A child’s illness and a parent’s fears

The main reason our antibiotics are becoming less effective is they’re being drastically overused in both medicine and food production. But cutting usage isn’t always simple. This video by British GPs nicely addresses one such complicating factor: a parent’s understandable desire to get their sick child well – but making a very common mistake in the process:

Understandably GPs will always get pressure especially from parents to prescribe antibiotics every day. And we know that your worst fear is your children getting ill and you want to protect them but trust us to know when you and your family will need antibiotics – you don’t need to ask for them.

Specifically, the physicians remind us, antibiotics don’t work on the cold and flu, and that sore throats, colds, coughs and earaches usually get better on their own, without antibiotics. Instead, they say, drink lots of fluids, rest, and eat at least one hot meal a day. And expect that a sore throat will usually last a week, and that a cold can last 10 days.

Say hello to your little valentine …

From Professor Sheena Cruickshank at the University of Manchester –

Oh what lovely eyes you have: With 38 trillion bacteria living in and on you and microbes such as Demodex caressing your face – it’s typically found in your eyelashes – you are never alone.

Happy valentines day.

 

 

Trade Wars – The superbug edition

The problem, say the Brits, is exactly as advertised: that the beef is US born & raised. And not just the beef, but the pork, chicken, and turkey, as well.

Britain’s beef bashing arose this week, The Guardian reports, as US trade reps in London are attempting to negotiate new contracts on food and agriculture in anticipation of Britain leaving the European Union.

As things stand, US meat is about as welcome over there as the flu virus. The EU already bans imports of American beef throughout the continent, mainly because of the free use of growth hormones in the US. And a row apparently broke out over the potential for imports of US chlorinated chicken, also banned by the EU. Bleaching chicken, according to UK experts, is a dangerous practice because it can serve to disguise poor hygiene practices in the food chain.

But the hot item is the overuse of antibiotics in food animals. The UK science-based NGO, Alliance to Save Our Antibiotics, is urging their government to stick to their guns and not import US meat because:

US cattle farmers are massively overusing antibiotics. This finding shows the huge advantages of British beef, which is often from grass-reared animals, whereas US cattle are usually finished in intensive feedlots. Trade negotiators who may be tempted to lift the ban on US beef should not only be considering the impact of growth hormones, but also of antibiotic resistance due to rampant antibiotic use.

 

It’s precisely this kind of farming that gives rise to superbugs such as MRSA – bacteria that antibiotics have zero effect on – that can kill or cause serious illness. This chart from the US Centers for Disease Control shows the relationship between farm and fork:

 

Notice something. By the time the meat arrives overseas, one of the two modes of transmission of the bugs from the farm to you has already been cut out – bugs moving through the environment, shown in the bottom half of the diagram. The Brits’ sole concern, therefore, is with the upper half of the diagram – meat that has been contaminated with the bugs (which are trickier to get rid of than you’d think). In other words, the Brits are unwilling to be exposed to even half the risk of infection from these bugs that Americans are forced to live with.

And what is Washington’s reasoned response to the health concerns raised by the UK? Ted McKinney, US under-secretary for trade and foreign agricultural affairs, told an audience of British farmers last month he was “sick and tired” of hearing British concerns about chlorinated chicken and US food standards.

 

 

 

 

They were supposed to save his life not take it

We know that hospital-acquired infections in Canada kill 8,000 to 12,000 people every year and may well be the 4th leading cause of death in the country. Yet we hear very little about that and even less about how those deaths occur.

However, the compelling story of George Gould (below), who caught an untreatable superbug infection at the Vancouver General Hospital is an exception. His wife went public because of his prolonged suffering that involved some 22 hospitalizations over 18 months. And she went public because, in her words, the hospital was “supposed to save his life not take it.”

We understand her anger. But as the high number of infection-related deaths suggest, the problem doesn’t lie with any one hospital; rather, it’s a systemic issue – and so we all have to be on guard.

Brad Spellberg, MD, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, tells us why hospitals are such dangerous places:

I do think that people need to understand that the hospital is an inherently dangerous place and it’s not because hospitals are dirty or doctors are lazy or anything like that. Think about it this way. You’re taking the sickest people in society, crowding them into one building, tearing new holes in their bodies that they didn’t use to have by placing plastic catheters in their bloodstream, their bladder, putting tubes into their lungs that can breathe for them, and we’re using very large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic resistant bacteria.

 

Armed with this knowledge, is there anything we can do to protect ourselves? Andrew Simor, MD, an infectious disesae specialist with the Sunnybrook Hospital in Toronto, says we need to be more assertive:

I think patients need to advocate for themselves to ensure that there are proper infection prevention control standards in place. That hand hygiene is being done consistently as it should be. And that other barrier precautions [such as] use of gowns and gloves environmental cleaning is being done as it should be. I think we all need to advocate for ourselves and for our patients to ensure that this is happening.

 

The flu vaccine can protect you from MRSA and other deadly pathogens

 

U.S. influenza activity is now the most widespread since the 2009 influenza pandemic, according to the Centers for Disease Control and Prevention in its latest weekly update on flu activity. The CDC therefore urges Americans to get a flu vaccine if they haven’t already because “There is still a lot of the season to go, and vaccination now could still have some benefit.” That doesn’t guarantee that you’ll be 100 per cent protected from the flu, however, “Even if you get the flu, having received the flu vaccine may help you in terms of not having as serious a course or as devastating a course.” And that, as it turns, can matter a lot.

Tandy Harmon (above), 36, a single working mother of 11- and 12-year old boys from Portland, Oregon, was in good health until she starting feeling ill with the flu one Sunday earlier this month. The next day, she stayed home from her job as a bartender at a local sports lounge. By that Wednesday, she ended up in intensive care at Legacy Emanuel Medical Center in North Portland, diagnosed with the flu, pneumonia and an infection from Methicillin-resistant Staphylococcus aureus (MRSA).

Harmon’s symptoms became severe fast. Her organs started to shut down. Her liver failed. Her skin started to discolor. They even considered the amputation of limbs as an option to keep her alive. And two days later, after a decision was made to remove her from life support, she died, leaving family and friends stunned. “That’s all it took was a couple of days,” said her boyfriend Steven Lundin. “I can’t believe it.”

Dr. John Townes, head of the infectious disease program at Oregon Health & Science University explained what happened in an interview with The Oregonian:

[T]hey get the flu. That opens the floodgates for the bacteria to invade their body. This happens every year. This is why we harp about getting a flu vaccine. The flu can lead to severe bacterial infection. The usual average healthy person doesn’t die of influenza [but] influenza will lower your resistance to certain bacterial infections like staph infection or pneumococcal infection.

People at high risk for the flu – and thus should be vaccinated – are children younger than age 5 but especially less than age 2, adults age 65 and over, pregnant women, and people with underlying medical conditions such as lung disease, heart disease and diabetes.

Townes says you probably have the flu if you feel “sick all over.” In which case you should stay home, rest and stay away from others.

But what you really need to watch out for, he says, is if you start to feel better and then get worse. That’s when you should see a doctor because it’s a sign of something serious: that a bacterial infection such as MRSA has set in secondary to the viral infection – as was the case with Tandy Harmon.

 

 

 

 

 

Kitchen Karate: How to protect yourself from superbugs while cooking

Antibiotic use in our food animals fuels the growth of “superbugs” in those animals. Those bugs then contaminate the meat – beef, pork, chicken, turkey, and even fish – that we bring home. This puts us at risk for infection by those bacteria, infections that are harder to treat and sometimes untreatable.

Those are the words of Dr. Lance Price, Director of the Antibiotic Resistance Action Center at the George Washington University School of Public Health, and “chef” in the (live, not animated) video below.

Though we should bring home meats labelled “no antibiotics,” Price’s message is that the kitchen is the place to confront foodborne bugs. And the number one weapon at our disposal? The faucet.

The faucet is the most important tool in the kitchen because you should be washing a lot of things when handling meat – cutting boards, knives, counter top, and especially your hands.

 

Surprisingly, though, you shouldn’t be washing the meat because that just spreads bacteria all over the place, says Price.

And as far as the crucial hand washing factor is concerned, which seems so straightforward, it appears that most of us are way off the mark:

 

What Anita Hill Can Teach Us

 

If there isn’t a word or phrase for something, does that something exist?

According to the Washington Post, the Trump administration, without warning and without giving reasons, has ordered the Centers for Disease Control and Prevention (CDC) to stop using certain words in their budget documents and in communications with Congress. The words are “evidence-based,” “science-based,” “vulnerable,” “fetus,” “diversity,” “transgender” and “entitlement.”

The Post reports that CDC staffers were stunned by what they say is an unprecedented act of censorship. Swift condemnation followed from across the science community. For example, here’s part of a joint statement called Reports of Censorship in Federal Budget Document, issued by the Infectious Diseases Society of America (IDSA), the HIV Medicine Association, and the Pediatric Infectious Diseases Society:

We find this unacceptable and disturbing… When ideology, fear, and ignorance dominate discourse in the public health arena, consequences are deadly. More than three decades ago when HIV first appeared in the U.S., the federal government’s unwillingness to acknowledge the epidemic and to allocate resources allowed the HIV epidemic to expand further and faster…. Timely intervention could have saved many thousands of lives. (Emphasis added.)

 

The allocation of resources, i.e., government funding, is a crucial determinant of health. As Jack Halberstam, professor of gender studies at Columbia University told Democracy Now, when you prohibit these words in funding requests to Congress:

[I]t has the effect of suppressing the exact kinds of health projects that people might submit that are based [on] and are in relationship to, people of color, queer people, women. Those are the targeted groups in that list. And it’s a very—or not very subtle way of saying, ‘We don’t particularly care about delivering … healthcare to those people.’ (Emphasis added.)

 

The IDSA charge that the ban constitutes an “unwillingness to acknowledge” a problem or a category of people is a very serious one, especially given our history with AIDS. But there’s another equally serious problem that’s caused by stripping the CDC of critical language – a basic inability to even think about let alone publicly acknowledge, the health issues of vulnerable people.

To understand this induced inability to tackle an issue, take another look at the story that’s front page news across the country: the sexual harassment of women in the workplace. Historically, there was an unwillingness to tackle it. But in the very beginning the issue wasn’t so much unwillingness as it was an inability to tackle it, and that inability was also grounded on what’s happening at the CDC – the lack of critical language.

In 1974, professor Lin Farley ran a Woman and Work class at Cornell University where she unexpectedly discovered that every one of her female students had been forced out of a job or fired because they rejected the sexual advances of a male boss. My God, Farley thought, it can’t be just this group of kids; but sure enough, further study convinced her that across the country women labored in hostile work environments ruled by men.

But Farley had another problem – no one knew what to call this phenomenon. No word or phrase then existed to describe the pathology she was witnessing. So she invented one: “sexual harassment of women on the job,” thereby giving birth to (1) the ability to talk about the subject and raise the consciousness of men and women, and (2) the ability to hold transgressors accountable.

Accountability was the issue on October 11, 1991, when University of Oklahoma law professor Anita Hill, using the charged language of “sexual harassment,” sought redress not for herself, but for a nation. In a publicly televised senate confirmation hearing for U.S. Supreme Court nominee Clarence Thomas, professor Hill, sitting alone at a table, facing some of the most powerful men in the country, provided painful, detailed, credible testimony of the prolonged sexual harassment she suffered from Thomas, who had been her boss at – of all places – the Equal Employment Opportunity Commission (EEOC).

Though Thomas was eventually confirmed – narrowly, the vote was 52 to 48 – some things began to change. For example, women filed twice as many sexual harassment complaints to the EEOC over the next few years.

But the coming out moment for sexual aggression had to wait until October 5, 2017, when the New York Times, in a groundbreaking report, revealed multiple allegations of sexual harassment against powerful film producer Harvey Weinstein, which led to the resignation of four members of the Weinstein Company’s all-male board, and to Weinstein’s firing – and that was just the beginning.

Innumerable similar allegations have spread far and wide ever since. So much so that Wikipedia has a new entry called the “Weinstein effect,” defined as a global trend in which people come forward to accuse powerful people, mostly men, of sexual misconduct.

And that trend will be publicly adjudicated in the United States by non-other than Brandeis professor of law and social justice, Anita Hill. On December 16 this year professor Hill was appointed to head the Commission on Sexual Harassment and Advancing Equality in the Workplace. It was created by Lucasfilm and the Nike Foundation to tackle widespread sexual abuse and harassment in the media and entertainment industries.

And remember those senate confirmation hearings? They were chaired by then senator Joe Biden who last week, according to Time magazine, finally acknowledged how badly Hill was treated: “I wish I had been able to do more for Anita Hill. I owe her an apology,” Biden said. “My one regret is that I wasn’t able to tone down the attacks on her by some of my Republican friends. I mean, they really went after her.”

So far so good. But imagine something. What if an order came down stripping Hill of some of the critical language she will need to do her work. For example, what if Hill’s funding was conditioned on her not using the words “sexual harassment.” And she was further ordered not to refer to young actresses as “vulnerable,” or say that her findings were in any way “evidence-based.” That, of course, would be absurd, it would be cruel – it would never happen.

But that’s exactly what just happened at the CDC. Where the victims are once again women, plus some of our most vulnerable – transgender people, communities of color, and everyone living with and at higher risk of HIV – and their partners and families.

With the wisdom of being able to look back on it all, Anita Hill says:

People in power are actually the ones who often exhibit the worst behavior. And they’re setting the tone for others in their workplaces that women are not to be valued. That’s the real tragedy.

That’s the reason the CDC story is a tragedy – precisely because the Executive Branch has knowingly increased the number of people who are “not to be valued.”

 

MRSA goes to the beach

 

Dr. Tara Smith’s research group from Kent State’s College of Public Health spent two summers on a MRSA hunt at a place rarely checked for the bug – the beach.

From April to September in 2014 and 2015, Smith’s group collected a combined 280 sand and water samples from 10 freshwater beaches that lie on the shores of Lake Erie in Northeast Ohio. They were looking for Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) and found a higher-than-expected prevalence for both: Staph aureus was found in 64 sand and water samples (23 percent) and MRSA in 23 samples (8 percent). Most of the bugs were found in June and July when it’s the hottest and most humid.

Smith’s findings matter because with all that exposed skin minor cuts easily occur. And that’s all the opportunity Staph needs to turn a non-event into a severe or life-threatening illness such as sepsis or endocarditis. As Dr. Smith’s paper reminds us, “roughly 11,000 people every year in the United States die of staph and MRSA-related disease, while the bacteria cause another 80,000 invasive infections and millions of skin and soft-tissue infections.”

Here’s the good news: “Simply using the showers that many beaches provide to rinse off after being on the beach or in the water can help you avoid carrying that bacteria home with you,” Smith says.

And for those lucky enough to have a backyard pool: Although Staph and MRSA are able to survive for extended periods of time in freshwater (and seawater), “they are killed within 24 h in properly chlorinated pool water.”

How parents can introduce their children to the world of microbes and disease

How do you get kids to brush their teeth and wash their hands when your rather dodgy argument is that, if they don’t, millions of invisible creatures will invade and make them sick? To bring that world to life, here’s a clever story told from the perspective of Staphylococcus aureus – “but you can call me Staph” – that rounds the bases on important issues without using the fancy words. For example, why do bugs live in us – what’s in it for them? What has this “crazy evil thing called antibiotics” done to their lives – and to ours? And the big question: Will they get a happy ending – that day when our poisonous antibiotics will no longer threaten their lives?

All that and more in 4 minutes:

Bacteria are like opossums – they live stupid and have a lot of offspring

 

Bacteria are essentially DNA wrapped in a coat. No brain, no spinal cord, no ability to think. So why, then, do we say they “outsmart” us? Is it really, as we so often read, an “arms race” between us and “clever” bacteria who have begun to “outsmart” us and our drugs? Or is there something else going on that better explains things?

Mike Apley, a veterinarian, and professor of medicine and clinical pharmacology at Kansas State University’s College of Veterinary Medicine, offers us an alternative view of bacteria:

Bacteria are like opossums; they live stupid and have a lot of offspring. It’s not that the bacteria outsmart us, but it’s that there are so many offspring with so many different mutations that the ones that can survive multiply, and we have a new, adapted population.

 

Apley is nobody’s fool. Aside from the above credentials, he was also a member of President Obama’s prestigious Advisory Council on Combating Antibiotic-Resistant Bacteria.

To understand his seemingly silly statement, take a look at the standard diagram used to teach antibiotic resistance. The trick is in going from step 2 to step 3. Question: What did the two (antibiotic resistant) bacteria do in step 2 that was so “clever” that resulted in so many of them in step 3?

 

Answer: Not a thing. They survived – that’s all they did. And then they did what bacteria do all day – they had “a lot of offspring.” So now we have a ton of bacteria all of whom are resistant to our drugs – Apley’s “new, adapted population.”

So if it’s not a case of us being outsmarted by the bacteria, then what’s going on here? In Apley’s view, it’s just your basic case of evolution and natural selection – which isn’t what most people think it is.

Carefully thought through, the antibiotic resistance diagram – going from step 2 to 3 – corrects this common yet crucial misunderstanding: Bacteria under threat from antibiotics don’t change by acquiring the trait of antibiotic resistance, thereby “outsmarting” us. Instead, what happens is that those few bacteria that already possess the trait of resistance to antibiotics, survive the onslaught of the drug and go on to reproduce.

This Khan video smartly explains what evolution is and isn’t. To get the most out of it, keep in mind that the example they use of an advantageous trait selected to be passed on to future generations – longer legs – is analogous to the advantageous trait of antibiotic resistance in bacteria that they, too, pass on to future generations.

 

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