Maryn McKenna

Journalist and Author

One more set of recommendations

By Leave a Comment

… and then next week I’ll be back to analyzing the medical literature: A stack of interesting new journal articles is threatening to topple and bury my computer.

For the moment, though:

First, the Hearst newspapers chain has conducted a nationwide investigation into medical errors that should be required reading for anyone who wonders why hospitals can’t do a better job controlling hospital-acquired infections. It is a 7-part series focusing on the 5 states (New York, Texas, California, Connecticut, Washington) where there are Hearst papers, and hosted on the site of the San Francisco Chronicle. The introductory article says:

Ten years ago, a highly publicized federal report called the death toll shocking and challenged the medical community to cut it in half — within five years.
Instead, federal analysts believe the rate of medical error is actually increasing.
A national investigation by Hearst Newspapers found that the medical community, the federal government and most states have overwhelmingly failed to take the effective steps outlined in the report a decade ago.
… in five states served by Hearst newspapers — New York, California, Texas, Washington and Connecticut — only 20 percent of some 1,434 hospitals surveyed are participating in two national safety campaigns begun in recent years.
Also, a detailed safety analysis prepared for Hearst Newspapers examined discharge records from 1,832 medical facilities in four of those states. It found major deficiencies in patient data states collect from hospitals, yet still found that a minimum of 16 percent of hospitals had at least one death from common procedures gone awry — and some had more than a dozen. (Byline: Cathleen F. Crowley and Eric Nalder)

From that opening statement, the investigation goes on to explore many patient stories that individually are tragedies and collectively — as we here know all to well — are a scandal.

There is just one notable MRSA story in the mix, the death of a retired hospital president who contracted the bug in his own hospital. But they are all worth reading.

Second, an executive and apparently new writer named David Goldhill has written for The Atlantic a passionate and well-thought out piece on his father’s death from a hospital-acquired infection and on what needs to change for such deaths to never happen again. “My survivor’s grief has taken the form of an obsession with our health-care system,” he writes:

My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

You may not agree with his conclusions, but it is worth reading through to the end to experience how one intelligent citizen from outside health care understands and attempts to re-think our broken system.

One more set of recommendations

By Leave a Comment

… and then next week I’ll be back to analyzing the medical literature: A stack of interesting new journal articles is threatening to topple and bury my computer.

For the moment, though:

First, the Hearst newspapers chain has conducted a nationwide investigation into medical errors that should be required reading for anyone who wonders why hospitals can’t do a better job controlling hospital-acquired infections. It is a 7-part series focusing on the 5 states (New York, Texas, California, Connecticut, Washington) where there are Hearst papers, and hosted on the site of the San Francisco Chronicle. The introductory article says:

Ten years ago, a highly publicized federal report called the death toll shocking and challenged the medical community to cut it in half — within five years.
Instead, federal analysts believe the rate of medical error is actually increasing.
A national investigation by Hearst Newspapers found that the medical community, the federal government and most states have overwhelmingly failed to take the effective steps outlined in the report a decade ago.
… in five states served by Hearst newspapers — New York, California, Texas, Washington and Connecticut — only 20 percent of some 1,434 hospitals surveyed are participating in two national safety campaigns begun in recent years.
Also, a detailed safety analysis prepared for Hearst Newspapers examined discharge records from 1,832 medical facilities in four of those states. It found major deficiencies in patient data states collect from hospitals, yet still found that a minimum of 16 percent of hospitals had at least one death from common procedures gone awry — and some had more than a dozen. (Byline: Cathleen F. Crowley and Eric Nalder)

From that opening statement, the investigation goes on to explore many patient stories that individually are tragedies and collectively — as we here know all to well — are a scandal.

There is just one notable MRSA story in the mix, the death of a retired hospital president who contracted the bug in his own hospital. But they are all worth reading.

Second, an executive and apparently new writer named David Goldhill has written for The Atlantic a passionate and well-thought out piece on his father’s death from a hospital-acquired infection and on what needs to change for such deaths to never happen again. “My survivor’s grief has taken the form of an obsession with our health-care system,” he writes:

My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

You may not agree with his conclusions, but it is worth reading through to the end to experience how one intelligent citizen from outside health care understands and attempts to re-think our broken system.

Catching up on some reading: health care reform, food bugs, vaccine, MRSA+flu

By Leave a Comment

Folks, while I was caught in travel hell, some excellent stories and blogposts were released. Here’s a quick round-up of recommendations for a rainy weekend:

  • At Roll Call (covers Congress like a blanket), Ramanan Laxminarayan, PhD MPH, of the rational-use-of-antibiotics project Extending the Cure and infection-control physician Ed Septimus, MD make a strong argument for including control of hospital infections in health care reform. Hard to argue against when you realize that HAIs cost the United States more than $33 billion each year.
  • At Meat Wagon, a blog of the online magazine Grist, the always-excellent Tom Philpott digs into the ongoing outbreak of antibiotic-resistant Salmonella in hamburger meat. Key quote: “Outbreaks of [antibiotic-resistant foodborne illnesses] are really ecological markers — feedback that our way of producing meat is deeply unsustainable and really quite dangerous.”
  • The Associated Press reports that the long-in-development staph vaccine made by Nabi Pharmaceuticals may have received a second life: It’s been purchased by international pharma giant GlaxoSmithKline in a $46-million deal.
  • And finally and sadly, the Sacramento Bee reports that a California nurse who died of H1N1/swine flu also had MRSA pneumonia. Karen Ann Hays, 51, died despite being extremely healthy: she was a triathlete, skydiver and marathon runner. No one yet has been able to say whether she caught the flu — or MRSA — at work (though her partner believes that to be true), but her death has fueled disquiet among members of the California Nurses Association, who are protesting a lack of protective equipment for nurses.

For those of us concerned about MRSA pneumonia — and we have been talking here since the start of the H1N1 pandemic about the danger of MRSA co-infection — that last item about Hays’ very sad death should underline a vital point. Public health authorities have been stressing that H1N1 is most deadly when the infected person has a pre-existing condition: pregnancy, heart disease, obesity, diabetes, cystic fibrosis. It is possible that MRSA infection is also a pre-existing condition that will put anyone infected with flu at risk of deadly complications.

If you have had MRSA, even a minor skin infection — and especially if you have experienced recurrent infections — you should probably discuss with your personal physician whether you should take the H1N1 vaccine when or if it becomes available. It could be the step that prevents a minor case of flu from tipping over into something much more serious.

Catching up on some reading: health care reform, food bugs, vaccine, MRSA+flu

By Leave a Comment

Folks, while I was caught in travel hell, some excellent stories and blogposts were released. Here’s a quick round-up of recommendations for a rainy weekend:

  • At Roll Call (covers Congress like a blanket), Ramanan Laxminarayan, PhD MPH, of the rational-use-of-antibiotics project Extending the Cure and infection-control physician Ed Septimus, MD make a strong argument for including control of hospital infections in health care reform. Hard to argue against when you realize that HAIs cost the United States more than $33 billion each year.
  • At Meat Wagon, a blog of the online magazine Grist, the always-excellent Tom Philpott digs into the ongoing outbreak of antibiotic-resistant Salmonella in hamburger meat. Key quote: “Outbreaks of [antibiotic-resistant foodborne illnesses] are really ecological markers — feedback that our way of producing meat is deeply unsustainable and really quite dangerous.”
  • The Associated Press reports that the long-in-development staph vaccine made by Nabi Pharmaceuticals may have received a second life: It’s been purchased by international pharma giant GlaxoSmithKline in a $46-million deal.
  • And finally and sadly, the Sacramento Bee reports that a California nurse who died of H1N1/swine flu also had MRSA pneumonia. Karen Ann Hays, 51, died despite being extremely healthy: she was a triathlete, skydiver and marathon runner. No one yet has been able to say whether she caught the flu — or MRSA — at work (though her partner believes that to be true), but her death has fueled disquiet among members of the California Nurses Association, who are protesting a lack of protective equipment for nurses.

For those of us concerned about MRSA pneumonia — and we have been talking here since the start of the H1N1 pandemic about the danger of MRSA co-infection — that last item about Hays’ very sad death should underline a vital point. Public health authorities have been stressing that H1N1 is most deadly when the infected person has a pre-existing condition: pregnancy, heart disease, obesity, diabetes, cystic fibrosis. It is possible that MRSA infection is also a pre-existing condition that will put anyone infected with flu at risk of deadly complications.

If you have had MRSA, even a minor skin infection — and especially if you have experienced recurrent infections — you should probably discuss with your personal physician whether you should take the H1N1 vaccine when or if it becomes available. It could be the step that prevents a minor case of flu from tipping over into something much more serious.

Recommending a new MRSA site

By Leave a Comment

Constant readers, I’ve been away on travel. Apologies for dropping out of sight, but I always worry about saying in advance that I am going away; it seems not-secure to me. At any rate, I’m back. There’s tons to catch up on in the MRSA world, but here is something to get us started.

I want to recommend to you a new, comprehensive MRSA site. It has been put up by the MRSA Research Center of the University of Chicago, who are the research team (headed by Robert S. Daum, MD) that first identified the emergence of community-associated MRSA in the mid-1990s. (Disclosure: These folks play a prominent role in the book, but we have no relationship other than that of reporter and source.)

The site has channels for researchers, infection-control professionals, and MRSA patients and their families. It is broad and deep and well worth a look. I’ll add it to the blogroll on the right.

Federal plan to reduce HAIs: public meetings

By Leave a Comment

Let’s switch back for a moment to MRSA and other infections in hospitals. An estimated 1.7 million healthcare-associated infections (HAIs) occur in the US each year. Approximately 99,000 of the infected die. Care for the infected costs the health care system $33 billion (yes, with a B) each year.

The US Department of Health and Human Services (parent agency of the CDC, USDA, Center for Medicare and Medicaid Services, etc.) in late June issued a draft of a National Action Plan to Prevent Healthcare-Associated Infections. The plan is here (.pdf, 116 pages). It calls for more research, changes in regulation of health care, more disclosure and significant simplification of the more than 1,200 actions for reducing HAIs that are currently recommended in government documents (yes, 1,200.)

HHS is taking the plan on the road: Before Labor Day, there will be public meetings to air the plan in Denver (tomorrow, July 25), Chicago (July 30) and Seattle (Aug. 27). If you are concerned at all about HAIs and government and health care industry response to them, these meetings would be a good place to be.

The HHS statement about the plan and the meetings, including contact information to sign up to attend, is here. Go, already.

Federal plan to reduce HAIs: public meetings

By Leave a Comment

Let’s switch back for a moment to MRSA and other infections in hospitals. An estimated 1.7 million healthcare-associated infections (HAIs) occur in the US each year. Approximately 99,000 of the infected die. Care for the infected costs the health care system $33 billion (yes, with a B) each year.

The US Department of Health and Human Services (parent agency of the CDC, USDA, Center for Medicare and Medicaid Services, etc.) in late June issued a draft of a National Action Plan to Prevent Healthcare-Associated Infections. The plan is here (.pdf, 116 pages). It calls for more research, changes in regulation of health care, more disclosure and significant simplification of the more than 1,200 actions for reducing HAIs that are currently recommended in government documents (yes, 1,200.)

HHS is taking the plan on the road: Before Labor Day, there will be public meetings to air the plan in Denver (tomorrow, July 25), Chicago (July 30) and Seattle (Aug. 27). If you are concerned at all about HAIs and government and health care industry response to them, these meetings would be a good place to be.

The HHS statement about the plan and the meetings, including contact information to sign up to attend, is here. Go, already.

Decolonization: disappointing news

By Leave a Comment

I know that many of you who are MRSA patients, especially with recurrent infections, are especially interested in the issue of decolonization, the grueling regimen of antibiotic nasal gel (containing mupirocin; usually sold as Bactroban) combined with body washes with chlorhexidine (Hibiclens) that is believed to eradicate MRSA carriage in the nose and on the skin. Decolonization is an essential part of the “search and destroy” measures practiced by zero-tolerance hospitals who want to detect any MRSA transport in their institution, and it is a last-ditch hope in recurrent community-strain infections. (I told the story of several women’s struggles with recurrent infections in SELF and Health magazines.)

It’s disheartening, then, to realize that decolonization is not a universally agreed-upon measure, and there is relatively little research that can say in which setting (household, hospital, ICU) it works best, and why. There have been a few studies, and a few review papers summing up studies, on the role that decolonization can play in reducing the risk of infection in already hospitalized, colonized patients — ones about to undergo surgery, for instance. A meta-analysis by the Cochrane group, of 8 trials, found that decolonization in the hospital did reduce the likelihood of infections in surgical patients.

The role that decolonization can play in short-circuiting community infections is much less clear, though there are many, many people who have suffered recurrent infections and testify that it worked for them. (Please speak up in the comments if you are!) One problem is that outside hospitals, there is no one recommended regimen: One physician might tell her patient to use mupirocin and chlorhexdine only, whereas another might tell his patient to also take bleach baths, or bleach all the laundry or household surfaces. The CDC has so far declined to put its muscle behind decolonization in community-strain infections, recommending only that frustrated patients with recurrences seek the advice of an infectious-disease specialist. (See this flowchart of treatment options (.pdf) that the CDC published in 2007.)

Comes now the infectious-diseases division of Evanston Northwestern Healthcare, whom some of you will recognize as being among the most successful and evangelical practitioners of “search and destroy” in the United States. (ENW has recently been renamed NorthShore University HealthSystem and is affiliated with Northwestern University. Disclosure, in case you care: I went to grad school at Northwestern, though not in medicine.) In a paper published in Infection Control and Hospital Epidemiology, the group evaluates the use and success rate of decolonization in ENW/NorthShore’s 3 hospitals and finds, well, not such good news: a temporary reduction in patients’ being colonized with MRSA, but no success in preventing infection.

This is an important and troubling finding, because decolonization comes with costs. There is the obvious cost to hospitals (and the follow-on cost to insurance companies and consumers) of paying for mupirocin and chlorhexidine themselves. But there is also a hidden cost that we here should be particularly sensitive to: Because mupirocin is being used so lavishly, mupirocin resistance is rising.

In the same issue of ICHE (which, yes, is pronounced Itchy), a related editorial by Dutch researchers reviews the difficulty of conducting decolonization trials, but summarizes the ENW/NorthShore study as not an endorsement of decolonization regimens:

It is clear that staphylococcal carriage is an important risk factor for infection and that eradication of carriage has proven successful for patients who are undergoing elective surgery. For other groups of patients, it is still unclear what the benefits are. It is obvious that indiscriminate use of mupirocin is associated with development of resistance. Therefore, additional studies are warranted to define the optimal MRSA decolonization strategy, including what should be given, to whom, and at what moment and who should guide and supervise the regimen.

The cites are:
Robicsek A, Beaumont JL, Thomson RB Jr et al. Topical therapy for methicillin-resistant Staphylococcus aureus colonization:impact on infection risk. Infect Control Hosp Epidemiol. 2009 Jul;30(7):623-32.
Kluytmans J, Harbarth S. Methicillin-resistant Staphylococcus aureus decolonization: “Yes, we can,” butwill it help? Infect Control Hosp Epidemiol. 2009 Jul;30(7):633-5.

Decolonization: disappointing news

By Leave a Comment

I know that many of you who are MRSA patients, especially with recurrent infections, are especially interested in the issue of decolonization, the grueling regimen of antibiotic nasal gel (containing mupirocin; usually sold as Bactroban) combined with body washes with chlorhexidine (Hibiclens) that is believed to eradicate MRSA carriage in the nose and on the skin. Decolonization is an essential part of the “search and destroy” measures practiced by zero-tolerance hospitals who want to detect any MRSA transport in their institution, and it is a last-ditch hope in recurrent community-strain infections. (I told the story of several women’s struggles with recurrent infections in SELF and Health magazines.)

It’s disheartening, then, to realize that decolonization is not a universally agreed-upon measure, and there is relatively little research that can say in which setting (household, hospital, ICU) it works best, and why. There have been a few studies, and a few review papers summing up studies, on the role that decolonization can play in reducing the risk of infection in already hospitalized, colonized patients — ones about to undergo surgery, for instance. A meta-analysis by the Cochrane group, of 8 trials, found that decolonization in the hospital did reduce the likelihood of infections in surgical patients.

The role that decolonization can play in short-circuiting community infections is much less clear, though there are many, many people who have suffered recurrent infections and testify that it worked for them. (Please speak up in the comments if you are!) One problem is that outside hospitals, there is no one recommended regimen: One physician might tell her patient to use mupirocin and chlorhexdine only, whereas another might tell his patient to also take bleach baths, or bleach all the laundry or household surfaces. The CDC has so far declined to put its muscle behind decolonization in community-strain infections, recommending only that frustrated patients with recurrences seek the advice of an infectious-disease specialist. (See this flowchart of treatment options (.pdf) that the CDC published in 2007.)

Comes now the infectious-diseases division of Evanston Northwestern Healthcare, whom some of you will recognize as being among the most successful and evangelical practitioners of “search and destroy” in the United States. (ENW has recently been renamed NorthShore University HealthSystem and is affiliated with Northwestern University. Disclosure, in case you care: I went to grad school at Northwestern, though not in medicine.) In a paper published in Infection Control and Hospital Epidemiology, the group evaluates the use and success rate of decolonization in ENW/NorthShore’s 3 hospitals and finds, well, not such good news: a temporary reduction in patients’ being colonized with MRSA, but no success in preventing infection.

This is an important and troubling finding, because decolonization comes with costs. There is the obvious cost to hospitals (and the follow-on cost to insurance companies and consumers) of paying for mupirocin and chlorhexidine themselves. But there is also a hidden cost that we here should be particularly sensitive to: Because mupirocin is being used so lavishly, mupirocin resistance is rising.

In the same issue of ICHE (which, yes, is pronounced Itchy), a related editorial by Dutch researchers reviews the difficulty of conducting decolonization trials, but summarizes the ENW/NorthShore study as not an endorsement of decolonization regimens:

It is clear that staphylococcal carriage is an important risk factor for infection and that eradication of carriage has proven successful for patients who are undergoing elective surgery. For other groups of patients, it is still unclear what the benefits are. It is obvious that indiscriminate use of mupirocin is associated with development of resistance. Therefore, additional studies are warranted to define the optimal MRSA decolonization strategy, including what should be given, to whom, and at what moment and who should guide and supervise the regimen.

The cites are:
Robicsek A, Beaumont JL, Thomson RB Jr et al. Topical therapy for methicillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol. 2009 Jul;30(7):623-32.
Kluytmans J, Harbarth S. Methicillin-resistant Staphylococcus aureus decolonization: “Yes, we can,” but will it help? Infect Control Hosp Epidemiol. 2009 Jul;30(7):633-5.

Media round-up: recommending MRSA stories

By Leave a Comment

By chance — or is it because interest is really picking up? — a couple of worthwhile stories on MRSA have been published almost simultaneously:

  • For when the science gets wonky: Environmental Health Perspectives has an excellent lay-language explanation of how drug resistance emerges and spreads — with gorgeous graphics!
  • For when yet another drug doesn’t work: Scientific American covers development of new antibiotics, and even more important, development of new ways of creating antibiotics.
  • For yet more depressing news about MRSA in meat: Prevention adds to the discussion of MRSA in the food supply with a “special report” review. Constant readers who have been following along as we’ve drilled into this topic over the past two years won’t find a lot new, except for an intriguing account of an outbreak of MRSA in an Arkansas chicken plant (in which the bug went disappointingly untyped, so we don’t know whether it was a human strain or ST398). The story hits on issues we have talked about here: Surveillance for MRSA in animals is non-existent, practically speaking, and when the bug is found, investigation falls between human and animal health agencies. It’s a longer than usual story for Prevention, and should bring the knotty food-policy questions around MRSA in meat to a new audience.

New England Journal editorial: MRSA, H1N1 parallels

By Leave a Comment

There’s a very interesting piece in a recent New England Journal of Medicine (unfortunately, only the abstract is online) that draws parallels between MRSA and public expectations for pandemic flu. Written by Dr. Kent Sepkowitz, chief of infection control at Memorial Sloan-Kettering Cancer Center in New York and one of the authors of the “Medical Examiner” column at Slate, it’s an exploration of microbial sleight of hand: We were looking in one direction for a problem to develop, and — like Wile E. Coyote staring after the Road Runner but missing the Acme anvil — the problem came around and socked us in the back of the head.

In the case of flu, Sepkowitz writes, we concentrated on the threat of H5N1 avian influenza — the focus, until H1N1/swine flu arrived, of billions of dollars and years of effort in pandemic preparation — but were surprised by the sudden catastrophic emergence of seasonal flu strains resistant to oseltamivir (Tamiflu), one of the few antiviral drugs that can reduce illness and death from flu if taken early enough. In the case of MRSA, medicine focused on containing the spread of hospital MRSA and its rare transformation into VRSA, vancomycin-resistant staph — and mostly discounted, until far too late, the enormous threat of community MRSA strains:

The intensity of our concern and the frequency of the doomsday dispatches were appropriate. We were simply chasing the wrong microbe. It is community-acquired MRSA, not VRSA… that now occupies the center of the public health stage. And just about everything predicted for VRSA has come true for community-acquired MRSA. It’s everywhere; it’s deadly; it has changed the day-to-day management of skin infections and pneumonia in clinics, emergency rooms and intensive care units. It’s a true public health disaster. It’s just a different disaster from the one we were exercised about.

As we wrangle the new threat of H1N1, Sepkowitz warns that it is vital to remember how many millennia of practice microbes have in foiling our expectations:

We should marvel at the raw, restless power of microbes. They have the numbers — trillions and quadrillions and more that replicate wildly, inaccurately and disinterestedly. Nothing microbes do, whether under the duress imposed by antimicrobials or from some less evident pressure, should surprise us. It’s their world; we only live in it.

(Image courtesy Sansceo Design)

New England Journal editorial: MRSA, H1N1 parallels

By Leave a Comment

There’s a very interesting piece in a recent New England Journal of Medicine (unfortunately, only the abstract is online) that draws parallels between MRSA and public expectations for pandemic flu. Written by Dr. Kent Sepkowitz, chief of infection control at Memorial Sloan-Kettering Cancer Center in New York and one of the authors of the “Medical Examiner” column at Slate, it’s an exploration of microbial sleight of hand: We were looking in one direction for a problem to develop, and — like Wile E. Coyote staring after the Road Runner but missing the Acme anvil — the problem came around and socked us in the back of the head.

In the case of flu, Sepkowitz writes, we concentrated on the threat of H5N1 avian influenza — the focus, until H1N1/swine flu arrived, of billions of dollars and years of effort in pandemic preparation — but were surprised by the sudden catastrophic emergence of seasonal flu strains resistant to oseltamivir (Tamiflu), one of the few antiviral drugs that can reduce illness and death from flu if taken early enough. In the case of MRSA, medicine focused on containing the spread of hospital MRSA and its rare transformation into VRSA, vancomycin-resistant staph — and mostly discounted, until far too late, the enormous threat of community MRSA strains:

The intensity of our concern and the frequency of the doomsday dispatches were appropriate. We were simply chasing the wrong microbe. It is community-acquired MRSA, not VRSA… that now occupies the center of the public health stage. And just about everything predicted for VRSA has come true for community-acquired MRSA. It’s everywhere; it’s deadly; it has changed the day-to-day management of skin infections and pneumonia in clinics, emergency rooms and intensive care units. It’s a true public health disaster. It’s just a different disaster from the one we were exercised about.

As we wrangle the new threat of H1N1, Sepkowitz warns that it is vital to remember how many millennia of practice microbes have in foiling our expectations:

We should marvel at the raw, restless power of microbes. They have the numbers — trillions and quadrillions and more that replicate wildly, inaccurately and disinterestedly. Nothing microbes do, whether under the duress imposed by antimicrobials or from some less evident pressure, should surprise us. It’s their world; we only live in it.

(Image courtesy Sansceo Design)

Media round-up: recommending MRSA stories

By Leave a Comment

By chance — or is it because interest is really picking up? — a couple of worthwhile stories on MRSA have been published almost simultaneously:

  • For when the science gets wonky: Environmental Health Perspectives has an excellent lay-language explanation of how drug resistance emerges and spreads — with gorgeous graphics!
  • For when yet another drug doesn’t work: Scientific American covers development of new antibiotics, and even more important, development of new ways of creating antibiotics.
  • For yet more depressing news about MRSA in meat: Prevention adds to the discussion of MRSA in the food supply with a “special report” review. Constant readers who have been following along as we’ve drilled into this topic over the past two years won’t find a lot new, except for an intriguing account of an outbreak of MRSA in an Arkansas chicken plant (in which the bug went disappointingly untyped, so we don’t know whether it was a human strain or ST398). The story hits on issues we have talked about here: Surveillance for MRSA in animals is non-existent, practically speaking, and when the bug is found, investigation falls between human and animal health agencies. It’s a longer than usual story for Prevention, and should bring the knotty food-policy questions around MRSA in meat to a new audience.

Antibiotic overuse in animals: Obama administration comes out against

By Leave a Comment

For anyone who cares about the overuse of antibiotics in food animals, and the resistant bacteria that overuse has been shown to produce, this is important news.

In testimony today, new FDA Commissioner Dr. Joshua Sharfstein announced the administration’s opposition to the use of growth promoters: sub-therapeutic doses of antibiotics used not as disease treatment, but to encourage animals to put weight on rapidly. Further, he also came out against the administration of antibiotics in food animals without the involvement of a veterinarian — a common situation out here in farm country, where veterinary antibiotics are freely available over the counter. (We discussed Scott Weese’s proposal to end that practice here.)

Both of these practices have been repeatedly linked to antibiotic resistance, and for the administration to come out against them is highly significant — not just for the struggle against resistant bacteria, but also for the movement to reduce industrial-scale agriculture, which relies on antibiotics to keep food animals healthy while they are in the close confinement of CAFOs.

Sharfstein made the announcement while giving testimony on behalf of Rep. Louise Slaughter (D-NY)’s Preservation of Antibiotics for Medical Treatment Act of 2009, which has been introduced (and opposed into nonexistence) multiple times over the past decade. (Earlier post on the legislation, including its text, here.) He said:

To avoid the unnecessary development of resistance under conditions of constant exposure (growth promotion/feed efficiency) to antibiotics, the use of antimicrobials should be limited to those situations where human and animal health are protected. Purposes other than for the advancement of animal or human health should not be considered judicious use. …
Important factors in determining whether a prevention use is appropriate include evidence of effectiveness, evidence that such a preventive use is consistent with accepted veterinary practice, evidence that the use is linked to a specific etiologic agent, evidence that the use is appropriately targeted, and evidence that no reasonable alternatives for intervention exist. FDA also believes that the use of medications for preventino and control should be under the supervision of a veterinarian. …
FDA supports the treatment of ill animals according to appropriate veterinary practice within a valid veterinary-client-patient relationship.

Also on the docket at Slaughter’s hearing:

  • Margaret Mellon, PhD, of the Union of Concerned Scientists (who specifically discussed MRSA ST398): “As long as the massive use of antibiotics continues, animals … will remain a fountain of resistant pathogens, dangerous to both animals and humans. The straightforward solution to the problem is to reduce the use of antibiotics in animal production and thereby diminish the pool of resistant organisms and traits.”
  • Robert Martin of the Pew Environment Group (Pew Charitable Trusts): “The present system of producing food animals in the United States is not sustainable and presents an unacceptable level of risk to public health, damage to the environment, as well as unnecessary harm to the animals we raise for food.”
  • And statements of support from the Chipotle restaurant chain and the Bon Appetit Management Company (which operates catering services in corporations and universities).

Of note, the Pew Commission on Human Health and Industrial Farming, which supports Slaughter’s bill, said after the hearing that Sharfstein’s proposals are only necessary but not sufficient: ““The proposed FDA position does not go far enough in this regard and would allow the continuation of conditions that necessitate the improper use of antibiotics in the first place.”

Antibiotic overuse in animals: Obama administration comes out against

By Leave a Comment

For anyone who cares about the overuse of antibiotics in food animals, and the resistant bacteria that overuse has been shown to produce, this is important news.

In testimony today, new FDA Commissioner Dr. Joshua Sharfstein announced the administration’s opposition to the use of growth promoters: sub-therapeutic doses of antibiotics used not as disease treatment, but to encourage animals to put weight on rapidly. Further, he also came out against the administration of antibiotics in food animals without the involvement of a veterinarian — a common situation out here in farm country, where veterinary antibiotics are freely available over the counter. (We discussed Scott Weese’s proposal to end that practice here.)

Both of these practices have been repeatedly linked to antibiotic resistance, and for the administration to come out against them is highly significant — not just for the struggle against resistant bacteria, but also for the movement to reduce industrial-scale agriculture, which relies on antibiotics to keep food animals healthy while they are in the close confinement of CAFOs.

Sharfstein made the announcement while giving testimony on behalf of Rep. Louise Slaughter (D-NY)’s Preservation of Antibiotics for Medical Treatment Act of 2009, which has been introduced (and opposed into nonexistence) multiple times over the past decade. (Earlier post on the legislation, including its text, here.) He said:

To avoid the unnecessary development of resistance under conditions of constant exposure (growth promotion/feed efficiency) to antibiotics, the use of antimicrobials should be limited to those situations where human and animal health are protected. Purposes other than for the advancement of animal or human health should not be considered judicious use. …
Important factors in determining whether a prevention use is appropriate include evidence of effectiveness, evidence that such a preventive use is consistent with accepted veterinary practice, evidence that the use is linked to a specific etiologic agent, evidence that the use is appropriately targeted, and evidence that no reasonable alternatives for intervention exist. FDA also believes that the use of medications for preventino and control should be under the supervision of a veterinarian. …
FDA supports the treatment of ill animals according to appropriate veterinary practice within a valid veterinary-client-patient relationship.

Also on the docket at Slaughter’s hearing:

  • Margaret Mellon, PhD, of the Union of Concerned Scientists (who specifically discussed MRSA ST398): “As long as the massive use of antibiotics continues, animals … will remain a fountain of resistant pathogens, dangerous to both animals and humans. The straightforward solution to the problem is to reduce the use of antibiotics in animal production and thereby diminish the pool of resistant organisms and traits.”
  • Robert Martin of the Pew Environment Group (Pew Charitable Trusts): “The present system of producing food animals in the United States is not sustainable and presents an unacceptable level of risk to public health, damage to the environment, as well as unnecessary harm to the animals we raise for food.”
  • And statements of support from the Chipotle restaurant chain and the Bon Appetit Management Company (which operates catering services in corporations and universities).

Of note, the Pew Commission on Human Health and Industrial Farming, which supports Slaughter’s bill, said after the hearing that Sharfstein’s proposals are only necessary but not sufficient: ““The proposed FDA position does not go far enough in this regard and would allow the continuation of conditions that necessitate the improper use of antibiotics in the first place.”

News!

By Leave a Comment

Folks, it’s been a little busy in my non-blog world, but here’s why:

SUPERBUG now has a publication date!
And — even more exciting — it has a cover! (And it’s gorgeous.)

… And I’ll be able to reveal both of them soon — when the publisher’s spring catalog is published.

Not long now. Stay tuned, please.

Bad news from California

By Leave a Comment

Constant readers, some of you may be aware that one major nexus of MRSA infection gets very little attention, though I’ve tried to raise it here periodically. That’s MRSA in jails and prisons: Thanks to poor hygiene and extraordinary overcrowding, jails and prisons are hotbeds of the bug, and it is very common for people to develop an infection after they are incarcerated, and then to be unable to shake it because they cannot keep up with hygiene, cannot get access to a doctor, etc.

Some commenters, here and elsewhere online, have suggested that this is no more than prisoners deserve. This seems to me both extraordinarily uncompassionate and epidemiologically foolish. In case no one has noticed, prison overcrowding is so serious that many prisoners don’t stay in prison for their sentenced time. And when they come out, and come back to their communities, they bring MRSA with them. That’s not even to mention the risk to the very large numbers of people who are not themselves incarcerated, but go in and out of jails and prisons every day: correctional officers, cooks, medical staff, and on and on.

All of which makes the news from California on Friday more than usually depressing.

Prison medical care in California has been so bad (see Gov. Arnold Schwarzenegger’s 2006 emergency declaration) that it is no longer under control of the state, but rather administered by a court-appointed receiver, who said in 2007:

Across the board we see delays in diagnosis and access to care and needed tests; misfiled, incomplete or illegible medical records; lack of space, sanitation and staffing; botched hand-offs of medical information during inmate transfers; failures by clinicians to recognize and evaluate “red flag” symptoms, follow published guidelines, perform basic physical examinations or respond to patient complaints; abdication of responsibility for patient care and lack of critical thinking or requests for help in difficult cases.

The prevalence of MRSA in California prisons is an important part of that picture : Correctional officers have sued over MRSA they acquired at work. (And yes, you can read all about it in SUPERBUG.)

Now, you may also know that California is in the midst of a gruesome budget crunch — and on Friday, the push for better prison medical care and the deficit in the state budget collided, and the deficit won. According to the Associated Press and the San Francisco Chronicle, the Schwarzenegger administration backed off an agreed-upon plan that would have ended the receivership and returned control of the medical system to the state at a cost of $1.9 billion, one-fourth of what was originally thought to be needed.

Schwarzenegger said in a statement Thursday that California cannot afford the additional cost.
“We cannot agree to spend $2 billion on state-of-the-art medical facilities for prisoners while we are cutting billions of dollars from schools and health care programs for children and seniors,” he said.
Schwarzenegger and lawmakers are considering eliminating or significantly reducing education, state parks and core social programs to address the $24.3 billion budget shortfall. (AP, byline Don Thompson)

The Chronicle story makes clear that the prison spending would not have made the deficit any worse, because the money was coming from new bonds, not from the state’s general fund. Its online commenters don’t seem to have paid attention to that, as they hit the same familiar themes:

  • “Why should the public have to babysit them for the medical problems they brought on themselves… Let them rot.”
  • “In my opinion bad medical services in prison should be only one of the deterrents that keeps one from wanting to go to jail. “
  • “Prison should be a place that is so intolerable, that no sane person would ever want to go there.“

It’s easy to moralize. It’s much harder, as we know here, to control the continuing spread of a microbe that has already gotten a solid foothold in the community. California’s decision to not improve medical care in its prisons — and therefore not address the threat of MRSA to its prisoners and staff — is practically a guarantee that the state’s already substantial community MRSA problem is going to get much worse.

Bad news from California

By Leave a Comment

Constant readers, some of you may be aware that one major nexus of MRSA infection gets very little attention, though I’ve tried to raise it here periodically. That’s MRSA in jails and prisons: Thanks to poor hygiene and extraordinary overcrowding, jails and prisons are hotbeds of the bug, and it is very common for people to develop an infection after they are incarcerated, and then to be unable to shake it because they cannot keep up with hygiene, cannot get access to a doctor, etc.

Some commenters, here and elsewhere online, have suggested that this is no more than prisoners deserve. This seems to me both extraordinarily uncompassionate and epidemiologically foolish. In case no one has noticed, prison overcrowding is so serious that many prisoners don’t stay in prison for their sentenced time. And when they come out, and come back to their communities, they bring MRSA with them. That’s not even to mention the risk to the very large numbers of people who are not themselves incarcerated, but go in and out of jails and prisons every day: correctional officers, cooks, medical staff, and on and on.

All of which makes the news from California on Friday more than usually depressing.

Prison medical care in California has been so bad (see Gov. Arnold Schwarzenegger’s 2006 emergency declaration) that it is no longer under control of the state, but rather administered by a court-appointed receiver, who said in 2007:

Across the board we see delays in diagnosis and access to care and needed tests; misfiled, incomplete or illegible medical records; lack of space, sanitation and staffing; botched hand-offs of medical information during inmate transfers; failures by clinicians to recognize and evaluate “red flag” symptoms, follow published guidelines, perform basic physical examinations or respond to patient complaints; abdication of responsibility for patient care and lack of critical thinking or requests for help in difficult cases.

The prevalence of MRSA in California prisons is an important part of that picture : Correctional officers have sued over MRSA they acquired at work. (And yes, you can read all about it in SUPERBUG.)

Now, you may also know that California is in the midst of a gruesome budget crunch — and on Friday, the push for better prison medical care and the deficit in the state budget collided, and the deficit won. According to the Associated Press and the San Francisco Chronicle, the Schwarzenegger administration backed off an agreed-upon plan that would have ended the receivership and returned control of the medical system to the state at a cost of $1.9 billion, one-fourth of what was originally thought to be needed.

Schwarzenegger said in a statement Thursday that California cannot afford the additional cost.
“We cannot agree to spend $2 billion on state-of-the-art medical facilities for prisoners while we are cutting billions of dollars from schools and health care programs for children and seniors,” he said.
Schwarzenegger and lawmakers are considering eliminating or significantly reducing education, state parks and core social programs to address the $24.3 billion budget shortfall. (AP, byline Don Thompson)

The Chronicle story makes clear that the prison spending would not have made the deficit any worse, because the money was coming from new bonds, not from the state’s general fund. Its online commenters don’t seem to have paid attention to that, as they hit the same familiar themes:

  • “Why should the public have to babysit them for the medical problems they brought on themselves… Let them rot.”
  • “In my opinion bad medical services in prison should be only one of the deterrents that keeps one from wanting to go to jail. “
  • “Prison should be a place that is so intolerable, that no sane person would ever want to go there.“

It’s easy to moralize. It’s much harder, as we know here, to control the continuing spread of a microbe that has already gotten a solid foothold in the community. California’s decision to not improve medical care in its prisons — and therefore not address the threat of MRSA to its prisoners and staff — is practically a guarantee that the state’s already substantial community MRSA problem is going to get much worse.

Food and ag policy sites: New in the blogroll

By Leave a Comment

Folks, when I was writing the last post (regarding Scott Weese’s blog), I had to stop and look up several sites. In mid-click, I realized how silly that was, because they are sites I visit all the time — and you should too, if you’re concerned about the veterinary, zoonotic, agricultural and food-policy issues that we discuss here so frequently.

So I’ve created a new category in the blogroll to the right, showcasing food and ag-policy sites that I think are worth reading. Among them you’ll find:

If you have other recommendations, please send them!

Restricting antibiotics in animals: Start by restricting access

By Leave a Comment

Constant readers, those of you who follow the pressing issue of MRSA in animals will know the work of J. Scott Weese, DVS, associate professor of pathobiology at the University of Guelph in Ontario and supervising author of many crucial papers on MRSA in food and companion animals, including the first finding of MRSA in pigs and pig farmers in North America.

You may not know that Weese and his postdoc Maureen Anderson publish an excellent blog on veterinary and zoonotic diseases called Worms and Germs. This weekend they have an important post that deserves wider attention: Antibiotics: A Dose of Common Sense. In it, they propose that one way to reduce the overuse of drugs in food animals is to make animal antibiotics prescription-only. It’s worth taking the time to read it.

Those of you in the cities may not know this, but out here in the Great Flyover, antibiotics for veterinary use are surprisingly easy to buy (as I discovered when I stumbled into a farm-related store in search of a Carhartt jacket against the Minnesota winter). They’re not even over-the-counter — they’re on the shelf, or stacked on the floor with the implements and feed, or blended into the feed itself. And as Weese points out in this post, they are also available without prescription over the Internet (as human antibiotics are too).

It’s a potentially controversial proposal: I don’t think I have any farming readers, but I would imagine their response would start with an objection to the extra cost of hiring a veterinarian to assess whatever situation might require the drugs. And since most farmers (NB: not the overarching ag-biz companies, but the farmers themselves) exist on razor-thin economic margins, they would have a point. But as we know from the excellent work of Extending the Cure and the Center for a Livable Future, unnecessary antibiotic use comes with a cost as well — one that is borne by all of us when antimicrobial resistance prevents antibiotics from working.