On International Women’s Day Meet Canadian Scientist Julia Levy

 

VANCOUVER, CANADA  #IWD2018  #WomenInMicrobiology

Dr. Julia Levy’s research at the University of British Columbia in the 1980s led to the development of photodynamic therapy (PDT), initially for the treatment of cancer.

Julia Levy was born in Singapore. Her father was captured by the Japanese during WWll and put into a POW camp. Just before this, her mother had escaped to Vancouver with Julia and another daughter.

Inspired by her grade 11 biology teacher, a woman, Julia went on to obtain her BA in biology from the University of British Columbia, her PhD in experimental pathology from University College London, and after grauation became a professor of microbiology at UBC.

Together with her colleagues at UBC they developed photosensitive drugs which, upon being exposed to light, change in a way that makes them toxic to cells. The initial targets were cancer cells: cancers of the skin, lung, esophagus, stomach, bladder and cervix.

Dr. Levy also formed her own company, embarking on research that broadened the reach of PDT to treat other diseases such as skin infections, arthritis, psoriasis, multiple sclerosis, and – perhaps the most promising target – age-related macular degeneration. “It’s way beyond cancer,” Levy tells science.ca, excited about the potential to cure other diseases with this technology.

But here’s what’s most impressive about Dr. Levy – the impulse that led to her corporate success:

In 1986 she was giving a talk to some doctors in Waterloo, Ontario about her work on new light-activated drugs. The doctors were trying these drugs on cancer patients and they were very upset because Johnson & Johnson was closing down their drug development program which appeared to be effective against cancer. Many people were being helped by this technology, but soon they would not be able to get the drug. “It was a very upsetting experience for me,” says Levy, who until that point had worked on these drugs only in a laboratory. “For the first time, I became aware that we were talking about real patients being treated for real cancer.” And so right then and there Levy decided that “We’ve got to do something.” So she made a deal with J & J, raised $15 million, and took over the Canadian subsidiary. It was a major turning point for Levy and her company – and for cancer patients in Canada.

These days she lives a varied life. Some days are spent in meetings with other companies, others reading scientific literature, still others meeting her colleagues to work out business strategies. Levy likes everything about her work – except the travelling and talking to investors.

Looking back on it all, Dr. Levy is quick to credit the value of teamwork: “Well, when I look at it I think … me? And a lot of other people – you can’t do it alone.” And despite the wealth she has generated says, convincingly, “I’ve never found money to be a compelling reason to do anything.”

 

 

 

 

 

 

 

Antibiotic Therapy: Shorter = Better, Especially For Sicker Patients

A core issue in antibiotic therapy these past few years is duration; namely, should patients complete every dose of antibiotics prescribed, even after they feel better? The emerging consensus is no, and one of the leading proponents of this school of thought is the impeccably qualified Brad Spellberg, MD, Chief Medical Officer of the Los Angeles County-University of Southern California Medical Center, who says:

Every randomized clinical trial that has ever compared short-course therapy with longer-course therapy … has found that shorter-course therapies are just as effective.… Patients should be told that if they feel substantially better, with resolution of symptoms of infection, they should call the clinician to determine whether antibiotics can be stopped early. Clinicians should be receptive to this concept, and not fear customizing the duration of therapy.

That was in 2016 – and now we have an update. Just last week Dr. Spellberg added to the shorter is better mantra by saying that with sicker patients, those on 5-day courses of antibiotics have better treatment outcomes than those on 10-day courses. And that’s because the shorter duration group experience less antibiotic-driven superinfections, less drug resistance, and less antibiotic side effects.

The following are Dr. Spellberg’s remarks given at a webinar last week hosted by the Health Services Advisory Group in the United States. He addresses the antibiotic duration question beginning at the 41-minute mark. If you haven’t heard Spellberg in action, you want to. The written word cannot capture his passionate, sometimes sardonic, quick-witted way of speaking:

Since then, studies have come out on the sicker type of patients…. And the trials with the sicker patients found the same thing – not only are the antibiotics just as safe & effective [but] [t]here was one subpopulation in which there was a statistically significant difference found. That was the Port 4 & 5 population [people who should be hospitalized].

The sicker patient was the only population that found a difference in outcome between the short course therapy and the long course therapy group. And here’s the fascinating thing: The patients who were sicker did better with short course therapy. They actually had better clinical outcomes when they got 5 days than 10.

And so somebody commented to me at one point, Well that doesn’t make any sense. That would only be true if antibiotics were harmful. YEAH! That’s what it’s telling you. Antibiotics are harmful. They’re not this thing that magically cures disease and has no unfortunate side effects – that’s not real. Antibiotics have lots of problems associated with them: They breed out resistance. They breed out superinfections like C. diff [an antibiotic-driven bacterial infection] and Candida [a fungal infection]. They cause side effects.

Right? Who gets the resistance, the superinfections and the side effects? The sickest patients in the ICU. This makes perfect sense. Not only was there no improved outcome with longer therapy, patients who were sicker did better … with short course therapy.

Sneezing, as it turns out … is nothing to sneeze at

Range: 20 feet.

Speed: 25-50 mph.

Nature of the threat: “violent expirations” of tiny droplets from the nose or mouth of an individual that contain the flu virus.

With the cold and flu season still with us, NPR looked at the question of how the pathogens of one person become the pathogens of another. The answer, it seems, is that by getting us to cough or sneeze, these clever critters get free passage to a new “host” – us – and thus a new lease on life.

The other clever bit is that we’re tricked into thinking that if we feel okay then we’re not contagious. In truth, we’re contagious one day before we start feeling sick and up to seven days after we’re feeling better.

This matters because even beyond the harm the flu virus itself can do, it actually has a much longer reach. For instance:

It paves the way for secondary and deadly bacterial infections to set in, for example, MRSA, as happened with this woman.

It strains hospital resources breaking down infection control practices which can lead to superbug outbreaks as happened recently at this Ontario hospital.

And we commonly prescribe the wrong treatment for the flu – namely, an antibiotic – and suffer a severe side effect as a result. For example, the painful and often deadly C. difficile-caused diarrhea; irregular heartbeats and sudden death; tendon rupture; drug interactions causing people to end up in the emergency room; and the creation of drug-resistant bugs.

The CDC says there’s 3 ways to fight the flu: vaccinate, take an antiviral drug (these are not antibiotics), and “stop germs.” This engaging NPR video shows us that one important way to stop germs is to stay out of range of the sneeze.

 

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.”

 

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