Maryn, Author at Maryn McKenna - Page 14 of 38

Drug Shortages: Endangering Human Lives and Pets, Too

August 27, 2011 By Maryn Leave a Comment

198.

That’s how many critically needed antibiotics, cancer drugs, diuretics, sedatives, stimulants and vaccines — among other drug categories — currently are in short supply in the United States. If you print out the list, which is maintained by the American Society of Health System Pharmacists, it runs to seven pages.

Back in February, I wrote in the Annals of Emergency Medicine, and also here at this blog, about ongoing shortages of critical drugs, and how physicians were beginning to worry about them. At the time, the list of drugs in short supply was up to about 140. [Read more…]

Antibiotics: Killing Off Beneficial Bacteria … for Good?

August 26, 2011 By Maryn Leave a Comment

It’s an accepted concept by now that taking antibiotics in order to quell an infection disrupts the personal microbiome, the population of microorganisms that we all carry around in our guts, and which vastly outnumbers the cells that make up our bodies. That recognition supports our understanding of Clostridium difficile disease — killing the beneficial bacteria allows C. diff room to surge and produce an overload of toxins — as well as the intense interest in establishing a research program that could demonstrate experimentally whether the vast industry producing probiotic products is doing what it purports to do.

But implicit in that concept is the expectation that, after a while — after a course of antibiotics ends — the gut flora repopulate and their natural balance returns.

What if that expectation were wrong?

Cost of Compassion: Drug Resistance in Military Hospitals

August 24, 2011 By Maryn Leave a Comment

Back in June, there was an unnerving report from the Centers for Disease Control and Prevention that NDM-1, the “Indian supergene” that renders common hospital-acquired infections practically untreatable, had been found in the military hospital at Bagram Air Base in Afghanistan.

The gene was being carried by a gut bacterium, Providencia stuartii, that was causing septicemia in an Afghan national who had been taken in by the military hospital. The particular strain of NDM-1 could be treated only by a single drug, aztreonam; it was resistant to everything else. Unsurprisingly, the victim died.

Though it wasn’t explicitly stated, the subtext of the CDC’s brief bulletin was clear: By extending compassion to the local resident (who was badly burned and had been treated at a hospital in Kabul), the military staff had brought into their hospital a highly resistant organism that could endanger their troops. It made me wonder, at the time, how often this happened, and what the consequences might be.

A study performed at Bagram, and published this month in Infection Control and Hospital Epidemiology, supplies an answer, and it’s a troubling one.

Food Safety in China, and the Risk to the U.S.

August 23, 2011 By Maryn Leave a Comment

Another week, another food-safety crisis in China. Several news networks — Associated Press, Australian Press and Xinhua — report that 11 people have died and anywhere from 120 to 140 were sickened by contaminated vinegar. Stoking tensions further is the reason so many were poisoned at once: The victims live in a small village in far-west Xinjiang province and are ethnic Uighurs, the minority group whose desire for political independence from Beijing led to brutally suppressed riots in 2009. Uighurs are overwhelmingly Muslim, and most of the small village, about 150 people, had gathered for an iftar meal to break their Ramadan fast.

The poisoning appears to be due to ethylene glycol; the vinegar had been stored in barrels that previously contained antifreeze. According to the AP, investigators haven’t yet been able to say whether the vinegar was put in the barrels out of ignorance, making it a problem of accidental contamination, or deliberately by an unscrupulous producer seeking to cut corners.

Ringing the Warning Bell: Colistin-Resistant Klebsiella

August 17, 2011 By Maryn Leave a Comment

In all the latest bad news about bacteria becoming highly resistant — through carbapenem resistance, or the “Indian supergene” NDM-1 — there has been one hopeful thread: All of the organisms have remained susceptible to one very old, little-used drug called colistin.

That might be about to change. Which would be very, very bad news.

How a U.S. Court Case Explains Problems Eradicating Polio

August 15, 2011 By Maryn Leave a Comment

One of the perennial problems blocking polio eradication is the persistent belief that the rounds of vaccination meant to protect children are actually a covert campaign to harm them. I’ve seen it myself, in my reporting, and studies examining the 23-year effort’s inability to get to zero describe it as well.

From the sanitized safety of the industrialized world, it’s hard to imagine how any neighborhood or tribe could hold such views. Which is why the report on Friday of news regarding a 15-year-old court case is so important. The actions that prompted the case created mistrust so long-lasting that it undermines unrelated medical campaigns, including polio, today.

Drug Resistance in Food — Coming From Aquaculture?

August 12, 2011 By Maryn Leave a Comment

In the midst of the giant Salmonella Heidelberg outbreak last week — now up to 107 cases in 31 states, and triggering a recall of 36 million pounds of ground turkey — it was easy to miss that a second and even more troubling strain of resistant Salmonella is on the move. As I wrote last week, that strain is called Salmonella Kentucky ST198, it is much more drug-resistant than the U.S. Heidelberg outbreak, and it has been spreading since 2002 from Egypt and north Africa through Europe, and has now been identified in the United States. Its primary vector appears to be chicken meat.

There is an interesting and troubling aspect to the spreading Kentucky strain that there wasn’t time to talk about last week, in the midst of the Heidelberg news. It’s this: The authors suspect that this enhanced resistance — to Cipro, and thus the class called fluoroquinolones that are very important in treating Salmonella — may have come into African chickens via drug use in aquaculture.

Resistant Salmonella: Deadly Yet Somehow Not Illegal

August 5, 2011 By Maryn Leave a Comment

As the scale of the nationwide outbreak of Salmonella Heidelberg started to sink in Thursday — along with the stunningly large recall of 36 million pounds of ground turkey, much of it probably already eaten — there were a number of moments that made a careful listener need to stop and just think.

Highly Resistant Salmonella: Poultry, Antibiotics, Borders, Risk

August 3, 2011 By Maryn Leave a Comment

If you’re a strain of Salmonella, it’s a very good week. If you’re a human, not so much.

There are two stories occurring simultaneously that underline the rising danger of drug-resistant organisms in the food supply, and the porousness of networks for detecting the dangerous bugs in time.

Are Counterfeit Drugs Driving Antibiotic Resistance?

August 1, 2011 By Maryn Leave a Comment

A British couple have been convicted and jailed for running a black market in veterinary drugs that was so large, it earned more money than legal sales of the same drugs — 6 million pounds (almost $10 million) just in the United Kingdom where the case was brought.

(In a detail that seems made for the beleaguered UK tabloids, the wife of the couple moonlighted as a Princess Diana lookalike.)

The business — lucrative enough to pay for an 11-bedroom farmhouse in France — was based on counterfeit and falsely labeled drugs purchased primarily in India, imported covertly, and resold through a network of companies to farmers, stables and kennels, and veterinary practices. The drugs offered included anti-inflammatories, pain medications, sedatives and antibiotics. Which means that the case raises an important questions: How much counterfeit and covertly distributed drugs are contributing to the international epidemic of antibiotic resistance — in this case, not just in human medicine, but in veterinary medicine as well.

Attack of the Deadly Slime: Farm Effluent Ruins French Beaches

July 26, 2011 By Maryn Leave a Comment

Vacationers in northwest France are being warned to stay away from beaches, which are growing a bumper crop of a seaweed that releases a potentially toxic gas. The culprit: Up-stream releases of manure from intensive farming that overload the near-shore waters with nitrates.

The seaweed (sea lettuce, Ulva lactuca) must be removed within 48 hours of washing ashore — because as it rots, it releases so much hydrogen sulfide that swimmers and strollers are endangered. The French ministry for health and the environment has warned visitors to avoid areas with overgrowth, and told workers scooping up the seaweed that they must wear monitors to alert them they have entered especially toxic pockets and must clear out within minutes.

Is Polio Eradication Slipping Out of Reach?

July 26, 2011 By Maryn Leave a Comment

Over the weekend, I sat in an airport in the midwestern United States for a 12-hour stretch, trying to get a standby seat. Time after time, the goal was in sight — the customer service agents and the video screen hanging from the ceiling all told me I was No. 1 on the waitlist — but every time a flight opened up to boarding, a few higher-priority customers popped up at the last minute and slid onto the list in front of me. The possibility of my getting a seat dangled just out of reach: never impossible, but despite the exhausting wait, never quite achieved.

I suspect this is what polio eradication feels like.

The long effort to wipe the paralyzing disease from the planet, begun in 1988 by a coalition of the World Health Organization, the Centers for Disease Control, UNICEF and the service organization Rotary International (recently joined by the Bill and Melinda Gates Foundation), has several times missed its goal of interrupting all transmission of wild virus — first in 2000, then in 2002 and then again in 2005. The hoped-for date has been moved again, to the end of 2012 this time.

But last week, an independent assessment bluntly warned that the international effort “is not on track to interrupt polio transmission as it planned to do by the end of 2012” and likely will miss that goal as well.

Some Paranoia for Your Weekend: CONTAGION Trailer

July 15, 2011 By Maryn Leave a Comment

Warner Brothers has released the first trailer for CONTAGION, a Steven Soderbergh bio-thriller about an influenza strain gone virally rogue that will open Sept. 9. Quoting from the movie’s website:

“Contagion” follows the rapid progress of a lethal airborne virus that kills within days. As the fast-moving epidemic grows, the worldwide medical community races to find a cure and control the panic that spreads faster than the virus itself. At the same time, ordinary people struggle to survive in a society coming apart.

Delicious exchange from the trailer (zinger response from Laurence Fishburne):

“Is there anyway someone could weaponize the bird flu?”

“Someone doesn’t have to weaponize bird flu. The birds are doing that.”

Here’s the trailer. You are made of stern stuff if it doesn’t make you want to wash your hands. (I’ll be over here in the corner, rubbing mine together in scary-disease glee.)

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File Under WTF: Did the CIA Fake a Vaccination Campaign?

July 13, 2011 By Maryn Leave a Comment

A number of years ago, I was in New Delhi, at the end of an exhausting 18 hours in which I had torn around the city to watch a National Immunization Day. On those days — like a national holiday, with flags and banners and kids let out from school — tens of millions of children line up to stick out their tongues and receive the sugary drops that contain the vaccine that should protect them against polio.

The Indian government, along with the Centers for Disease Control, the World Health Organization and the volunteer ground troops of Rotary International, has been organizing these days now for most of two decades, always coming closer to the goal of eradicating polio, never quite getting there. On this day, which occurred close to the end of weeks I had spent embedded with a WHO “STOP Polio” team, 135 million children were expected to queue in cities and suburbs and rich neighborhoods and slums. I spent the day with the team I had been observing, racing in a battered turquoise Tata from neighborhood to neighborhood, trying to understand where the campaign’s message was working and where its earnest persuasions had failed. (You can read my account of the day here.)

The Clap Came Back: Multidrug-Resistant Gonorrhea

July 11, 2011 By Maryn Leave a Comment

Among the many unintended consequences of the 30-year AIDS epidemic has been a profound change in status for other sexually transmitted diseases. It feels slightly bizarre, for anyone who came of age after HIV arrived, to realize that syphilis and gonorrhea and their ilk were once as profoundly dreaded as AIDS is now, so important that they were considered major threats to military campaigns and were the first treatment targets for the earliest antimicrobial drugs.

Judging by data released Friday by the Centers for Disease Control, it might be time to take them seriously once again.

E. coli: A Risk for 3 More Years From Who Knows Where

July 7, 2011 By Maryn Leave a Comment

The latest news from the European Centre for Disease Prevention and Control, the EU’s CDC, suggests that the massive outbreak of E. coli O104 is declining. The number of new cases being discovered has fallen, and the most recent onset of illness among confirmed cases was June 27. The toll is now 752 cases of hemolytic uremic syndrome and an additional 3,016 cases of illness in 13 countries, for a total of 3,768 illnesses including 44 deaths. (The EU adjusted that total to remove 161 cases that were suspected but not lab-confirmed. It also did not include the five confirmed cases, one suspect case and one suspect death in the United States.)

But a simultaneous report from the European Food Safety Authority (EFSA) reveals that, despite the epidemic curve’s trending down, the outbreak can’t be considered over. The ultimate source — the contaminated seeds from which salad sprouts were grown — has been so widely distributed that no one really knows where they have gone or for how long they might remain for sale. One prediction, based on the probable package labeling, is that they could remain on shelves for three more years.

How Much Is a Drug-Resistance Death Worth? Less Than $600

July 5, 2011 By Maryn Leave a Comment

So, antibiotic resistance: We care about it, right? The World Health Organization does: It made antimicrobial resistance the theme of this year’s World Health Day. The Centers for Disease Control and Prevention does. The journal Lancet Infectious Diseases says it’s a “global health concern.” The major association for infectious disease physicians has pleaded for attention. Two separate sets of legislators have introduced two bills in Congress.

You’d think, with all those calls for attention, that combating antibiotic resistance would be a priority in the United States. But if we can take how much we spend to research a problem as a gauge of how much we care about it, then antibiotic resistance is no priority at all.

As in: For every death from AIDS, the US federal research establishment awards approximately $69,000 in grant funds. And for every death from MRSA, it awards $570.

WCSJ: Plant Diseases, Farmer Suicides And The Peril of A Hungry Future

July 3, 2011 By Maryn Leave a Comment

Here’s my second report from the World Conference of Science Journalists — and if you thought the first one on diabetes in China was depressing, just wait for this one.

Since I wrote SUPERBUG the book and started this blog, I’ve been fascinated by stresses and problems in food production. (For evidence, see any of this long archive.) This conference in Qatar, which drew 726 journalists, most from the global south, was a chance to hear from people immersed in food issues in places we in the north don’t know enough about. So for my panel on agriculture and food security, I invited people whom I wanted to learn from.

And wow, did I.

WCSJ: Maybe The Biggest Disease Threat Isn't Infectious At All

July 1, 2011 By Maryn Leave a Comment

I’ve been away the past week at the World Conference of Science Journalists, a biannual gathering that brought 726 writers and broadcasters from 87 countries to Doha, Qatar. I was there to give a presentation about blogging, and also because I organized two panels on under-reported epidemics and on food and farming issues in the developing world. My panelists’ testimony was so powerful that I wanted to share some of the details.

Going into the conference, the epidemics panel was my favorite. That’s not because I cheated and made myself one of the speakers, but because it brought into public view so many of the disease-control issues that we talk about here. When I say hidden epidemics, what I mean is this: The diseases that routinely grab headlines are almost never the ones that cost society the most in illness and deaths, and also in money to control and repair them.

Think of Ebola, for instance. There has never been a case of human Ebola in the United States. And as I’ve written before, viral hemorrhagic fevers repeatedly have been imported to North America without ever starting an outbreak. Yet whenever Ebola sparks in Africa, it earns scare-font headlines here, as though it were about to rampage across the continent — even though, in all its known engagements with humans, Ebola has killed less than one-tenth of the 19,000 that MRSA, for instance, kills in the US in a single year.

I asked a set of distinguished health journalists, all friends, to come to Doha to talk about diseases that deserve headlines, but never get them. Here’s what they said:

Is Drug Resistance in Humans Coming From Chickens?

June 28, 2011 By Maryn Leave a Comment

There’s a new paper out in the CDC’s journal Emerging Infectious Diseases that makes a provocative claim: There is enough similarity between drug-resistance genes in E. coli carried by chickens and E. coli infecting humans that the chickens may be the source of it.

If it is correct — and it seems plausible and is backed by past research — the claim provides another piece of evidence that antibiotic use in agriculture has a direct effect on human health.