a medical condition because they are uncomfortable in the tight space of the scanner. Ultimately, fear is more than just an emotion—it’s a lens that distorts reality, a winding path through fields of both danger and illusion. True peace lies in understanding which threats are worth the worry and which can be set aside. Life’s real value unfolds only when we release the imagined perils that bind us and learn to sail freely, even when the waters seem uncertain.

According to the National Lightning Safety Council, 2021 marked a new milestone for the fewest documented lightning-related deaths in the U.S., with only 11 fatalities. Previously, the record low, documented by NOAA (National Oceanic and Atmospheric Administration), was 16 deaths in 2017. Statistically, in a given year, only about one in 30 million Americans will be killed by lightning, underscoring how extraordinarily rare such incidents are. However, the distribution of lightning strikes varies significantly by location, creating unusual and even repeated encounters with this phenomenon for some individuals.

One notable case is that of Jorge Marquez, who, remarkably, survived being struck by lightning for the fifth time in 2002. While he emerged uninjured, he did experience some consequences: his hair was burned in the first incident, and he lost his fillings. Marquez’s experience might seem to defy all probability, yet his circumstances may partially explain his repeated misfortune. As a Cuban farm worker, Marquez likely spends much of his time outdoors, even in inclement weather. Furthermore, Cuba is recognized as one of the most lightning-prone regions globally. Although his line of work and geographical location increase his risk, Marquez still exemplifies an unusually unlucky streak. Another such case of misfortune is that of assistant director Jan Michelini, who was struck by lightning twice while filming Mel Gibson’s The Passion of the Christ in Italy. Although Michelini was not seriously harmed, his double encounter with lightning raises questions about the role of chance—and perhaps divine intervention—in such incidents.

Beyond sheer probability, Marquez and Michelini’s stories touch on a broader human response: fear, especially fear of the uncontrollable. Many people feel heightened anxiety when they cannot influence or control their surroundings. For instance, passengers on airplanes often feel uneasy, as they are not in control; the pilot holds that power. Similarly, people generally prefer to drive rather than be driven, as driving provides a sense of control. Congested traffic becomes frustrating partly because we can’t freely move through it. As a result, limited control often leads to heightened worry and anxiety. Underneath these reactions lies a desire for control over every situation, whether reasonable or not.

Yet this fear of losing control is only one factor in the complex landscape of human anxieties and phobias. Unpredictable and untameable elements—such as lightning, wild animals, and confined spaces—tend to evoke more anxiety than situations we perceive as manageable, like riding a bike, handling a firearm, or taking medications ourselves. Even when these “controllable” activities carry real risks, they may feel safer because they appear to be within our grasp.

The human drive for control can even influence drastic decisions, such as the choice to end one’s life, seen by some as a final attempt to assert control over an otherwise uncertain existence. Moreover, the desire to regulate one’s environment and body often manifests in psychological issues, including eating disorders, addiction, and even suicidal ideation. In eating disorders, individuals obsessively control what enters their bodies, reflecting a need to dominate their physical self. With addiction, a person may be attempting to modulate their internal state and emotions artificially. Each of these struggles highlights how attempts to impose control can, paradoxically, become destructive.

Our quest for control, while rooted in the natural desire to manage risks, can drive us to harmful behaviors when taken to extremes. Understanding this urge might help us approach anxiety with compassion and awareness—recognizing that some things will always be beyond our control, and that acceptance can bring a peace that rigid control cannot.

“The thunder glorifies Him with His praise, and so do the angels, in awe of Him. And He lets loose the thunderbolts and strikes with them whom He wills. Yet they stubbornly argue about God, (notwithstanding all evidence that) He is severe in repelling and retribution” (Qur’an 13:13). This verse reminds us of a higher order beyond our understanding, a power that commands nature itself—thunder, lightning, and all the forces we perceive yet cannot control. As the thunder praises the Creator, even the angels tremble, not out of irrational fear, but out of a reverent awe that aligns them closer to truth. And so, this passage calls us to reflect on what we choose to fear, teaching us that the highest purpose of fear is reverence and humility before the Creator, not to be burdened by the uncertainties of the world.

Say: “Death, from which you flee, will surely meet you in any case. Then you will be returned to the Knower of the Unseen and the witnessed, and He will make you understand all that you were doing (and call you to account)” (62:8). No matter how much we fear or try to evade death, it is an inevitable reality. It will find us, no matter where we hide or how hard we try to avoid it.

The true essence of this message lies in understanding what we should genuinely fear. It is not the uncertainties of life or the inevitability of death, but rather failing to fulfill the duties we are assigned with in this life. The real fear should stem from the accountability of our actions when we stand before our Creator. Life is a test, and its true success is determined by how well we adhere to divine guidance.

When we focus solely on the fears of this world—whether they pertain to failure, loss, or even death—we risk overlooking the greater purpose of our existence. Such fears are fleeting, temporary, and often exaggerated. However, the fear of standing before God unprepared, having neglected His commands, is a fear that is both real and worthy of reflection. Thus, our energies should not be spent running from death but rather preparing for what comes after it. In this preparation lies true peace, as it aligns us with our ultimate purpose and brings clarity to our actions. Let us redirect our fears toward accountability to God, for only in fulfilling His commands can we find salvation and eternal tranquility.

When we anchor our lives in this perspective, fear transforms into wisdom, liberating us from the false dangers conjured by our imagination. Fear, often born from the unknown, becomes a shadow that looms over every step we take. However, when we shift our mindset and accept that uncertainty is a natural and inevitable part of life, we realize that it is not our enemy but an integral part of our growth. Life, in its essence, is unpredictable—a complex dance of joy and sorrow, triumph and failure, discovery and loss. By resisting this truth, we trap ourselves in a cycle of anxiety, trying to control what cannot be controlled. But when we embrace life’s unpredictable journey, something remarkable happens. Fear gives way to peace—a deep, abiding peace that comes from knowing that we are not meant to foresee every turn or avoid every challenge. Courage begins to take root, not as the absence of fear but as the strength to move forward despite it. This courage fuels a faith that empowers us to rise above fleeting worries, grounding us in a profound trust in the process of life itself. In this new perspective, every challenge becomes an opportunity, every setback a lesson, and every unknown a chance to grow. We cease being prisoners of uncertainty and instead welcome it as a companion that propels us toward self-discovery and resilience. By transcending fear, we break free from the illusions of control and security, allowing ourselves to fully embrace the present moment. Life, with all its unpredictability, becomes not something to endure but something to cherish. In the end, it is this freedom—the courage to face life with an open heart—that reveals the true essence of living. Fear dissolves, and in its place, we find the boundless possibility of life itself.

References

http://lightningsafetycouncil.org/

https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

https://www.fearof.net/

https://www.statista.com/statistics/263443/worldwide-air-traffic-fatalities/

https://theweek.com/articles/462449/odds-are-11-million-1-that-youll-die-plane-crash

What is meant by ‘ilm ladun, or the special knowledge from God’s Presence, is knowledge of the Unseen or knowledge of mysteries, or knowledge which God imparts into one’s heart and the truths occurring to it. Primarily included is the knowledge of all the Prophets and Messengers, as well as the knowledge of saints, purified saintly scholars, virtuous and godly ones, and those especially favored with God’s nearness. It is the knowledge which God has imparted into their hearts by way of Revelation or inspiration, and therefore it is considered to be some sort of special knowledge from God’s Presence. Particularly the knowledge of God’s Messenger, the Sultan of ‘ilm ladun, upon him be peace and blessings, whether it relates to the Unseen “absolute” or the Unseen “restricted,” is included in this consideration of special knowledge from God’s Presence. Süleyman Çelebi expresses this in the following couplet:

That one who has come is the Sultan of ‘ilm ladun,
That one who has come is the source of the knowledge of Divine Oneness.

That “unique one” of time and space is the perfect treasurer of this knowledge of secrets, and the greatest of those who have drunk out of this pool of special knowledge. Neither the other Prophets, nor the Messengers, nor the saints were favored with special knowledge to the same degree as that of the Prophet Muhammad, upon him be peace and blessings.

The knowledge which a saint claims to have received from God’s Presence specially may sometimes be incompatible with the decrees of Shari’a. For this reason, those who do not correct any such knowledge or spiritual discovery according to the basic rules or the fundamentals of the Religion may err and cause their followers to err. However, those others who have established their spiritual discoveries and inspirations on the ground of the basic rules of the Religion always see the physical and metaphysical dimension of existence together at the same time, observe this world and the others like the two faces of a single entity, and offer their students sweet “waters” of Divine gifts from the physical and metaphysical worlds.

In Surat al-Kahf, the holy Qur’an mentions a distinguished servant of God favored with special knowledge from God’s Presence, one who God’s Messenger said was called Khadr [1]. It says: And they found (there) one of Our servants to whom We had granted a mercy as a grace from Us and taught special knowledge from Our Presence (18:65). According to the Sufi scholars, the knowledge which God taught Khadr was special knowledge from His Presence. Despite being one of the five greatest Prophets and a perfect guide in Divine truths, the Prophet Moses, upon him be peace, desired to fully comprehend the special knowledge from God’s Presence by following Khadr to learn a particular aspect of it. Sahih al-Bukhari records a saying of our Prophet, upon him be peace and blessings, which points to the difference between the Prophetic knowledge of Divine truths and some aspects of special knowledge from God’s Presence: “Khadr said to Moses: ‘O Moses! I have some sort of knowledge from God, which you do not know, and you have some other sort of knowledge which I do not know'” [2].

The special knowledge discussed is a special favor from God to certain people; others—even though they may be more knowledgeable in different subjects—lag behind these people in respect to special knowledge from God’s Presence. It is true that in order to be favored with this knowledge, one should have the ability and merit to receive it and enjoy particular nearness to God; but it is primarily a special favor of God to His servants whom He has chosen. For this reason, it cannot be acquired through study, research, or other similar ways. That is God’s grace; He grants it to whom He wills. Surely God is of tremendous grace (62:4). So, this is a special manifestation of God’s grace.

It should be pointed out that although such knowledge is extremely attractive, enchanting, and desirable, and although it is related to certain Divine mysteries, the knowledge of the Religion and Divine truths with which the Prophets were favored is much more elevated than this knowledge; the knowledge of the Prophets is objective, applicable to everybody, and secures the worldly and otherworldly happiness of people. We can explain the difference between these two kinds of knowledge as follows:

Moses’s knowledge was the knowledge of the Shari’a, which was absolutely necessary for everybody regarding their happiness in both worlds and was therefore taught to order people’s worldly life and secure their happiness in the Hereafter, while Khadr’s knowledge was a special favor to know some aspects of the Unseen and certain Divine mysteries. Moses’ knowledge related to the rules and judgment by which public order and security could be realized, while Khadr’s consisted of some special gifts relating to the metaphysical dimension of life and existence. This second kind of knowledge has also been called “special knowledge that is purely from God’s Presence,” “the knowledge of truth,” and “the knowledge of the inner dimensions of existence.” It is a significant source by which one can realize the Divine mysteries. In this respect it is said:

O teacher of religious sciences, 
pay no attention to the knowledge of what people say. 
Instead, search for the secrets of the Ultimate Truth 
In the special knowledge from His Presence.

Although there is some sort of connection between this knowledge and personal efforts to obtain it, such knowledge cannot be obtained through mere study or efforts, for this knowledge occurs in pure hearts as a Divine gift in the form of a sacred power. It comes directly from God’s Presence through the ways of spiritual discovery and inspiration. However, as inspirations coming to the heart manifest themselves in the hearts to varying degrees, so those who cannot continue their spiritual journeying under the guardianship of the Master of creation, upon him be the perfect blessings and peace, may be the target of some suggestions of Satan.

Revelation (wahy) came to the Prophets and it is absolutely beyond all doubt. However, inspiration (ilham) occurs to saints and it is a broad channel for the manifestations of God’s Knowledge. If an inspiration manifests itself in the heart of a human being as a Divine gift beyond his or her willpower, this is called an “occurrence.” Satan may mix some things with an occurrence. An occurrence that is certain to have come from God without any interference from Satan can be regarded as special knowledge from God’s Presence. The firmest sign of an occurrence having originated in God’s Knowledge is its conformity with the Qur’an and the Sunna. It is highly possible that any occurrences which are not in conformity with these two primary foundations or basic sources of the Religion are whisperings or suggestions of Satan or of the human carnal soul. Since occurrences in which Satan and the human carnal soul have interfered bear Satanic and carnal elements, an initiate who has been driven to such an area of deception should immediately turn to God Almighty and regulate his or her state according to the basic rules of Shari’a.

The Sufi leaders call the meanings coming from God’s Presence and which echo in the heart “occurrences from the Ultimate Truth,” while those known to come from the angels are called “occurrences from the angels,” and the “sparks” which come from Satan and the carnal soul and invade the spirit are known as ” carnal or Satanic suggestions.” To differentiate between these occurrences one must depend on the criteria established by the fundamentals of the Religion and the elevated Sunna of the Prophet, upon him be peace and blessings. We should also point out that although these occurrences can be differentiated through the basic rules of the Shari’a, some others may come as a result of, or lead to, certain secret Satanic goals or ambitions even though they appear to be in conformity with the fundamentals of the Religion. For this reason, only those people who are well-versed in this field can establish the true differentiation.

Since the suggestions of the carnal soul and Satan are outside the sphere of “special knowledge from God’s Presence,” we will not go into details about them here.

O God! Show us the truth as the truth and enable us to observe it; show us falsehood as falsehood and enable us to avoid it. And bestow Your blessings and peace upon our master, Muhammad, and on his Family and Companions.

References

• al-Bukhari, “‘Ilm” 44; Muslim, “Fadail” 170.
• al-Bukhari, “‘Ilm” 44.

On a less than memorable episode of The Simpsons, Bart, the hell-raising ten-year-old, is struggling to begin a paper on World War I that is due the next day. Books are piled on his desk. The pen is in his hand, touching the paper (back when kids still wrote essays by hand). He looks around the room and sees an especially inviting book on his bookshelf.

“Oh, algebra,” he says excitedly. “I’ll just do a few equations…”

He then hits himself to refocus.

Everyone finds the gag relatable: a task so difficult or boring, with a deadline looming, where the distraction of doing math equations is not only tempting but preferable.

I have no algebra books in my home, but plenty of other distractions that stand out and glitter like half buried pearls. Laundry that suddenly needs doing or trying to decide which is the perfect way to organize my bookshelves (by color? alphabetically?). There are the kinds of distractions that announce themselves randomly and demand my attention. My son deciding he’s hungry ten minutes after refusing lunch. My mother calling with the vague, dreaded, “are you busy right now?” Making sense of what it was I wanted or was supposed to be doing after all of these detours can take more mental energy than I’m capable of, which means I often leave everything unfinished.

Usually, I’m good at hiding my half-done priorities, but not everything can be swept aside or pushed into a closet. My lawn, for instance, is something everyone can see as the result of these shifting priorities. The grand list of plans to repair and care for my lawn every spring has now increased to where the grounds crew of Yankee Stadium would find it difficult. To get rid of all the overgrown bushes and tree branches would take a full weekend, but didn’t we want to take my son to the aquarium? Wasn’t getting him out of the house and away from the TV important? Mowing the lawn itself takes at least two hours, yet my mother isn’t well enough to go grocery shopping on her own. She can’t go without food, right? I can’t put it off, not when I’m supposed to be seeding all the empty patches and pulling out the dandelions and spraying deer repellent. An unending stream of guilt causes me to lurch one way then another, leaving my lawn a mess, an outward expression of things left half-finished or completely unstarted.

The secret, as we are told by various self-help gurus online and daytime talk show hosts, is to put aside the things that aren’t important and embrace the things that are. This is meaningless gobbledygook that looks good on the kind of cheap coffee mugs you see in greeting card stores. If the slogan was “do what makes you happy,” or “prioritize the good in life!” it would have just as much meaning and probably as much impact. The definition of what makes something important is too vague, too changing. After all, each distraction blares its importance to you like a screaming baby. Rather than limit things to important or not important, the best method for avoiding distractions is to prioritize everything. From restocking the scotch tape dispenser to fleeing a house fire.

Discovering that hierarchy is the real trick, and it is a process. Little children are hardwired to not think about the world around them (as newborns, we think things stop existing when they leave our field of view). When we age, our priorities change. Hopefully for the better, but not always. Some people need a lot of time and experience to help learn what’s most important. And even as you figure it out, the distractions come fast and hard. Every week a person is recommended to watch a new TV show, even though they probably haven’t finished watching the latest hit everyone’s talking about. Then comes the dilemma: should that person stop the old show and pick up the new one? What if they’re someone who never skips a Sunday crossword puzzle? Do they continue to do them and watch TV, knowing they might put off work they brought home from the office? When do they get around to paying bills? Calling up their parents to catch up? All these options just from having one show introduced to us.

By the time you’re a young single adult, it becomes easy to think that whatever makes you happy is what’s important. For a long time, my biggest concern was how to be a rock star even though I spent my high school years playing trombone. Once I was out of college and that dream was as realistic as eating unicorn steaks, I went ahead and started waiting tables. All that mattered to me at that age was whether I would walk out of each shift with enough to pay off the essentials. These consisted of gas, rent, and food, not always in that order. Often the food came from McDonald’s and the refreshments from local bars. But happiness was the goal, not nutrition. As long as I wasn’t too picky about it all, I managed to make it work. I was satisfied.

When I started working as a teacher my own happiness depended on others. Staff members needed help. Students wanted feedback from me. The distractions and the goals I needed to accomplish were so numerous it became dangerous to my career to leave some incomplete. I learned early, though not as early as I should have, to prioritize what mattered without leaving everything undone. There were too many days scrambling to finish lesson planning five minutes before the students walked in. Too many mornings struggling to discuss the merits of The Great Gatsby while feeling far from clear-headed. The less said about the burgers that contributed to my expanding waistline the better. It would be wonderful if people learned this earlier in life. But a lot of people don’t. Some never learn to prioritize at all. Judging by how many people still take on Tik Tok challenges, it stands to reason people are not always acting with their best interests (judging by how many challenges there are, there are never too many distractions either).

The vast majority of people also learn that once you have a spouse or partner and children who count on you, or extended family that needs help, their safety and security becomes the most important thing. Something in my lizard-brain activated once I held my newborn son for the first time, a little voice that said, “This thing matters. It’s counting on you.” After that, my brain took all the stimuli around me and, like a badly kept 90s desktop computer, put everything it receives through a quick analysis: on one side, that nagging distraction that demands attention; on the other, my wife and son.

The system isn’t perfect, of course. Sometimes it says that nagging thing is my son, and my brain therefore questions how long I can go and ignore it. The effect is doubled when the request is something innocuous, like demanding we do the same dinosaur puzzle for the sixth time in a row. (Ignoring him is a generally all-around terrible thing to do – newborns and toddlers have to be dealt with eventually if you ever want to get five consecutive seconds of peace).

Ignoring my responsibilities to myself for too long, like any engine that burns too hard for too long, causes me to crash. When things come up that relate only to me – a new videogame demanding my attention, some of my friends making plans to unwind after work, maybe a free hour where I can sneak in a nap – my systems work on autopilot, telling me to brush them aside. The little voice inside my head will sometimes pipe up: “Yes, you have papers that need grading, but shouldn’t your son have fifty meal options for dinner, just in case?” The messaging gets confusing, and this ultimately hurts everyone else. You should definitely do work for your job, and when it comes to toddlers, falling asleep while playing with blocks means I get a rude awakening when they’re chucked at my head. Sometimes I need a reminder, often from my wife, to take care of myself as well.

Some distractions, like Bart’s algebra, we just can’t help but be tempted by. They fill our head and make us think they need to be done right this second. Giving everything a label of important vs not important rarely helps. By prioritizing things first, especially when helping others, has shown me what matters in my own life. Family first, always. Then myself, my career. Maybe, eventually, some day, my lawn will make it a little higher up the list.

Sometimes I wonder how we all got here.

To a state in the world where the very air we breathe is toxic. I pull my mask back up over my mouth and push on through the abandoned aisles of the local convenience store. Any more than a few moments in this air without a mask, and my lungs will collapse.

Since the Third World War, sickness has been running rampant throughout countries. For a while, it seemed like we may have been able to flatten the curve of those infected and stop the spread. But the sickness just worsened and spread further throughout the Earth. The air became contaminated, and those who didn’t wear some form of filtration fell ill and died in large numbers.

Now here we are. A few stragglers among dilapidated cities, struggling to find enough necessities to survive.

I rummage through the near-empty shelves in hopes of finding something to eat that isn’t from the forest and that I must skin alive to cook. My prayers are answered as I pull out a can of bready noodles in indistinguishable red sauce. But I can’t eat it here. If I inhale any more poison, I may not make it back to base camp.

So instead of digging into it ravenously, like I want to, I shove the can into my satchel and begin skirting my way back towards the front door. I blink away the dark spots flitting across my vision as I fail to breathe in enough suitable oxygen and grip the door handle to keep from falling.

The feeling of suffocating fades after a few moments, and I am back on my way. I cross the street, glancing up at the abandoned buildings with a nostalgic tug on my heart. Everything is so different now. It’s crazy to think that nothing will ever be the same after this. It hasn’t been for nearly four years, anyway, so I don’t know why I’m complaining.

Maybe because I’m about ready to give up entirely. The world isn’t what it used to be, and I see no signs of anything getting any better, so why try?

I shake my head, trying to dislodge the thoughts that weigh so heavily on me, and turn to soak in the remaining shafts of sunlight falling through the clouds.

That night, in my plywood lean-to with plastic sheets draped overhead, I light a candle and pull the can of noodles out of my leather satchel.

I mumble a prayer under my breath and then crack open the lid, grimacing as the smell seeps through my cotton mask and into my nose. Being careful not to cut my fingers on the edge of the metal can, I snatch a scoop of noodles from inside and carefully slip my mask down just long enough to toss the food into my mouth and then yank it back up. The noodles are cold and slimy as I swallow, and my mask quickly fills with hot air as I try to breathe and chew at the same time.

I repeat the process until the can is empty, and I promptly dunk it in the tub of dirty water sitting outside of my lean-to shelter. I reread the same novel I’ve had since society collapsed: Les Misérables by Victor Hugo. I’m almost able to speak French from reading it so many times, and by the time I finish two chapters, my stomach is cramping so bad I must lie down.

Maybe it was stupid to eat something from a dented can that expired two years ago.

I toss and turn for the rest of the night, stopping only to vomit into the dead bushes behind my camp multiple times. By morning, my head is throbbing, and my face is blotchy. I wander down to the river and swish some brown water in my mouth in an attempt to get the bitter taste of old food out.

It doesn’t work, and I smell the rancid odour within my mask for the rest of the day until I find some wild strawberries and devour them.

It isn’t until the next night that I realise the sickness I’m feeling must not be from the canned noodles at all.

It’s the sickness in the air. I took my mask off more than usual that day anyways, and I must have wandered closer to a heavily infected area. My head swims as I make the realization, and I decide to head for the next town over. I’ve heard rumors of small communities within the remains of old towns or farms. Maybe they would let me in.

And maybe one of them can help me get rid of the sickness.

I am going to leave today. I have lived here for the past six months, and I was all alone for the three years before that, so I don’t know how to feel about going out in search of other people that I don’t want to see. I’d have a higher risk of getting contaminated with others around anyways, and as these thoughts fly through my head, I start to think that maybe I should just call the whole thing off right now.

But I won’t, no matter how much my hands are shaking or how fast my heart is beating. Because I can’t go on like this. I need to be free. I need a fresh start. And this is the only way I know how to get that.

I focus myself as I walk by listing off all the symptoms of the airborne sickness one by one. Weak muscles, swollen joints, red face, dry mouth, loss of voice, brittle fingernail-

My thoughts drop away suddenly as I hear a shriek come from the sky. A kettle of hawks rushes up and out of the dying trees towering above me, swooping in a huge arch, only to dip and dive to the North.

Almost as if they want me to follow them.

I shake my head. Now I’m just making things up. A group of hawks isn’t going to be communicating to me while I search for a group of survivors.

I want desperately to rip the cloth from my face, to take a deep breath like I haven’t gotten to in years, but then my mind fills with the horror stories I was told of the sickness taking unassuming people who wouldn’t wear masks, conspiracy theorists that believed there was no sickness at all. There were ones that coughed up blood or suffocated to death, others that just collapsed and died on the spot, and still others that experienced such debilitating nerve pain that they didn’t even want to live anymore.

These thoughts are the only things keeping my twitching fingers from my mask, and calmly at my sides. The only things keeping me breathing.

The sun begins setting seemingly seconds later, and I hurry to set up a makeshift tent beneath a dead tree and start a fire nearby. The crunching sounds that echo constantly throughout the night keep me awake and tense, unable to think about anything besides the horror that may lie past the orange glow of the fire.

When morning finally comes, I’m shocked by two things. First, that I managed to fall asleep at all during the subtle chorus of bugs and dancing shadows that raged through the night. And second, that it seems my mask fell off at some point during my slumber. For a short moment, I revel in the feeling of cool air against my lips as I blink my eyes open. Then the panic sets in as I realise why I am feeling anything at all. I shoot up from my cramped position beneath the tattered cloth tent held up by mouldy wooden rods and begin scrambling to find my mask. With one hand rummaging among the dead, decaying leaves below me, and the other clamped against my mouth and nose, I search for it in a panicked frenzy.

Finally, there, I see the crusted, dirt-smeared rag in front of me and grab it, pulling the loops up and over my ears to hold it in place. I take huge gulps of dank air as soon as it’s back on my face and try to force my racing pulse to slow.

I’m going far too slow if I want to arrive in any survivor camp before the sickness takes me. It may be too late already. I pull on my mismatched, tight leather shoes and kick at the embers of my fire until all traces of me are long gone. Then I set out once more to find safety.

I say one more prayer under my breath, that I will find a camp before I’m gone forever. No more than a smudge in the world’s dark, sick history.

By the next evening, my feet are throbbing like I walked a mile with nails in my shoes and my eyes are watering like Niagara Falls. Which ironically, was bombed in the war, and is now no more than a pile of rubble in a pit of stagnant water.

I collapse on top of a hill overlooking a darkened field that stretches out for almost three miles. In the quickly dimming evening, I can’t see anything but a small speck that I assume is a bonfire.

My throat feels raw, and I imagine myself passing away quietly as I sleep. Or waking up in a mad panic and trying to claw at the air while my lungs disintegrate.

I blink away the mental image and decide to push on. I can go one more night without sleep if it means I can find a cure.

But the hope that was so palpable three days ago is waning, and I’d rather jump off this hill than take another step. I feel that my journey, my very life itself, is coming to a close, and even my eyes don’t want to stay open to see the next sunrise.

I know if I don’t get down to that community now, I’m going to die. So, I push myself up off the ground, letting my satchel slip from my shoulder and come to rest in the cold grass beneath me. I drag my feet forward, the uneven terrain drawing sharp gasps and cries of pain from me as my legs weaken.

My lungs are beginning to make a high-pitched wheezing sound each time I inhale, and my eyes feel like a thousand pounds of pressure are behind them. The sickness has its hooks in me, and I can’t see any way out now. Even my muttered prayers are too painful to croak out.

It looks like this is the end, for me. All this way, all these years: For nothing. There is no cure, there is no rest, and there are no survivors. These words spiral in my head over and over again as I make my way down the hill and closer to what looks like an arched gate.

No one will be there to greet me, no one will be able to cure me. I take shallow, bitter smelling breaths through my dirty mask as I limp closer to what seemed like a good idea so long ago.

I finally come to a halt at the abandoned gate, falling heavily on my knees, my palms raking across the dirt path below me. I can almost taste the blood in my mouth as my vision fades. All I want is to breathe.

I open my eyes to find two people above me, arms crossed, heads tilted down, sharing whispers. They don’t notice me until I move, and I notice why I feel terror pounding through my veins at an insane rate.

They aren’t wearing masks.

My hand flies up to my uncovered mouth with a gasp. The two people stare at me, eyes wide, and one leans forward, hands outstretched innocently.

“I need a mask,” I say, my hand muffling my panicked words. The woman behind the first tries to hide a smirk, and the other shoots her a stern look.

She turns back to me with a gentle smile.

“You’re alright, now,” she says. I shake my head, sure that I’m inhaling the sickness every second that I sit here.

“No, please-” I start, ready to begin rambling like mad, when she stops me.

“Listen,” she snaps. “The sickness is gone.” For a moment, the world falls away. She nods and continues. “It ended almost three years ago. It just…died out.” She punctuates her sentence with a shrug, and I blink away nervous tears, hand still clasped against my face.

“No, no,” I mumble, shaking my head. “That’s not- I’m infected, I’ve been sick for three days…” The woman shakes her head.

“We did tests with the equipment we have, and you’re perfectly fine,” she assures me. “Could it have been… Have you ever heard of the placebo effect?” I shake my head again, and I’m sure that by now, I look like a plastic bobble head figure. The woman sighs.

“It’s not that- I know I was sick-” I stammer, struggling to breathe past my hand. The woman seems fed up with my rambling and the other intervenes.

“We have a community here,” she explains. “We have livestock, and homes, and gardens where we harvest our own food. It’s amazing.” She blinks a few times. “And there is no more sickness.”

My heart lifts as I picture the possibilities. No more masks and dirty water. I can breathe and sing and laugh and be free. For the first time in years.

But what if it doesn’t last? I can’t go back to hopelessness after being offered a one-way ticket to freedom and family.

As if she read my mind, the woman adds, “If you don’t try, how will you ever know if anything is safe?”

It’s my turn to shrug, and I plead with my eyes for her to give me a mask. They retreat outside the spacious tent, leaving me on a small, padded cot. One of them stops before pushing out the tent flap and says over her shoulder, “Come outside when you’re ready to embrace the revival of our society.” Then she’s gone, and I’m all alone again. I hear laughter and cries of joy outside the tent, and I wonder if it’s true. If the sickness really is gone.

I stand up, keeping my mouth covered for now. But the woman was right, I’m perfectly fine. My legs feel strong, and my eyes are clear. Even my chest feels light.

I push my way out into the light and am shocked to see the beauty of a recovering community. So shocked that my hand falls away from my mouth and I take a deep breath. Everything is bright, and alive. No death sullies the image of greenery and joy before me.

I’ve found it, this beautiful place where I can start over and feel alive once more. I feel brand new, now that I’ve found what I needed so desperately.

A breath of fresh air. My revival.

Medicines and vaccines have transformed the prevention and treatment of diseases. In addition to their benefits, medicinal products may also have side effects, some of which may be undesirable and/or unexpected.

For example, thalidomide was introduced in the late 1950s as a sedative and a treatment for morning sickness in pregnant women. By the early 1960s, reports began to emerge of severe birth defects associated with its use, including phocomelia, a condition characterized by the malformation of limbs. The thalidomide crisis resulted in significant human suffering and marked a turning point in drug regulation. Thalidomide was sold in over 46 countries, with the highest number of cases reported in Germany, the UK, Canada, and Australia. It’s estimated that around 10,000 babies were born with thalidomide-related birth defects worldwide. These numbers underscore the profound impact of the thalidomide crisis on public health and drug regulation. The crisis prompted significant changes in drug regulation, leading to the enactment of stricter testing and approval processes, such as the 1962 Kefauver-Harris Amendment in the U.S.

All medicines and vaccines undergo rigorous testing for safety and efficacy through clinical trials before they are authorized for use. However, the clinical trial process involves studying these products in a relatively small number of selected individuals for a short period of time. Certain side effects may only emerge once these products have been used by a heterogenous population, including people with other concurrent diseases, and over a long period of time (Figure).

Figure. Overview of investigation into drug safety in the United States.

· Medicines may affect the body in unintended, harmful ways. These effects, called side effects, adverse events or adverse reactions, represent the risks of taking medication. An adverse drug reaction (ADR) can be defined as ‘an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product; adverse effects usually predict hazard from future administration and warrant prevention, or specific treatment, or alteration of the dosage regimen, or withdrawal of the product.’ Since 2012, the definition has expanded to include reactions resulting from errors, misuse, or abuse, as well as suspected reactions to unlicensed or off-label uses of medicines, in addition to those occurring with authorized use at normal doses. Adverse drug reactions have been observed and monitored for many years: In 1937, 107 deaths, many in children, occurred in the United States from the use of a cough syrup that used diethylene glycol as a solvent. This event led to the 1938 Food, Drug, and Cosmetic Act, which for the first time required proof of safety prior to marketing.

· In 1955, over 40,000 children developed abortive polio (51 of whom were permanently paralyzed) and five died from a polio vaccine made by Cutter Laboratories that was not effectively inactivated during manufacturing. The incident also sparked a polio epidemic in the families and communities of those immunized with the defective vaccine, leading to an additional 113 people who were paralyzed and five more deaths. In ensuing law suits, it was determined that pharmaceutical companies could be held liable for harm from their products even if there was no negligence.

· In 1961, more than 10,000 children worldwide were born with severe birth defects (phocomelia) due to in utero exposure to thalidomide, a drug that had been used to treat pregnancy-related nausea. Even though thalidomide had not been released in the United States, this event led to the Kefauver–Harris Amendment, which strengthened the requirements for safety testing and for the first-time required proof of efficacy prior to a drug being marketed. This public health disaster also spurred the development of formal spontaneous reporting systems for pharmacovigilance, which are still the primary method of identifying safety issues in approved medications.

· In the 1970s, it was discovered that diethylstilbestrol caused clear cell adenocarcinoma of the cervix and vagina in women exposed in utero decades earlier.

· In 1984, psoralen and ultraviolet A (PUVA) was definitively linked to an increased risk of squamous cell carcinoma, approximately 10 years after the first description of PUVA therapy for psoriasis. It took over 20 years to establish a link between PUVA and melanoma, which remains controversial.

· Of drugs approved by the US Food and Drug Administration (FDA) between 1996 and 2012, one-third received boxed warnings and more than 40% of these drugs acquired the warning a median time of 4 years after approval.

· Since 2000, many of the prescription drugs removed from the market include classes of medications that are commonly prescribed, such as antihistamines (e.g., terfenadine), nonsteroidal anti-inflammatory agents (rofecoxib, valdecoxib), antibiotics (trovafloxacin), lipid-lowering medications (cerivastatin), and an immunosuppressant for the treatment of psoriasis (efalizumab).

· Between 2008 and 2015, 29% of boxed warnings issued to drugs on the US market were new and 32% were major updates to previous warnings.

· The incidence of adverse drug reactions has remained relatively unchanged over time, with research suggesting that between 5% and 10% of patients may suffer from an ADR at admission, during admission or at discharge, despite various preventative efforts.

· In 2012, McKinsey & Company estimated that the cost of 50 to 100 million preventable, error-related adverse drug events ranged from $18 billion to $115 billion.

It is important to quickly identify new risks or changes to known risks associated with the use of medicines. Timely actions must be taken to minimize these risks, maximize the benefits, and promote the safe and effective use of medicines by patients. These activities are collectively known as pharmacovigilance.

Pharmacovigilance, also known as drug safety, is the pharmaceutical science concerned with the “collection, detection, assessment, monitoring, and prevention” of adverse effects associated with pharmaceutical products. The term “pharmacovigilance” is derived from the Greek wordpharmakon(meaning drug) and the Latin wordvigilare(to keep watch). As such, pharmacovigilance focuses primarily on adverse drug reactions, defined as any noxious and unintended response to a drug, including lack of efficacy. Medication errors—such as overdose, misuse, abuse, and drug exposure during pregnancy or breastfeeding—are also of interest, even when no adverse event has occurred, due to their potential to result in harm.

In recent years, the scope of pharmacovigilance has expanded to include:

· Herbals

· Traditional and complementary medicines

· Blood products

· Biologicals

· Medical devices

· Vaccines

Many other issues are also relevant to the science of pharmacovigilance, including:

· Substandard medicines

· Medication errors

· Reports of lack of efficacy

· Use of medicines for unapproved indications with insufficient scientific support

· Case reports of acute and chronic poisoning

· Assessment of drug-related mortality

· Abuse and misuse of medicines

· Adverse interactions between medicines and chemicals, other drugs, or food

Pharmacovigilance activities include:

• Collecting and managing data on the safety of medicines
• Looking at the data to detect “signals” (any new or changing safety issue)
• Evaluating the data and making decisions with regard to safety issues
• Pro-active risk management to minimize any potential associated risks
• Acting to protect public health (including regulatory action)
• Communicating with and informing stakeholders and the public
• Audit of the outcomes and key processes involved.

The specific aims of pharmacovigilance are to:

· Improve patient care and safety in relation to the use of medicines and all medical and paramedical interventions

· Enhance public health and safety concerning the use of medicines

· Contribute to the assessment of the benefits, harms, effectiveness, and risks of medicines, thereby encouraging their safe, rational, and more effective—including cost-effective—use

· Promote understanding, education, and clinical training in pharmacovigilance, along with effective communication to the public

Information received from patients and healthcare providers via pharmacovigilance agreements, as well as other sources such as the medical literature, plays a critical role in providing the data necessary for pharmacovigilance to take place. In order to market or to test a pharmaceutical product in most countries, adverse event data received by the license holder (usually a pharmaceutical company) must be submitted to the local drug regulatory authority.

Ultimately, pharmacovigilance is concerned with identifying the hazards associated with pharmaceutical products and with minimizing the risk of any harm that may come to patients. Companies must conduct a comprehensive drug safety and pharmacovigilance audit to assess their compliance with worldwide laws, regulations, and guidance.

The activity that is most commonly associated with pharmacovigilance and which consumes a significant number of resources for drug regulatory authorities (or similar government agencies) and drug safety departments in pharmaceutical companies, is that of adverse event reporting. Adverse event reporting involves the receipt, triage, data entry, assessment, distribution, reporting (if appropriate), and archiving of adverse event data and documentation. The source of adverse event reports may include spontaneous reports from healthcare professionals or patients, solicited reports from patient support programs, reports from clinical or post-marketing studies, reports from literature sources, reports from the media (including social media and websites), and reports reported to drug regulatory authorities themselves. For pharmaceutical companies, adverse event reporting is a regulatory requirement in most countries. This reporting also provides data to these companies and drug regulatory authorities that play a key role in assessing the risk-benefit profile of a given drug.

Organizations such as World Health Organization (WHO), International Council for Harmonization (ICH), The Council for International Organizations of Medical Science (CIOMS), and International Society of Pharmacovigilance play a key collaborative role in the global oversight of pharmacovigilance.

The number of National Centers participating in the WHO International Drug Monitoring Program has grown from 10 in 1968, when the program began, to 67 in 2002, and continues to increase. The centers vary considerably in size, resources, support structure, and scope of activities. Collecting spontaneous reports of suspected adverse drug reactions remains their core activity.

In conclusion, maintaining balance in life is essential in all aspects. The usefulness of almost anything can diminish and even become harmful when used excessively. Although medicines play a vital role in healthcare, their effects must be closely monitored to prevent potential adverse events. In addition, with the rapid spread of drug information worldwide—especially highlighted during the COVID-19 pandemic—there is a growing need for routine and timely communication between National Centers and national regulatory authorities. Many regulatory bodies across different regions have established strong collaborations to share safety data, discuss regulatory decisions, and align on policies. Regular dialogue and coordination among National Centers are crucial to ensuring the safe and effective use of medicines.

References

1. https://www.who.int/teams/regulation-prequalification/regulation-and-safety/pharmacovigilance

2. Offit P. The Cutter incident, 50 years later. N Engl J Med. 2005;352(14):1411–1412.

3. Talbot JC, Nilsson BS. Pharmacovigilance in the pharmaceutical industry. Br J Clin Pharmacol. 1998 May;45(5):427-31. doi: 10.1046/j.1365-2125.1998.00713.x. PMID: 9643613; PMCID: PMC1873545.

4. Solotke MT, Dhruva SS, Downing NS, Shah ND, Ross JS. New and incremental FDA black box warnings from 2008 to 2015. Expert Opin Drug Saf. 2018;17:117–123.

5. Coleman JJ, Pontefract SK. Adverse drug reactions. Clin Med (Lond). 2016 Oct;16(5):481-485. doi: 10.7861/clinmedicine.16-5-481. PMID: 27697815; PMCID: PMC6297296.

6. Ebel T, George K, Larsen E, Neal E, Shah K, Shi D (October 2012). “Strength in unity:The promise of global standards in healthcare” (PDF). gs1.org. McKinsey & Company.