The heat is on: Anthrax has already escaped from our melting permafrost. It probably will again, with other pathogens to follow.

Anthrax is a deadly bacterium. Inhaled, it will kill 8 in 10 people if not treated in time. That’s why, in the wake of the 9/11 attacks, it was the microbial weapon of choice sent through the mail to Capitol Hill and media figures. It affected 22 people, closed down the Hart Senate Office Building for months, disrupted mail delivery, took billions of dollars to fix – and terrorized a nation. Imagine, then, what would happen if Nature were to melt the earth’s layer of permafrost, thereby causing the release of centuries-old stored anthrax into our atmosphere.

The drip, drip, drip of Nature’s involvement in pathogen release began, perhaps, last summer in northwest Russia when it was reported that a 12-year-old boy was killed by anthrax and 90 others were sent to hospital. Officials said the outbreak was caused by an unusually intense summer heat that melted the permafrost, exposing a reindeer carcass containing anthrax that spread to the local population. The regional governor imposed a quarantine on the Yamal Peninsula – the affected area – and insisted that the situation was under control. In the Yamal, it probably was.

But the melting permafrost problem we’re left with wraps around the global north – which includes the upper areas of provincial Canada – and is growing. For example, Inside Climate News reported in February that a massive permafrost thaw is underway in Canada: that 52,000 square miles are in rapid decline and this is potentially accelerating global warming.

Permafrost acts like a giant freezer. More than 1,000 feet deep in places, it has captured, stored and kept alive bacteria and viruses for a very long time. But as the permafrost thaws those infectious agents such as anthrax will come back to life and eventually infect people and animals. That’s in addition to the more publicized effects such as methane gas emission – which warms the planet by 86 times as much as CO2 – and a heaving landscape strewn with impassable undulating roads, drunken trees, and collapsing homes & buildings.



Physician Birgitta Evengård, who heads the infectious disease unit at Sweden’s Umea University, studies how climate change alters the spread of diseases. She told NPR there’s likely to be more cases of anthrax resurfacing because climate change is causing the temperature in the Arctic Circle to rise very quickly.

EVENGARD: It’s about three times faster than in the rest of the world. And this means that the ice is melting, and the permafrost is thawing.

NPR: A hundred years ago, there were repeated anthrax outbreaks in Siberia. More than a million reindeer died. Now there are about 7,000 burial grounds with infected carcasses scattered across northern Russia.

EVENGARD: It’s not that easy to dig to bury these animals, so they are kind of very close to the surface.

NPR: Wow. So there could be these outbreaks happening every summer?

EVENGARD: Yes, this is serious.

NPR: People and animals have been buried in permafrost for centuries. There could be bodies infected with all kinds of viruses and bacteria, frozen in time. [Evengard] says scientists are just starting to look for it.

EVENGARD: So we really don’t know. This is Pandora’s box.

NPR: There’s also likely smallpox buried up there and the bubonic plague. So the question for researchers is, could these pathogens, like anthrax, ever be reactivated?

Healthy Reading

The irony of the Information Age is that because there’s so much of it, it can be even harder to figure out what to read. For example, if your concern is better health for you & your family, what books can you turn to that will actually prove helpful? That was the very question put by Medscape to its panel of primary care physicians. In response, the doctors came up with seven books they said they wished their patients would read. Here’s that list along with their comments.


Slide 3

Last Child in the Woods, by Richard Louv

“This book will make you really rethink the kind of activities in which your child engages and will make you want to unplug everything electronic! An iPad is no substitute for interaction with parents and nature.” —William T. Basco, Jr, MD, MS


Slide 4

Being Mortal: Medicine and What Matters in the End, by Atul Gawande, MD, MPH

“This book can help patients and their families to focus on what is really important in their final months. Quality of life can be more important than extending life. Our medical system is not always good at stressing this fact. This book gives insight into the medical system and better prepares anyone for difficult decisions we will all have to face someday.” —Harvey Hsu, MD


Slide 5

Worried Sick: A Prescription for Health in an Overtreated America, by Nortin M. Hadler, MD

“Nortin Hadler is the best MD in America at explaining complicated medical issues clearly for an aware public audience.” —George D. Lundberg, MD


Slide 6

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, by Walter C. Willett, MD

“I have had more questions from patients about diet and nutritional supplements than any other topic. The misinformation available from quack doctors on television, junk articles in checkout line magazines, and even in legitimate publications is unbelievable. I’ve purchased many copies of Eat, Drink, and Be Healthy for my patients since I haven’t had hours to discuss nutrition extensively. It’s always been a good investment for keeping my patients healthy.” —James J. Foody, MD


Slide 7

How Doctors Think, by Jerome Groopman, MD

“Effective communication is critical to the patient-doctor relationship. Dr Groopman provides unique insight into the minds of how doctors are trained to think. Understanding will help patients get the care they need.” —Joseph Ming Wah Li, MD


Slide 2

The Art and Science of Aging Well: A Physician’s Guide to a Healthy Body, Mind, and Spirit, by Mark E. Williams, MD

“Williams weaves together solid practical advice with a great understanding of how cultural and scientific views of aging have evolved over time. Patients will feel more comfortable and knowledgeable with all aspects of the aging process.” —Arefa M. Cassoobhoy, MD, MPH


Slide 8

Pain Free: A Revolutionary Method for Stopping Chronic Pain, by Pete Egoscue and Roger Gittines

“Egoscue-type stretch and relaxation exercises are a fabulous way to warm up your body and stave off back and shoulder pain (and ‘computer neck’). It’s also very relaxing and de-stressing; you don’t sweat, which means you can do them any time. They can also improve your golf swing, which often gets my male patients to try them.” —Sandra Adamson Fryhofer, MD

Just how fast is climate change moving?

“Climate [change] is moving much faster than scientists will tell you…. [And] because the science is being deliberately obfuscated in the US … the consequences are being obscured as well.…”

That didn’t come from Greenpeace. It came just this week from the venerable Financial Times of London, whose very survival depends on getting their facts right: misleading powerful institutional investors would not bode well for their future.

Maybe that’s why their brief video is one of the most persuasive explanations on climate change out there – with the added bonus of some related investment advice.

The United States at its Best

On May 25, 1961, President John F. Kennedy stood before a special joint session of Congress and uttered these now immortal words:

“I therefore ask the Congress … to provide the funds which are needed to meet the following national goals:

First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth. No single space project in this period will be more impressive to mankind ….”

Today, there’s another visionary space project taking place in the U.S. which has the potential to be even more impressive to mankind: nothing less than the creation of a whole new field of science that can revolutionize health care – indeed, our lives – here on earth.

Imagine – you’re sitting at home and begin to feel ill. Reminiscent of the infamous medical scanner used on Star Trek, you pull out your home medical scanner called Gene Radar, a device that fits in your hand. In step 1, you draw a drop of blood. The scanner conducts a genetic analysis which yields an immediate diagnosis for any RNA or DNA-based disease, i.e. any infectious illness and even, it’s hoped, cancers. In step 2, once you have the disease’s genetic fingerprint, you know which drugs to use to target that fingerprint.

So why a space mission? Because of the almost zero-gravity environment in space, it’s thought that cells – the experiment uses staph aureus – will mutate faster allowing you to record a fuller mutational spectrum. If you know the complete mutational patterns of disease cells in advance, you can then develop algorithms that will tell you how the cells will mutate from any particular starting point, for instance, at the point of the genetic profile taken in step 1, above. These algorithms thus become the basis for novel drug development. In step 2, above, you’re then able to select the (novel) therapeutic based on what the current genetic fingerprint is, how it will mutate, & over what period of time.

We’ve written about this paradigm-shifting work before. Here’s the short version (“MRSA’s ‘Moon Shot'”), and here’s the earlier long read (“Minority Report 2: Pre-Disease”). After we came out with those articles NASA published a brief video, below, along with a short narrative that further explains their groundbreaking work.

Understandably, no time frames are given for when NASA & the team of Harvard scientists who’re running the experiments expect to fully complete their work. We note, however, that 8 years after President Kennedy’s dramatic space announcement, that on July 20, 1969, Apollo 11 astronauts Neil Armstrong and Buzz Aldrin fulfilled his vision by landing on the moon and, four days later, returned safely to Earth.

The Antibiotic Prescription Problem: A message from the honeybees

HoneybeeEvidence continues to mount that antibiotics have a significant downside. A study published this month from researchers at The University of Texas at Austin found that honeybees treated with the common antibiotic tetracycline were half as likely to survive the week after treatment compared with a group of untreated bees. That’s because in addition to killing bad bugs, antibiotics also kill your good ones – those that aid immune function and nutrition. And in addition to that loss of function the problem is compounded because with the good bugs out of the way the bad ones proliferate, increasing your chance of getting sick. The authors explain:

Studies with vertebrate models and human subjects suggest that antibiotic treatments greatly perturb the native gut community, thereby facilitating proliferation of pathogens. In fact, persistent infections following antibiotic treatment are a major medical issue. … [T]hese results suggest that dysbiosis [imbalance in gut bacteria caused by too few beneficial bacteria and an overgrowth of bad bacteria], resulting from antibiotic exposure affects bee health, in part due to increased susceptibility to ubiquitous opportunistic pathogens.

The researchers recognize the need for antibiotics. Their message, however, is one of caution: use only when necessary. However, we insist on getting it wrong: around a third of all antibiotic prescriptions handed out in the US are done so in error. But to heed the message of being careful, we have to know when to use an antibiotic and when not to. So here’s a handy chart put out by the Pew Charitable Trusts that shows us where we typically mess up:


It Takes a Village: IDSA’s Statement on the Executive Order on Travel to the U.S.

Idsa 2

Last night two U.S. federal courts issued orders putting a stop to President Trump’s executive order prohibiting travel to the U.S. from six Muslim-majority countries. The courts said the order is discriminatory because it’s a religious test that violates the separation of church & state doctrine, which flows from the 1st amendment to the constitution.

That’s front-page news. What’s less well known & also vital, is that the U.S. science & medical community is up in arms about the ban. That’s because they recognize that disease threats are global (think Ebola or the bird flu virus) & therefore believe the solutions are also global. Take, for example, the World Health Organization’s plea last month for world governments to coordinate their efforts to combat 12 “priority pathogens,” MRSA among them.

But for world-leading governments to be at their best they need the best people. And so the Infectious Disease Society of America has also weighed in with a statement condemning the ban. Notice that IDSA frames infectious disease as a national security threat. Essentially saying we need medical “soldiers” from across the globe, over here, standing shoulder-to-shoulder with us, to combat the problem – otherwise the annual body count will rise, needlessly:

IDSA Statement on Exec. Order on Travel to U.S

Infectious diseases do not respect national borders, and success in fighting them requires a global response. Broad international collaboration is critical to our ability to identify, track and respond to emerging infectious diseases.

As a medical society representing over 10,000 infectious diseases physicians and scientists from 100 countries over 6 continents, the Infectious Diseases Society of America (IDSA) joins many other medical and scientific societies in expressing deep concern about the impact of the recent executive order restricting the entrance of certain foreign nationals to the United States. Advances in medicine come as a result of international collaboration and the free exchange of scientific ideas and discoveries. Travel and attendance at international conferences, including those held in the U.S., is essential to such collaboration.

The executive order may also negatively affect our nation’s medical and scientific workforce. Over the past decade, about one third of physicians entering the ID specialty have come from countries other than the U.S., including those impacted by the executive order. These ID physicians contribute to America’s robust ID patient care, public health efforts, and biomedical research and innovation. … Limiting the capabilities of physicians and scientists to collaborate around the world threatens the very national security the administration is committed to protecting.

What is Antibiotic Resistance?

Here’s a great 3-minute video by Ohio State’s Debbie Goff explaining the resistance problem. Keep in mind there’s 3 main actors here: the bug, the drug, and you. And it’s the bug, e.g. MRSA, that becomes resistant to the antibiotic drug, e.g. methicillin, leaving you with a harder to treat, or untreatable, bug-driven infection.

We explored this issue in greater detail with Debbie Goff yesterday. You can access that here.


About all those resistant infections … We’re not doing anything wrong, are we?

Please think carefully about the brief and exceptional talk by Debbie Goff, an infectious disease clinical pharmacist of 30 years standing, and ask yourself a question: Because of how we misuse antibiotics, are we essentially engaging in a form of collective self-harm?

Before you write off the question as hyperbole, consider, first, the vast amount of harm caused by “superbugs,” i.e. bacteria that antibiotics have little or no effect on. To really come to grips with how much damage is being done, a thought experiment helps: Visualize the packed crowd in a large American football stadium, say from the Super Bowl. Now think of seven such stadiums, all jam-packed – say, the Patriots home field, the Packers, the Giants, and so on – and finally, imagine all those people dying … every football season, from an infection.

guiltThat’s the death toll every year, worldwide. Add to that the people who become seriously infected but recover, and the total harm is orders of magnitude greater.

There are no safe harbors. For example, in a U.S. hospital (you’re safe there, right?), you have a 1 in 7 chance of catching a superbug; in a nursing home, the risk goes up to 1 in 4. All-told in the U.S., over 2 million serious resistant infections happen annually – i.e. multiple hospitalizations, stays in the ICU, surgeries, amputations (and years of anxiety by patient & family over possible re-occurrence) – plus over 23,000 deaths, around half due to MRSA alone.

And consider, second, and most importantly, how much all this carnage is driven by what we do (vs. what the bug does), and by how we think. This is the thrust of Debbie Goff’s talk: It’s not just about the bug, it’s about us too, and probably more so. The threshold issue is how we (mis)understand antibiotics: unlike every other therapeutic, they’re a “societal drug,” which means the more we use them the less effective they become – for everyone – because bugs adapt to drugs by evolving resistant strains, as quick as overnight. The logical import is therefore crystal clear: conserve antibiotics as best we can by using them properly & only when we must.

But logic is not our strong suite. Instead, we humans drive resistance to antibiotics (in a sense, we manufacture it) through a worldwide network of misuse. For example, by health care providers handing out scripts like Halloween candy – “just-in-case” as Goff correctly puts it – and by us, as patients, demanding them just like, well, kids at Halloween. Hint: “Hey Doc, I need a Z-pak,” is not the way to go about it. With the upshot that we’ve developed a dangerous one-third rule of abuse: 33% of antibiotics prescribed in hospitals have errors – wrong drug, duration, or dose; and 30% of antibiotics prescribed at the doctor’s office are unnecessary, typically because your illness is viral – a cold or the flu – not bacterial.

The practice of medicine is, ultimately, very personal. Debbie Goff begins by introducing us to a 35-year old mother of two, fresh from a successful surgery, who is prescribed – unnecessarily – a 10-day course of antibiotics, “just-in-case” she develops an infection. Keep in mind that what unfolds next didn’t have to. And that’s the whole point: we’re doing this to ourselves. Another name for that is self-harm.


“Catch”: A new film about a world without antibiotics

Looks like there’s a must-see short film out there about what antibiotic resistance has in store for us. Britain’s leading medical journal, The Lancet, had this to say about in today’s online edition:

It is an ordinary enough scene—a young father playing with his daughter. But it is also a chilling one, set in a dystopian near future in which all antibiotics have failed. A lethal pandemic has gripped the country; Tom’s wife and young son have succumbed to the infection and been taken away by the authorities, and it is unclear whether they are still alive. Tom and 8-year-old Amy are being kept housebound under strict quarantine. Amy is now sick, and Tom has an impossible decision to make. Does he give her up to the same authorities that have “taken mummy and Ben away”, or risk his own life? This is the scenario in CATCH, a 16-minute film from first-time directors Paul Cooke and Dominic Rees-Roberts that presents the crucial issue of antibiotic resistance as a story that might so easily be part of our children’s future.

The Lancet is not in the habit of reviewing films, so there must be something to it. Have a peek:

The Idea Behind CATCH from BorderPoint Films on Vimeo.

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.”

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