Maryn McKenna

Journalist and Author

New MRSA group discussion, caveat lector

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A UK-based site called iCareCafe posted a link in the comments to the previous post, inviting readers who are MRSA patients or caregivers to visit. Per my rules I’m elevating it to post status so that you can see it and I can comment on it.

Here is their post:

…The icarecafe has been set up to provide a space for patients, carers and their supporters online.
Some of the members have set up a discussion group on the subject of MRSA. The group has asked lots of questions which are still in the process of being answered. So we thought it appropriate if we invited people from other MRSA discussion group and blogs to ask if they wished to participate.
To have a look at the discussions so far please have a look at http://www.icarecafe.com/?page_id=1107&group_id=71
Best wishes
Belinda Shale
Moderator – the icarecafe

My due diligence:

  • As you’ll see in the right-hand sidebar, I am a sympathetic member and promoter of authentic communities online. However, as I have warned before, I am skeptical of sites that exist mainly to sell products to patients.
  • The iCareCafe appears to be an authentic discussion forum that covers numerous diseases and conditions, though a few of the members are using what appear to be “stock art” pix of models to represent themselves; make of that what you will.
  • The MRSA forum currently has 6 threads running; in a few, people are sharing their stories, and in a few others, people are aggressively pushing nutritional regimens and recommending cleaning products.
  • The iCareCafe is backed by a marketing company, as it discloses here:

    …The icarecafe is a project from The Patients Voice (which is itself part of Healthcare Landscape. By way of earning our living we provide our clients with medical market research services. Or to put it another way we run surveys and focus groups and things of that nature so that we can provide patients with a voice.

FWIW.

If you don’t believe in evolution…

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…is taking new antibiotics an act of bad faith?

Given, you know, that they’re designed to counter the evolution of disease organisms into more resistant forms?

Just asking. Prompted, probably, by the news that our governor here in Minnesota, Tim Pawlenty, has endorsed teaching creationism in schools here.

Perhaps we’ll see him wearing these T-shirts? (I like the Atlantis one myself): Teach The Controversy.

(Actually, I would like an answer to my question. If anyone can explain the argument, post it in the comments please?)

Surveillance to stop MRSA: Where, when, how costly, how much?

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My colleague Joanne Kenen — longtime health policy correspondent for Reuters, now a staff member at the New American Foundation, and a Henry J. Kaiser Family Foundation Media Fellow with me in 2006-07 — very kindly invited me to guest-blog at the New Health Dialogue. Most of the post is reproduced below, but please be kind and visit them so they can record the hits!

Stopping the spread of MRSA in hospitals is one of the most contentious topics in infectious disease policy right now. A small sample of the, umm, highly divergent views on the subject filled up the letters pages of the Journal of the American Medical Association last week. Community-associated MRSA has grabbed the public’s attention over the past year, but hospital-acquired MRSA remains a huge problem — so much so that the Center for Medicare and Medicaid Services has proposed treating it as a medical error and declining to reimburse hospitals for the extra care that must be given to a patient when it occurs.

Within health care, there is vociferous debate over how to control MRSA. Because MRSA can live on the skin, nostrils and other body sites for a long period of time before causing an infection — either in the person colonized by the bug or in someone else who acquired it from the colonized person — many hospitals espouse a program of checking new patients who are most likely to be carriers, including patients in high-risk units such as ICUs, new admits from long-term care facilities, and people who have had MRSA infections on the past. But a small set of institutions are pursuing a more aggressive program, variously called “active surveillance and testing,” “universal screening” or “search and destroy,” that checks every inpatient for MRSA colonization and confines them to isolation until the bug has cleared.

“Search and destroy” was the topic of an important JAMA paper and editorial last March that decided the effort wasn’t worthwhile. (A simultaneously published paper in the Annals of Internal Medicine completely disagreed.) The five letters in JAMA tear the topic apart, examining definitions, methodology, cost-effectiveness, adherence to infection control and more. The most intriguing suggests that “search and destroy” contains a hidden agenda: That if hospitals can demonstrate patients were carrying MRSA on admission, they may be able to make a case for any subsequent infections not being their fault — and so escape the lowered reimbursement rates that CMS proposes.

A note on flackery.

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I believe in transparency (see Operating Instructions in the right-hand column), and some comments have been submitted to the blog recently that I was not willing to publish. So it’s time to declare a policy.

Here it is: I will not allow any comments that advertise any products, explicitly or by linkage, period full stop.

I am my readers’ filter; that’s the responsibility I accepted when I started this blog, and I take it seriously. So anything that might be published in this space goes through me first. If anyone out there has a product — pharma, natural, alternative, antibacterial, whatever — my email is on the right. Send me a note, send me some literature; especially send me some data. I’m happy to engage offline.

I may post on what you send, or I may not. But it will be my post, not someone else’s cloaked advertising. Just so we’re clear.

Sermon over. Donuts and coffee, anyone?

Closing the loop: meat, meat-eaters, health-care workers

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A posting on the international disease-alert mailing list ProMED led me to a scientific abstract presented at a European meeting this spring on the ST 398 MRSA strain. It adds another, quite unnerving piece to the emerging interplay of MRSA in pigs, humans who have close contact with pigs, humans who have contact only with pig meat, and health-care workers who treat those humans.

Brief precis: About a year ago, Dutch health authorities discovered that a patient who had come in for surgical debridement of a diabetic foot ulcer had an unrecognized MRSA strain in that ulcer. Subsequently, they discovered that four other patients and five health-care workers in the same institution were carrying the same strain. None of the patients reported any contacts with pigs (or calves, which have also been found to carry the strain). One of the health-care workers lived on a farm that raised pigs, but said that she had no contact with the animals in her daily life; nor did her partner.

The authors conclude:

While the source is not fully established it could be the HCW living on a pig farm. This outbreak makes clear that transmission on a larger scale can occur, even with NT-MRSA.

(Hat-tip to Helen Branswell of the Canadian Press for telling me about the ProMED report. And a note to loyal readers: The “MRSA in meat” story is being picked up by some US newspapers. Doesn’t it feel good to know you’ve been reading about the issue here for months? And if you’re a reader of Helen’s work, months more? Of course it does.)