Journalist and Author
Karen Jackson (CC), Flickr
Big news in the world of food policy, farming and antibiotic use: Perdue Farms, the third-largest chicken producer in the United States, announced today that during the past decade it has ceased using most of the antibiotics that formerly propped up its chicken production.
There are caveats to that “most,” and I’ll explain them. But it’s important to say up front that this is a nationally significant move and looks like an industry-leading step.
Daliborlev (CC), Flickr
I said last month that I was going to try to stay out of Ebola news because so much is being written about it elsewhere. Since then, the African outbreak — now really an epidemic, since it is in multiple countries — has ballooned to 3,000 cases, and the World Health Organization has predicted it may take 6 months or more to bring it under control.
Something caught my attention today though that felt worth highlighting. Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, gave a lengthy press conference immediately after returning to the US from a visit to the Ebola zone. Frieden has shown in the past that he knows how to be outspoken in a very strategic way; yet even so, the urgency of his language, and his call for an immediate, comprehensive global response, was striking.
Rama (CC), Flickr
The farm practice that underlies most agricultural use of antibiotics is known as “growth promotion”: It calls for giving very small doses of antibiotics routinely to meat animals because those doses cause them to gain fat and muscle more quickly than they would otherwise. Growth promotion dates back to the early days of the antibiotic era, and has always been somewhat mysterious. Though there were attempts to pick apart its mechanisms in the 1950s and 1960s (I’ve been reading some fascinating old accounts), for the most part, people simply accepted that it worked. It’s only in the past decade or so, as interest has increased in the microbes that reside everywhere in our and animals’ bodies (a vast community generally known as the microbiome), that researchers have begun trying to dissect what is going on.
The scientific team that has probably pursued this most intensely is the NYU Langone Medical Center lab led by Martin J. Blaser. Blaser published a popular account of their research into antibiotics’ effect on obesity, asthma, diabetes, and other disorders in Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues, published in April. (Disclosure: I reviewed the book for Nature.) Two years ago, the team showed that giving small doses of antibiotics to very young mice affected genes controlling metabolism of nutrients, and caused the mice to gain weight. Now they have followed up that research with detailed work exploring how much the timing and length of antibiotics affects weight gain. Though the work is still in mice, it leads to provocative conclusions about how growth promoters work in livestock, and what early-life antibiotics might do to humans as well.
Daliborlev (CC), Flickr
I’ve stayed out of the Ebola news so far, for a couple of reasons. First, as longtime readers know, I’m writing a book; I’m in the last 6 months of it and the work is intense and involves a lot of travel. I’m not always available at the exact moment news breaks. Second, I try to explore things here that readers may not have heard about elsewhere. The Ebola outbreak has been building in West Africa for a while, but when it was revealed at the end of last week that two American aid workers had caught the disease — and that they were being transported back to the US for treatment — the news and the reaction to it instantly filled every channel. Over the weekend, so much misinformation and outrage got pumped out that it feels as though there’s no way to cut through the noise.
But I have a few thoughts. Start with this: No, I don’t think the two aid workers who are being returned to the US pose any risk at all to the average American, or even the average Atlanta resident. Here’s my marker on that: I’m an Atlanta resident. I live less than 2 miles from the CDC and Emory University (the aid workers are being treated in a special unit housed at Emory on behalf of the CDC; the two institutions are next door to each other). My entire neighborhood and a good part of my various friendship circles are CDC employees, Emory healthcare workers, or both.
Klebsiella, Janice Carr, CDC
There’s worrisome news here in the southeastern U.S., buried in a journal that is favorite reading only for superbug geeks like me. The rate at which hospitals are recognizing cases of CRE — the form of antibiotic resistance that is so serious the CDC dubbed it a “nightmare” — rose five times over between 2008 and 2012.
Within that bad news, there are two especially troubling points. First, the hospitals where this resistance factor was identified were what is called “community” hospitals, that is, not academic referral centers. That’s an important distinction, because academic medical centers tend to be where the most cutting-edge care is performed, and where the sickest people are. As a result, they are where last-resort antibiotics are used the most, and therefore where resistance is most likely to emerge. That CRE was found so widely not in academic centers, but rather in community hospitals, is a signal that it is probably moving through what medicine calls “the community,” which is to say, anywhere outside healthcare. Or, you know, everyday life.
A second concern is that the authors of the study, which is in Infection Control and Hospital Epidemiology, assume that their finding is an underestimate of the actual problem.
[Read more…]
Variola, CDC
I was away reporting most of today, and while I was out, a few federal emails landed in my mail with what probably sounded like a thud. One was an official announcement from the Food and Drug Administration; the others were copies of FDA and NIH emails that people there thought I should see.
They all said the same thing: The six vials of smallpox virus found in an FDA cold-storage room on the National Institutes of Health campus July 1 and announced by the CDC last week had company. A lot of company: 321 other vials. Some of them contained other “select agents,” infectious pathogens considered serious enough — for the illness they create, or the lack of a vaccine to prevent or drugs to treat them — to be considered potential bioterror agents.
(If you’ve missed this story so far, catch up here, here, here and here.)
Here’s the gist of the FDA’s external announcement:
TEM image of influenza A H7N9, CDC
Leadership of the Centers for Disease Control and Prevention will appear today before the Energy and Commerce Committee of the House of Representatives, to answer questions about the lab accidents with flu and anthrax that the CDC disclosed in its press conference last week.
On deck: CDC Director Dr. Thomas Frieden; Dr. Joseph Henderson, Deputy Director of the CDC’s Office of Security and Emergency Preparedness; staff from the Government Accountability Office and the Animal and Plant Health Inspection Services of USDA; and academic experts.
Tuesday night, the witnesses’ written testimony was placed on the Committee’s webpage. Frieden’s says in part:
First, these incidents should never have happened, and the lack of adequate procedures and oversight that allowed them to happen was totally unacceptable. Although it does not appear that these incidents resulted in any illness, and there was no release of pathogens as a result of either event, this does not excuse what happened.
Second, we will take every step possible to prevent any future incident that could put our laboratory scientists, others in the CDC workforce and the broader community, or the public at risk… I am personally overseeing a series of reforms designed to address these specific incidents – but more broadly, recognizing that our challenge is larger than addressing these two specific incidents, I will oversee the careful and deliberate review of existing, and development of new safety practices at all levels of our Agency…
Third, we will explore the broader implications of these incidents and incorporate the lessons learned from them to proactively prevent future incidents at laboratories across the Nation that work with pathogens.
The two accidents, and especially the flu accident — in which a serious strain of avian flu was mistakenly sent to a poultry-research lab, instead of a mild one — have revived concerns about research currently being pursued, not at the CDC, that soups up flu strains to artificial combinations of transmissibility and virulence. The fear, which I’ve written about here and here, is that a lab accident could allow such manmade flu strains to escape.
In advance of the hearing, a group of scientists who have been critical of the lab-enhanced flu work (generally called “gain of function” or “dual use” research) have banded together as the Cambridge Working Group to put their concerns on the record. [Read more…]
Variola, CDC
Those of us who write about infectious diseases faced a conundrum last week, when the news broke that 60-year-old vials containing viable smallpox virus had been found on the National Institutes of Health campus. A responsible reporter always wants to talk to the experts in any subject. But when it comes to smallpox, experts can be hard to find.
Smallpox was one of the world’s worst killers, from prehistory through the first half of the 20th century. Yet there has not been a case of the dreadful disease anywhere since 1978, so few physicians working today have seen one. The virus is supposed to exist in only two highly secure stockpiles, so few scientists do research on it. And the aggressive campaign that chased the disease from the globe — the only human infection for which that claim can be made — ended 34 years ago. Many of the men and women who led it are in retirement, and a number have died.
Fortunately, the physician who headed that international campaign — 85-year-old Donald Ainslie Henderson, universally known as D.A. — is still working in public health, as a distinguished scholar at the bioterrorism-focused Center for Health Security of the University of Pittsburgh Medical Center. Henderson literally wrote the book on smallpox — twice, in fact: He co-authored the World Health Organization’s definitive 1,500-page reference, Smallpox and its Eradication (known in public health as the Red Book), and in 2009 wrote a personal reminiscence of the global battle, Smallpox: The Death of a Disease. Just last month, he published a lengthy, closely argued essay in the journal he co-edits, Biosecurity and Bioterrorism, urging the WHO to finally consent to destroying the last stocks of smallpox virus. (A decision the international agency declined to take; instead, for the sixth time in a row, it postponed a vote on destruction in favor of more study.) There are only a few people working in public health — not just in the United States, but in the world — who possess equivalent knowledge of smallpox, its eradication, and the persistent fears afterward that it could be used as a bioterror agent.
Last week, I talked to Henderson about the live-virus discovery and whether it will affect calls for all stocks of smallpox to be destroyed. He had some surprising things to say, particularly about the availability of smallpox vaccine. I edited our conversation for clarity and length.
Variola, CDC
Here’s an update on the vials found on the National Institutes of Health campus last week that were labeled smallpox, and transported earlier this week to the Centers for Disease Control and Prevention: The CDC and NIH have both confirmed that the virus in two of the tubes is viable.
That is, if the vials had broken, and someone had come in contact with the dried contents, the result could have been a smallpox infection — something that has not been seen in the world since 1978.
NIH director Dr. Francis Collins made the announcement in an email sent to staff today, which was shared with me. Simultaneously, CDC director Dr. Thomas Frieden announced in a press briefing that the CDC lab studying the vials, which earlier had identified the contents as smallpox virus based on PCR of the contents’ DNA, had induced growth of the contents in a tissue culture, and confirmed that the growing material is smallpox virus.
e-Magine Art (CC), Flickr
Among the groups that work on awareness of antibiotics resistance — which include major medical and public health organizations as well as nonprofits trying to direct attention to antibiotic misuse in medicine and agriculture — there has been a lot of anticipation of a forthcoming report by the President’s Council of Advisors on Science and Technology. The report, which has been in the works for months, will be published shortly, possibly as early as next week. Today, the council — known as PCAST for short — held a public meeting to discuss the report’s contents and vote as a group to accept or rejected. The meeting was webcast, and as far as I could tell, the vote was unanimous.
Though the report itself won’t be out for a bit, the meeting gave a good sense of what the report will say. For accessibility, PCAST runs live voice-recognition transcription of its meetings; so while the meeting was proceeding, I grabbed a transcript to review later. Here’s what seems to be coming.
