MRSA’s “Moon Shot”

This past Sunday, using the same launch pad that sent Neil Armstrong and Buzz Aldrin to the moon in the summer of ’69, NASA launched MRSA (below) to the International Space Station in order to conduct a novel experiment, as we explained last week.

The day before the launch, the lead scientist of the MRSA mission, Harvard’s Anita Goel, MD, PhD, in an interview with the CBC, told us why she selected MRSA, what she hopes the experiment will accomplish, and how she’s feeling on launch eve.

 

 

On MRSA: “MRSA … stands for methicillin-resistant staphylococcus aureus, a superbug, that’s a hospital-acquired infection that’s rampant in hospitals across North America and the world actually. And this bug rapidly mutates to become drug-resistant to current antibiotics which means it can easily spin out of control.”

On the experiment: “If we can use microgravity in space as an incubator to fast forward what these mutations of this superbug MRSA will look like in the future, we can build better drugs on Earth well before these mutant strains actually come, or emerge on the ground.”

Goel explained that the experiment is still proof of concept: namely, will the microgravity environment actually fast forward the growth rate of MRSA? And if so, how does it do that?

And how is she feeling one day before the big event? “It feels a little bit like what it might have been to be there on the first space launch when we had the first man mission to the moon … it feels like a moon shot.”

Planes, Trains, and Automobiles

air travel

 

Below is the second of three installments of NPR’s entertaining and informative animated series about our relationship to germs.

While you’re watching it, reflect on the significance of (then) Center for Disease Control Director Tom Frieden’s warning that “A disease outbreak anywhere is a risk everywhere …. We are all connected by the air we breathe, the water we drink and the food we eat, and the next outbreak may be just a plane ride away.”

Do you agree?

The video offers some supporting evidence from history: “When people figured out how to sail around the world new germs came with them. The results weren’t pretty. In the centuries after Columbus’s voyage across the Atlantic some estimates say 90% of the entire Native population of the America’s died, mostly from diseases the Europeans brought with them.”

I hope you like the 3 minute film and if you do pass it on. The final installment should air in 2 weeks.

 

The Choice

Choice 1

 

Do you know anyone who would take medicine away from a sick child?

Take a close look at the powerful opinion piece in today’s Times by Baylor College of Medicine physician Peter Hotez. He warns that because of the new U.S. administration’s view of science, 2017 is “looking as if” we will “see a reversal of several decades in steady public health gains,” and “[t]he first blow will be measles outbreaks in America … one of the most contagious and most lethal of all human diseases.” (My emphasis.)

Hotez’s point is that sickness and health is about more than just bugs and disease, it’s also about how we choose to fight disease. We can come at disease with all we’ve got, i.e. rely on the best available science or, as Hotez argues we’re beginning to do, rely on “pseudoscience” and “myth.” And that if we opt for this junk science approach then understand that the consequence will be lethal and personal: more of us – children and the elderly, especially, because of their weaker immune systems – will get sick, suffer, and die, inevitably.

And if that is the case then let’s be completely honest: the analogy drawn in the first sentence above isn’t quite right. It should read, instead:

Do you know anyone who would take medicine away from sick children across the country?

 

The Good Host

People 2

 

For germs to thrive they need help – ours. We’re what biologists call ‘hosts’: “the larger participant in a relationship … often providing a home and food source ….”

A new 3-part series on NPR examines our relationship with germs. Part 1 began with man’s early encounters with microbes and concluded with this observation:

 

Luckily, humans were so few and far between back then that this virus [or bacterium] can’t find any more humans to infect. That first mutant virus [or bacterium] doesn’t get very far. But after many thousands of years something big starts to change: humans discovered agriculture. This means we started to settle down …. We started having large families, more neighbors; there’s more food.

 

Part 2 of the NPR series will be aired Thursday. If you watch it, keep in mind that in the ensuing decades the U.N. estimates that:

(1) The world population will increase by 2.3 billion people by 2050, reaching almost 10 billion in all.

(2) We will have a lot more close neighbors: In 2014 there were 28 “mega-cities,” defined as having 10 million inhabitants or more; by 2030 the world is projected to have 41 mega-cities.

(3) The number of persons aged 60 or above – people with weaker immune systems – is expected to more than double by 2050.

In other words, there will be a lot more good hosts out there, all ready – willing or not – and able, to provide food and shelter to the germs mentioned in the broadcast as well as to these guys.

Here’s the series opener. It runs less than 3 minutes:

 

Back to Basics: The Bug, the Drug, and You

Before you tackle a problem, you need to understand it. But a 2015 World Health Organization survey confirms something we’ve suspected all along – there’s still way too much confusion out there about what antibiotic resistance actually is. For example, the WHO survey found that “76% [of respondents] think that the statement ‘Antibiotic resistance occurs when your body becomes resistant to antibiotics and they no longer work as well’ is also true, when this is in fact a false statement.”

This two-minute video from Stat News – which they run with most of their antibiotic resistance stories – addresses the above misunderstanding. As they teach you in first year law school, when you approach a problem, always identify who the “actors” are – in this case, the bug, the drug, and you – and what their relationship is to each other. So if you’re in the majority and don’t understand why the above statement from WHO is false, this video should help you. (A larger video can be found in the body of this article.)

Simply Unprecedented

Doomsday clock 2

 

In a bold, unprecedented move, U.S. scientists are planning the “next big march on Washington” because they’re “alarmed by the clear anti-science actions taken by the Trump Administration.”

For example, the Administration ordered the Environmental Protection Agency to get rid of mentions of climate change from its website, froze its ability to award of research grants and contracts, and ordered its scientists to stop talking to the press and the public – including Congress. Gag orders also issued to the Department of Agriculture, Health and Human Services, and the National Park Service.

“I’m not aware of any such policy in the past,” said David Lobell, a Stanford University agricultural scientist, in an interview with Scientific American. “Our society deeply depends on good science, and good science depends on open communication. … this as a sign that the administration does not appreciate the critical role that science plays in our nation’s success.”

A brief sampling of our leading science and medical journals also show unprecedented alarm. From the venerable New England Journal of Medicine: In “Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS,” the authors argue that HHS nominee Tom Price’s record “demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.” From Nature: “Scientists must fight for the facts — President Trump’s unconventional stances cannot go unchallenged.” From Science: “Here’s some advice for you, President Trump, from scientists.” And so on: simply Google your favorite science journal together with the word “Trump” and you’ll get a handful of listings in each.

And then yesterday came the dire announcement from the Bulletin of the Atomic Scientists — putting all this in a global perspective — that it moved its Doomsday Clock ahead to two and a half minutes to midnight, thus moving the planet closer to a catastrophic disaster than at any time since 1953:

In its two most recent annual announcements on the Clock, the Science and Security Board warned: ‘The probability of global catastrophe is very high, and the actions needed to reduce the risks of disaster must be taken very soon.” In 2017, we find the danger to be even greater, the need for action more urgent. It is two and a half minutes to midnight, the Clock is ticking, global danger looms. Wise public officials should act immediately, guiding humanity away from the brink. If they do not, wise citizens must step forward and lead the way.

(For those unfamiliar with the award-winning Bulletin, its Doomsday Clock may sound like something out of a Wile E. Coyote cartoon, so here’s yesterday’s NYT op-ed by Bulletin scientists, and here’s a little backgrounder on the Bulletin, from which I lifted this:

Founded in 1945 by University of Chicago scientists who had helped develop the first atomic weapons in the Manhattan Project, the Bulletin of the Atomic Scientists created the Doomsday Clock two years later, using the imagery of apocalypse (midnight) and the contemporary idiom of nuclear explosion (countdown to zero) to convey threats to humanity and the planet. The decision to move (or to leave in place) the minute hand of the Doomsday Clock is made every year by the Bulletin’s Science and Security Board in consultation with its Board of Sponsors, which includes 15 Nobel laureates. The Clock has become a universally recognized indicator of the world’s vulnerability to catastrophe from nuclear weapons, climate change, and new technologies emerging in other domains.)

Trump

 

What’s most telling about the Bulletin’s announcement — distinguishing it from all past announcements — is how they reached their conclusion: similar to the reasoning in the science journals they also zeroed in on Trump:

This already-threatening world situation was the backdrop for a rise in strident nationalism worldwide in 2016, including in a US presidential campaign during which the eventual victor, Donald Trump, made disturbing comments about the use and proliferation of nuclear weapons and expressed disbelief in the overwhelming scientific consensus on climate change …

Just the same, words matter, and President Trump has had plenty to say over the last year. Both his statements and his actions as president-elect have broken with historical precedent in unsettling ways. He has made ill-considered comments about expanding the US nuclear arsenal. He has shown a troubling propensity to discount or outright reject expert advice related to international security, including the conclusions of intelligence experts. And his nominees to head the Energy Department and the Environmental Protection Agency dispute the basics of climate science. In short, even though he has just now taken office, the president’s intemperate statements, lack of openness to expert advice, and questionable cabinet nominations have already made a bad international security situation worse.

Last year, and the year before, we warned that world leaders were failing to act with the speed and on the scale required to protect citizens from the extreme danger posed by climate change and nuclear war. During the past year, the need for leadership only intensified—yet inaction and brinksmanship have continued, endangering every person, everywhere on Earth. Who will lead humanity away from global disaster?

He probably doesn’t want the leadership role, but last October Noam Chomsky, “arguably the most important intellectual alive today,” essentially foretold what the Bulletin announced yesterday. But he added something:

Another major problem is the threat of pandemics — diseases that can’t be controlled. That’s already happening, and it’s happening for important reasons. One reason that we haven’t mentioned … is industrial meat production. Industrial meat production is a huge contributor to global warming. It’s an enormous producer of carbon dioxide and methane.

But it also has another feature. Corporations pour antibiotics into these systems. Animals are crowded together in horrible conditions and to prevent disease and to maintain growth there’s an extensive use of antibiotics. An enormous part of antibiotic production is for this. Use of antibiotics leads to mutations which make bacteria antibiotic resistant. We’re now … the rate of antibiotic resistance is growing faster than the techniques for dealing with them. So we may be destroying ourselves in that way too.

The Obama administration felt the same way. And so, guided by the presidential science advisor, John Holdren, PhD (Stanford), who headed the Presidential President’s Council of Advisors on Science and Technology (PCAST), they drew up the “National Action Plan for Combating Antibiotic Resistant Bacteria.” Significantly, when Obama announced the Plan, he said “it covers the next five years starting right now.” That was March, 2015.

The Trump administration has not yet filled three top government positions. The presidential science advisor is one of them. The two rumored choices are not popular with the science community: one is a climate skeptic, the other “a critic of liberal academia,” according to Nature.

Yesterday, I went to the PCAST website to check on the progress of the Action Plan for Combating Antibiotic-Resistant Bacteria, “one of the most serious public health issues we face today,” according to Obama. This is what I found:

Screenshot (2)

Farewell to the Science President

When it comes to US Presidents and science, “Barack Obama is seen as setting the modern standard,” writes the American Academy for the Advancement of Science. Here, for example, are 100 examples of his leadership on the subject – quite a legacy. And here’s a video of Obama addressing antibiotic resistance (he gets it), which he calls “… one of the most serious public health issues that we face today.”

But science is more than just serious stuff. This video of Obama at last year’s White House Science Fair shows us the fun side, while at the same time engaging the public and our youth in a subject that’s so vital to our future. We will miss this:

Feeling Confused? It could be the antibiotic

confused

 

Antibiotics are not who we thought they were: a wonder drug without consequences. For the last ten years or so evidence has been pouring out of our best institutions that antibiotics will harm you. For example, NYU’s Martin Blaser, MD, argues in his book Missing Microbes: How the Overuse of Antibiotics is Fueling Our Modern Plagues, that antibiotic use actually increases your risk for infection, especially over the long run, and for such other things as obesity, diabetes, asthma, food allergies, and esophageal reflux.

Now comes a report in Medscape News that antibiotics can compromise mental function as well. They can leave you feeling confused, sedated or delirius, and prone to seizures, mood changes, psychosis, and hallucinations. The elderly, especially, are at risk, as are those with central nervous system disorders, and renal dysfunction – both of which are more common in older people.

The incidence varies from a few isolated cases to, in one study, over 50% of elderly patients receiving high-dose clarithromycin (used to treat such common ailments as strep throat, pneumonia, and skin infections).

Researchers aren’t sure why this is. They think it may be due to the antibiotic adversely interacting with other medications the patient is on, or by interfering with neurotransmitter function.

Antibiotic-driven mental impairment is usually overlooked because of what psychologists call faulty attribution: attributing some effect or symptom to an easily recognized characteristic of a person – old age, say – rather than looking for some other, sometimes deeper, explanation. Fancy words for thinking that since this person is old and perhaps sick, that must be why they’re confused.

Here’s why this matters: By not considering the antibiotic as the real cause for mental impairment we’re missing an opportunity to correct it. For instance, by decreasing the drug dose, changing the antibiotic, or eliminating it when possible, researchers say that the confusion, etc. will usually resolve itself within 48 hours.

From Farm to Fork: How does giving antibiotics to livestock result in superbugs on your plate?

Of the more than 8 billion food animals — mostly cattle, pigs, chickens, and turkeys — raised for consumption in the U.S. every year, most receive some antibiotics during their lifetimes. The antibiotics are given for two reasons: to make the animals grow faster and to prevent them from getting sick (called ‘prophylactic use’). This confers a financial benefit to people who raise the animals. But with that benefit comes a hidden cost to the rest of us: more bacteria that are resistant to antibiotics. This makes infections harder, or even impossible, to treat. In other words, with more resistant bacteria in the environment, people remain sicker, longer.

But how does that work? How does putting antibiotics in the feed for cows on an industrial farm in Iowa increase the risk of an antibiotic resistant infection for someone living in Portland?

The basic equation is this: Antibiotics in, antibiotic resistant bugs (i.e. bacteria) out. When you expose bacteria – which line the gut of animals — to antibiotics, you create the risk that you kill off the susceptible bacteria and leave the resistant ones. The resistant ones quickly reproduce (e.g. a single E. coli bacterium can produce 69 billion progeny in just 12 hours) and fill up the spaces formerly occupied by the susceptible bacteria. During the slaughtering process these resistant bacteria enter the food chain and thus, eventually, our homes. The following graphic illustrates the point:

 

livestock

 

Infectious disease specialist Brad Spellberg, MD, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, explains:

I think the real concern is not so much that there is residual antibiotics in the meat. The concern is that during the butchering process there is almost invariably some degree of contamination of bacteria in the meat. And those bacteria that were exposed to antibiotics are often antibiotic resistant. So the concern is transmission of antibiotic resistant bacteria, from the meat, from the excrement of the animals which is used to fertilize crops, which can get into ground water, which has been shown possibly to even be spread by airborne ways. So it’s more about the spread of bacteria that are bred to be resistant by exposure to the antibiotics.

 

Notice something. The issue is not that antibiotics get into the flesh of animals, which we then eat. Rather, it’s that the routine use of antibiotics in food animals increases the number of antibiotic resistant bacteria in the environment, which in turn increases the chance we’ll be made sick by them.

In the same interview, Spellberg warns us of a trick used by food producers. They’ll label the meat with something like “Antibiotics not used for growth promotion.” What’s missing, he says, is the likelihood that they’re still using them for prophylactic use. Giving healthy animals antibiotics is no more acceptable than giving healthy people antibiotics, Spellberg says, as the above graphic suggests.

So, about that Christmas turkey. Be sure to read the labels, but even that can be tricky. For example, the labels “Antibiotic Free” or “Natural” can be meaningless. Here’s a useful guide from Consumer Reports on what to look for. This brief video from the report tells you a lot:

Follow the Money

Dr. Brad Spellberg

Dr. Brad Spellberg

Antibiotics are different than other drugs in one crucial respect: the more you use them, the less effective they become. That’s because the target of antibiotics – bad bacteria – are living organisms, and as such they, like humans, also struggle to survive. When they reproduce, for example, (bacteria can produce 500,000 generations in just 1 human generation) they do so in ways that fight our drugs, rendering them increasingly ineffective. This is the problem of antibiotic resistance, that the United Nations recently declared to be “the greatest and most urgent global risk.”

What’s less well known is that the great majority (~80%) of all antibiotic use in the United States is in food animal agriculture, where they’re routinely given to the animals to speed their growth and to prevent them from getting sick, what the medical community calls ‘prophylactic use’. The question is, are those legitimate medical reasons to dispense antibiotics? Or are they simply economic expedients that leave the rest of us unnecessarily exposed to harm, i.e. to an infection from bacteria that is resistant to treatment by antibiotics? The answer, according to one leading expert, is decidedly the latter.

Brad Spellberg, MD, is the Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, one of the largest public hospitals in the United States. Dr. Spellberg still sees patients, teaches clinical medicine, runs a research lab, and is a prolific author: in addition to his ongoing contributions to the medical literature on his research and on the public policy of antibiotic resistance, he wrote the uniquely informative book Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them.

What’s not on Spellberg’s resume but what’s abundantly clear from listening to him is that he’s refreshingly plain spoken. In an interview with PRI’s Science Friday, Spellberg took on the issue of our routine use of antibiotics in food animal agriculture.

Inside The Van Ommering Dairy As U.S. Milk Production Declines

“Resistance continues to spread,” he says, “because we continue to so badly abuse antibiotics and overuse them …. Four times as many antibiotics are purchased for use in livestock than for use in human beings in the U.S. It is true that we cannot say definitively what proportion of resistant infections in humans is attributable to the use of antibiotics in animals. But we can say there is a contribution. And so societally, rather than getting into a debate on the minutiae of what proportion of this causes that, the point really is, since we know it contributes – and that’s a serious societal negative, or con – what is the pro that it offers society that should allow us to want to put up with that con?” Here’s where the plain talking Dr. Spellberg hits his stride (the bold emphases are mine):

And the pro really is, the people who use antibiotics in livestock believe that it allows them to make more money. So one group in society believes it can make more money by putting antibiotics into livestock – which does create a risk of harm to other people in society. Why our society chooses to tolerate that remains unclear to me.”

Should we as a society decide that a small economic advantage to a small group of people in our society is a reason we should accept [for] creating a risk of harm to everyone else in this society? Does that make sense from a societal policy perspective?

When patients die of resistant infections … people say well I don’t know what proportion of those infections are caused by routine use of antibiotics. But when 80% of our antibiotic use is in livestock we have to acknowledge that we’re saying it’s okay that we know people will be harmed, because we don’t know how many and because some people are making money off it. To me, that equation does not add up.

The thing is, this routine use of antibiotics in agriculture may not even be delivering the financial benefit we thought. Spellberg: “… there have already been multiple countries that have already banned growth promotion and routine prophylactic use of antibiotics. And not only have farmers not been harmed economically, they have expanded their herds after the ban …. Denmark had a marked expansion in its pig production after they did the ban.”

And so we continue to engage in this risky behavior because?

 

 

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