Maryn McKenna

Journalist and Author

Re-Examining the FDA Antibiotics Decision: Banning Growth Promoters Won't Be Enough

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USDA Photos by Lance Cheung/Flickr

In my first take on the news of the FDA finalizing its request to agriculture to stop using growth-promoter antibiotics, I promised to come back for a more thoughtful reaction. And then this happened, and this happened, and the holidays happened, and, well, it’s been a busy few weeks.

So, finally getting back to it: When the news broke, a number of people, including me, said that this was a long-awaited first step on the part of the FDA, but of uncertain ultimate impact because it asks for voluntary action and does not address whether the drugs simply can be relabeled. I still agree with both those points, but think the possibly most important issue — which I raised briefly in the first post  — is that merely removing antibiotics, without changing the system in which those antibiotics have been administered, may cause significant animal-welfare problems, without having any real effect on human health.

(If you’d like the short version of this, listen to my chat with NPR’s Weekend All Things Considered.)

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Drug-Resistant Bacteria on Chicken: It's Everywhere and the Government Can't Help

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image: Thousand Robots (CC), Flickr

Two important, linked publications are out today, both carrying the same message: The way we raise poultry in this country is creating an under-appreciated health hazard, and the government structures we depend upon to detect that hazard and protect us from it are failing us.

The two pubs are:

Short version: Independent tests show that multi-drug resistant disease-causing bacteria are widely present on chicken, and the US Department of Agriculture’s Food Safety and Inspection Service (FSIS) has insufficient personnel, or legal authority, to change that.

Both these assertions are important, because foodborne illness, and especially drug-resistant foodborne illness, are also under-appreciated — for how serious the disease can be, and how long-lasting the after-effects are. (For more on those: Here’s a piece I wrote for The Atlantic about how drug-resistant bacteria on chicken are causing an epidemic of urinary tract infections, and one for Scientific American about the lifelong cost of foodborne illness.)

It’s worth emphasizing also that we are right now in the middle of an outbreak of Salmonella on chicken that has been going on for about a year. The Centers for Disease Control and Prevention posted an update just this morning: 416 people since since last February, in 23 states and Puerto Rico, 39 percent of them hospitalized, linked to a single producer’s brand of chicken.

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FDA Scrutinizes Antibacterial Products for Hormonal Disruption, Bacterial Resistance

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Image: Jim Belford (CC), Flickr

More news today out of the Food and Drug Administration — so while I’m still writing my follow-up to last week’s news on growth promoters, I want to toss this up first. The latest: The FDA has announced that it is formally reconsidering “antibacterial” soaps and other personal-care products, charging that the antibacterial ingredients confer no benefit over regular soap and water while carrying extra risks.

In a draft rule that will be published Tuesday in the Federal Register, the agency calls for manufacturers of consumer antibacterial products to begin providing data that shows the ingredients are both safe for daily use, and also more effective than plain soap and water. Deep in the 137-page rule, it also raises the issue that’s most interesting to me: whether the routine use of these products causes bacteria to develop resistance against the active ingredients, and against antibiotics as an unintended side effect.

Antibacterial products are a vast market; according to the FDA there are more than 2,000 currently for sale to consumers. (NB: This rule does not cover antibacterial hand-sanitizers; neither does it include the kind of washes and wipes used in healthcare.) The announcement today opens a 6-month comment period that ends next June. It will be interesting to see where this goes.

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FDA Finally Imposes Some Controls on Agricultural Antibiotics. Sort Of.

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USDA Photos by Lance Cheung/Flickr

This morning, the US Food and Drug Administration dropped some long-awaited-but-still-big news regarding the use of antibiotics in meat production. Tl;dr: The FDA asked (but did not compel) the livestock industry to stop using the micro-dose “growth promoter” antibiotics that are widely believed to contribute to increase in antibiotic resistant bacteria in animals, food and humans.

With exquisite timing, they happen to have picked a day when I am traveling, in order to get to my end-of-semester evaluation tomorrow for my  MIT fellowship. So I’m going to do what curation I can on this, and point to some important reactions and analyses. I’ll come back for a deeper look, probably on the weekend.

So here are the basics.

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Measles Cases Triple in U.S., Vaccine Refusal Here and Elsewhere to Blame

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Image: Teseum (CC), Flickr

Measles, one of the most communicable of all infectious diseases, is spiking in the United States, with three times as many cases as usual this year, the Centers for Disease Control and Prevention said Thursday. The spike is due to both foreign importations — infected travelers coming from places where measles is not under control — and local vulnerability: unvaccinated children and adults in the United States.

In a press briefing, the CDC’s director Dr. Thomas Frieden said that from January to November, there were 175 known cases of measles in the US, with 20 of those people having to be hospitalized. The agency would expect to see about 60 cases, he said. Those cases came from 52 separate travelers. Most of the time, the imported virus found only a few people to infect — but nine times, the imports caused large outbreaks, always in people who had not received the vaccine.

“It is not a failure of the vaccine,” Frieden said. “It’s a failure to vaccinate. Around 90 percent of the people who have had measles in this country were not vaccinated either because they refused, or were not vaccinated on time.”
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MRSA in UK Turkeys Raises Questions of Communication, Transparency and Risk

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Image: OZinOH (CC), Flickr

Two years ago, I celebrated Thanksgiving here on Superbug by announcing some new studies on resistant bacteria being found in turkey meat in the US. That did not go over well; so this year, I saved the bad-turkey news for the post-holiday week. And here you go:

Just in time for our Thanksgiving — and in the ramp-up to English Christmas, for which turkey is a traditional dish — the UK’s Animal Health and Veterinary Laboratories Agency announced that livestock-associated MRSA, drug-resistant staph, has been found in UK poultry for the first time. From their not-very-informative press release:

The Animal Health and Veterinary Laboratories Agency (AHVLA) has identified the presence of Livestock-Associated Meticillin Resistant Staphylococcus Aureus (LA-MRSA) in poultry on a farm in East Anglia… Once the poultry have been slaughtered and sold the owner will carry out cleansing and disinfection of their accommodation to ensure the next birds do not become colonised when they arrive on site. The AHVLA will revisit the farm after depopulation and thorough cleansing and disinfection to determine whether LA-MRSA is still present.

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When We Lose Antibiotics, Here's Everything Else We'll Lose Too

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A colony of an Actinomycetes bacteria taken at 140x magnification.Image courtesy Biology101.org/Flickr

This week, health authorities in New Zealand announced that the tightly quarantined island nation — the only place I’ve ever been where you get x-rayed on the way into the country as well as leaving it — has experienced its first case, and first death, from  a strain of totally drug-resistant bacteria. From the New Zealand Herald:

In January, while he was teaching English in Vietnam, (Brian) Pool suffered a brain hemorrhage and was operated on in a Vietnamese hospital.

He was flown to Wellington Hospital where tests found he was carrying the strain of bacterium known as KPC-Oxa 48 – an organism that rejects every kind of antibiotic.

Wellington Hospital clinical microbiologist Mark Jones (said): “Nothing would touch it. Absolutely nothing. It’s the first one that we’ve ever seen that is resistant to every single antibiotic known.”

Pool’s death is an appalling tragedy. But it is also a lesson, twice over: It illustrates that antibiotic resistance can spread anywhere, no matter the defenses we put up — and it demonstrates that we are on the verge of entering a new era in history. Jones, the doctor who treated Pool, says in the story linked above: “This man was in the post-antibiotic era.”

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Antibiotic Overuse on Farms: Is the Opinion Tide Turning?

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USDA Photos by Lance Cheung/Flickr

It’s been a busy few weeks here at Casa Superbug — including some conference appearances, more on them later — so the first thing I’d like to do is point out some things that appeared while I was offline. Notably: In editorials, three newspapers recently challenged the way antibiotics are used on farms and asked why we can’t do better.

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Science online and Science Online: A (Possible) Way Forward

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image: Doctorow (CC), Flickr

I mean this post to address the convulsions in the science-writing community that arose this past week in the wake of the problems faced by writer Danielle N. Lee, PhD regarding her Scientific American blog. That situation was resolved to good effect and quickly; if you’d like to catch up on that, the posts are here and here.

(Constant Readers, bear with me. I’ll get back to scary diseases and food policy next week.)

As most in that professional community know, but other readers and members of my other networks may not, Lee’s experience inadvertently triggered a cascade of revelations in which Bora Zivkovic, the blogs editor at SciAm and a very powerful and outspoken gatekeeper in science writing, was accused of sexual harassment by an aspiring writer. (Not Lee.) Over several days, additional accusations with and without names attached tumbled around the blogosphere and Twitterverse until, on Friday, one of his bloggers — the third woman to come forward by name — published a searing account of her experience which included quotes from sexually explicit emails he had written. Within hours, he resigned from his SciAm post. (The best wrap-up is Laura Helmuth’s at Slate.)

As a SciAm columnist and contributing editor, I am grateful that Zivkovic has been separated from the magazine and institution. But I think it is important to emphasize how wide the impact of his bad behavior has been. So I want to address the continuing ripples in the community, especially surrounding the forthcoming beloved and very hot-ticket conference, Science Online, which he helped create.

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CDC Director: In the Shutdown, 'We Are Juggling Chainsaws'

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The CDC’s Emergency Operations Center in Atlanta, from which it monitors disease outbreaks around the world.
Left: Currently. Right: Before the shutdown began.

We’re now on the sixteenth day of the federal shutdown. As I write, the Senate has announced a deal to avoid a debt default and open the government. It remains to be seen whether that will work, or how fast. Yesterday, on Day 15, I had a long conversation with Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, about what this shutdown has meant for his agency, its employees, and the health of Americans, and the world. I have lightly edited the conversation for clarity.

Maryn McKenna, WIRED: You’re on Day 15 of sending home 68 percent of your 13,000-person staff, in Atlanta and around the world. How is the CDC coping?

Thomas R. Frieden, CDC: Every day this goes on, it gets harder to manage. We’re used to juggling things at CDC, but this is like juggling chain saws.

We’ve got two-thirds of our staff out. The exempt staff, the ones who are here, are here just because of a happenstance of how they’re paid: They are people who are on multi-year money, or grant money, or people in the Commissioned Corps, the uniformed Public Health Service. Of the people who are furloughable, 95 percent are furloughed.

I walk through the offices and talk to the remaining staff to thank them for being here. A woman who was the only person on her floor said to me, “We have no idea what we’re missing right now.” For years people have asked me, ‘Do you sleep well, knowing all these terrible threats we face?” And I’ve always said, “I sleep great because I know we have fantastic staff on watch.” And now I’m not sleeping.

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