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Frontline Re-Airs “Hunting the Nightmare Bacteria” Tonight

Frontline

 

In case you missed it the first time round, be sure to watch Frontline’s re-airing tonight of their exceptional report on the rising plague of antibiotic resistance. As they put it:

Has the age of antibiotics come to an end? From a young girl thrust onto life support in Arizona to an uncontrollable outbreak at one of the nation’s most prestigious hospitals, FRONTLINE investigates the alarming rise of a deadly type of bacteria that our modern antibiotics can’t stop.

Infectious disease specialist Brad Spellberg, MD, who runs the Los Angeles County-University of Southern California Medical Center, calls their report a “phenomenal story.”

Here’s the trailer:

Health Care Watch: From Robin Hood to Robbing the Hood

Since 2004 the US health care system has consistently ranked last among high income countries, according to a report in The New England Journal of Medicine. For example, “its population is sicker and has higher mortality than those of other high-income countries” and “the rate of death from conditions that can be managed and treated effectively is far higher than in other high-income countries.”

Three reasons are given: Too many people simply can’t afford US health care; there’s too much bureaucratic “hassle” for those that can afford it, and; the system marginalizes the poor, the less-educated, and those of a certain “race or ethnic background” (read: African-Americans & Hispanics). The common thread is “these three features disproportionately affect the quality of care for populations with higher health risks due to lower income, lower educational level, or minority status.”

 

NEJM

NEJM

 

Yet the Journal goes on to argue optimistically that the “United States could achieve the best-performing health care system in the world by undertaking coordinated efforts that address each of these challenges.” And we should begin, the Journal says, by expanding the Affordable Care Act and Medicaid eligibility.

But the government has a better idea: repeal the ACA and thus eliminate Medicaid expansion. Which would, according to the Congressional Budget Office (1) increase the number of uninsured by 18 million in the first year of the repeal (2) increase that number to 32 million by 2026 (3) immediately hike insurance premiums by 20 – 25% for those able to afford private coverage, and (4) further raise those premiums by 50% by 2026.

Hmm, that seems like a strange way to move the US from the bottom right on the graph to the top left, as the Journal says we’re quite capable of doing. Oh, wait a minute, what was it President Obama (and pretty much everyone else) said about the real reason for the repeal?

The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. … Simply put, if there’s a chance you might get sick, get old, or start a family—this bill will do you harm.

 

MRSA Goes to Hollywood

 

BEVERLY HILLS, CA: MRSA, traditionally a hospital bug, is on the move. Increasingly it’s being found in the community, especially where people gather: athletic facilities, schools & daycares, military barracks, and downwind of industrialized food animal farms. And now, a California lawsuit reveals, it’s hanging out on Wilshire Blvd at the Beverly Hilton Hotel – home of the Daytime Emmy and Golden Globe Awards.

Texas businessman, reality show developer, & now plaintiff, Larry Poe, went for a facial at the Hilton Hotel spa just as he has 100 times before. But this time was different. Poe says the spa aesthetician poked him with a pair of tweezers in an attempt to remove a hair from his upper lip, and this caused a small wound to open. The tech applied a cream to try and sooth it but it was too late – MRSA had either already slipped in, or was contained in the cream and entered the wound upon application. Either way, his lip soon began to swell and after 3 days of unrelenting pain & swelling Poe finally went to the ER where he was diagnosed with MRSA. He was immediately quarantined and needed 4 days of hospital care to get well again.

Larry Poe is just one of the more than 80,000 people a year in the US who suffer a serious MRSA infection. Thankfully, he was not one of the more than 11,000 people who die from it. But he’s paying a price: on top of his pain, anxiety over treatment outcome, and missed work, he’s left with a permanent scar (troubling because he’s a public speaker), tens of thousands of dollars in medical bills, and the travails of pursuing a civil suit against a well-resourced corporation.

 

 

Antibiotics and unintended harm

Here’s a great infographic by ID specialist Michael Edmond, MD, on the unintended harm caused by antibiotics. It nicely summarizes the JAMA paper published last week that we ran a brief report on here.

Notice the figure at the bottom left that says “19% of antibiotic regimens not clinically indicated.” Meaning 19% of the antibiotics prescribed shouldn’t have been, and as the JAMA paper points out these prescriptions also harmed 1 in 5 patients. And this is Johns Hopkins, ranked as one of the best hospitals in the US. Across the country that number is much higher. A report in Medscape says “… up to 50% of antibiotic prescriptions in the United States continue to be unnecessary or inappropriate.”

 

Collateral Dmg

A gorilla walks into the operating room …

An emerging concept in medicine is the One Health movement that says human health is inextricably linked to the health of animals & the environment. And that human & veterinary medicine will unite as one discipline. For example, it’s been shown that MRSA travels back & forth between owner & pet.

The following story illustrates the idea. But that’s not really why we’re running it. It’s because it’s so darn heartwarming. And in this time of politically-driven pathology we need stories that remind us of our common humanity. In addition to the video, there’s a neat backgrounder piece – it’s brief – in the Atlantic about the surgeon who delivered the baby gorilla & her day at “the office.” Be sure to read it to the end where there’s a nice surprise waiting.

Johns Hopkins study: 1 in 5 patients harmed by antibiotics

ABx2

 

Question: What is the likelihood of developing an antibiotic-associated adverse drug event (ADE) for a hospitalized patient receiving antibiotic therapy?

Answer: 1 in 5 patients experienced at least one antibiotic-associated ADE.

Researchers looked at the medical records of 1488 adult inpatients at Johns Hopkins Hospital & found a total of 324 ADEs overall. The most common one’s were gastrointestinal, renal, and hematologic abnormalities, accounting for 78 (42%), 45 (24%), and 28 (15%) 30-day ADEs, respectively. Of those, 186 (57%) happened within 30 days, and 138 occurred within 90 days. Of the 138 ADEs occurring within 90 days, 54 (39%) were cases of the life-threatening Clostridium Difficile Infection, and 84 (61%) were Multi-Drug Resistant Organism infections, such as MRSA.

The researchers suggest the 1 in 5 figure is probably an underestimate because the study did not include patients seeking out-of-network care or those receiving prolonged or inappropriately broad antibiotic therapy.

The authors didn’t say this, but keep in mind that the study was done at Johns Hopkins – perennially ranked as one of the best hospitals on the planet.

Conclusion: “Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs,” said one researcher.

Decrease the Demand Please

Here’s a helpful video on antibiotic-resistant infections from Time. The key message is that we’re misusing antibiotics in 2 ways:

(1) We use them for the flu which isn’t affected by these drugs. And according to the CDC, antibiotics can’t cure the common cold or viral pneumonia, are almost never needed for bronchitis, are not recommended to treat many ear infections, and are typically not needed to treat a sinus infection (sinusitis).

(2) 80% of antibiotics are used in our food animals to keep infections at bay (i.e. they’re used on the animals when they aren’t even sick), and as a way to encourage chickens, pigs, cattle, turkeys, and (farmed) fish, to grow larger and produce more meat.

The upshot is that with so many antibiotics circulating in people and in animals, bacteria mutate to find ever more clever ways of becoming resistant to the drugs. The answer is to put the brakes on how we use antibiotics: we need to decrease the demand. Treat them more as a drug of last resort & limit their use in industrial farming to the treatment of sick animals.

 

Oops: The U.S. spends $3.4T a year on healthcare. And look what they get for it

From the Stanford School of Medicine’s conference on Big Data last week, the following graphic has emerged that’s attracting a lot of attention on Twitter. And as sobering as these numbers are, there was a report out of Johns Hopkins last year that said medical error is actually the 3d leading cause of death in the US – and that probably underestimates the scope of the problem.

This is from the Twitter feed of Eric Topol, MD, who was the opening speaker at the Stanford conference:

 

Big Data 2

 

 

 

 

The G20 enters the fray

German Chancellor Angela Merkel poses for a group picture at a meeting of the G20 health ministers in Berlin

While this guy is being lambasted for his approach to science & medicine, we can be thankful that the true leader of the free world, Angela Merkel – who holds a PhD in chemistry – is going about things quite differently.

For example, this past weekend under the leadership of Chancellor Merkel, Health ministers of the G20 leading economies met for the first time and agreed to work together on the growing problem of drug-resistant infections and to start implementing national action plans by the end of 2018. In a joint statement the Health ministers stressed the need to:

  • Combat antimicrobial resistance (AMR) through appropriate monitoring and surveillance of antimicrobial resistance and consumption in G20 countries
  • Raise awareness on AMR prevention and control across multiple stakeholders
  • Prioritise the need for infection prevention, control, sanitation and vaccination across health systems
  • Promote judicious use of antimicrobials through education and training of health professionals
  • Foster research and development for new antimicrobials, alternative therapies, vaccines and rapid-point-of care diagnostics

But why is the G20 – whose mandate is the promotion of international financial stability – making antibiotic resistance a priority? Here’s what economist & former chairman of Goldman Sachs, Jim O’Neill (who wrote a highly persuasive report on antibiotic resistance commissioned by then Prime Minister David Cameron) said last September:

As [drug-resistant infections] renders established antibiotics ineffective untreatable infections will make relatively routine procedures such as organ transplants or cancer chemotherapy increasingly risky. The human and economic toll of rising [drug-resistant infections] could easily spiral out of control: left unchecked, drug-resistant infections could claim ten million lives annually by 2050, with the cumulative cost in terms of global GDP reaching $100 trillion. [My emphasis.]

In other words, as the G20 said at the same time as the O’Neill statement, “AMR poses a serious threat to public health, [economic] growth and global economic stability.”

 

The other problem with antimicrobial resistance: We don’t know what the words mean

If you don’t understand the term “antimicrobial resistance,” don’t feel bad  —  neither does anybody else. In a commentary & interview this month with the leading science journal Nature, infectious disease specialist Marc Mendelson said the term “antimicrobial resistance” is not understood by the public and should be abandoned, replaced with “drug-resistant infection” and “antibiotic resistance.” Dr. Mendelson:

The studies … highlighted the fact that the main term … that is used … “antimicrobial resistance,” less than 50% of people have heard of the term; that it’s abbreviation which is commonly used, which is AMR, less than 20% have heard of this term; and there’s a complete blank look on people’s faces often when you discuss these terms. So, without understanding of the problem, use of … terminology … that people don’t understand can have serious impact on your ability to try and take the discussions and, more importantly, the actions, further.

This matters because the problem of drug-resistant infections requires more than just scientists to solve. Mendelson: “It requires engagement from a much broader array of players, from governments, regulators and the public, to experts in health, food, the environment, economics, trade and industry. People from these disparate domains are talking past each other. Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations.” Hence the need to get everyone on the same language page.

Mendelson offers a cogent example of the benefit of adopting the right words: The decision to name the cause of AIDS as human immunodeficiency virus (HIV) in 1986  —  instead of human T-cell lymphotropic virus (HTLV-III) or lymphadenopathy-associated virus (LAV)  —  helped people to understand that the disease was caused by a virus that harms the immune system. “As such,” he says, “it was crucial in tackling stigma and phasing out terms such as ‘the gay plague’, which had previously dominated communication around AIDS.”

The following video was made for the public and nicely explains what a drug-resistant infection/antibiotic resistance is. In brief, it’s a 3-part harmony between the bug, the drug, and you. As bugs like staph aureus or E. coli get increasingly exposed to our drugs (antibiotics) through rampant misuse and overuse, the bugs fight back by successfully resisting the drug’s effect, & thus we stay sick. The media coined the term “superbug” to refer to bugs that have evolved this resistance.

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