A Court decision with deadly consequences

pigsWe should all be concerned about Thursday’s 2-1 decision by the U.S. Court of Appeals for the 2nd District that the FDA needn’t consider the banning of antibiotics in healthy food producing animals.

Given the growing menace of antibiotic resistant infections among humans and the inveterate use of antibiotics in the meat industry to promote weight gain or combat disease, we draw closer to a pandemic in which even a minor wound or infection could prove deadly.

As is, the Centers for Disease Control and Prevention (CDC) informs us that at least two million Americans are sickened with anti-resistant pathogens annually

I may have been one of them, having just recently recovered from an extended bout with a staph infection that ultimately required daily IV.

I naively had told my infectious disease physician that I didn’t really want to leave the hospital until I was over the infection. His rejoinder was that a hospital wasn’t the safest place to be, given the infection rate incurred among patients (one out of three).

The Centers for Disease Control and Prevention comments that “much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”

More than 70% of all antibiotics are administered to animals, even when healthy.

To be fair, I can’t say what all the factors were in the court’s split decision, except that it imperils all of us.

I do know that according to the World Health Organization (April 2014), antimicrobial bacteria resistance increasingly threatens public health worldwide, “a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”

Consider that Carbapenem antibiotics used as a fallback in treating life-threatening infections from a common intestinal bacterium are now ineffective for nearly half of those treated in some countries. This bacterium is a major source of hospital acquired infections such as pneumonia, bloodstream infections and infections among newborns and intensive care patients.

Likewise, our best antibiotics for treating urinary tract infections caused by E. coli are now ineffective in more than half the cases.

Ten countries are now reporting that their last resort antibiotic for gonorrhea no longer works.

Unfortunately, while the FDA did ask pharmaceuticals, animal producers and vets to  exercise restraint in employing antibiotics that are also used for humans, the FDA appealed an earlier court ruling banning penicillin and two kinds of tetracyclides promoting growth, unless users can provide evidence it won’t produce drug resistant microbes. Thus, the Court’s decision in favor of the FDA’s appeal.

Overseas, the EU has banned the use of antibiotics in animal feed (2006) and now South Korea has done the same. In China, however, the use of antibiotics in animal production is widespread.

That animal and human health are linked was decisively demonstrated in outbreaks of multi resistant Salmonella in 2011, 2012 and 2013, traced back to ground beef and poultry sources (National Antimicrobial Resistance Monitoring System).

As physician David Angus admonishes in his best selling The End of Illness (2011),

Wealthy countries take for granted the triumph of science over bacteria, but increasingly doctors are battling infections that can only be quelled by the most powerful antibiotics known to medicine–or, at worst, by none of them at all. In the United States alone, antibiotic-resistant infections cause roughly 100,000 deaths a year. Imagine a world in which antibiotics produce toxic effects and unpredictable outcomes instead of the guaranteed cures we have come to expect–and you can understand what keeps epidemiologists awake at night (298-99).

 The Court’s decision brings that day much closer.

–rj

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Something worse than global warming?

We hear much about global warming these days, understandable given its smothering consequences for all life on earth.  Unfortunately, humans have at large remained callous to making lifestyle changes that may delay its full onset or lessen its consequences.  Recent research clearly indicts us as primary contributors to climate change in our dependency on fossil fuels.  Last year was the hottest on record.

Bad as the global warming scenario may be, I would argue we face a greater crisis elsewhere, simply because it’s happening right now and we’ve less than 20-years to find a solution.   I’m writing about the exponential increase in resistant microbes.  I don’t mean to push the panic button, but this isn’t a false alarm.

I wish things were otherwise, but an ostrich stance just won’t do.  Like many of you, I’ve read articles, even books, promising  not only the extinction of many of our primary diseases, but the near abolishment of death itself, or at least pervasive longevity.  This optimism, swelled by genetic research, hints at our finding targeted therapies that can prevent, modify, or eliminate diseases like cancer, diabetes, and dementia.  With dietary alterations, we may even speed the healing.

I’ve read recently that it’s essentially only 25-years and we’ll find medicine revolutionized.  Labs will diagnose your genomes and, like today’s culture specimens, suggest a solution.  No more fussing with finding the right medication and risking their frequent side effects.  We sometimes call it “metric” medicine, treatment individually tailored to get at or prevent what may ail you.

Unfortunately, this heaven-on-earth scenario isn’t likely to happen any time soon, given the inveterate increase of microbes resistant to antibiotics.  Again, its threat dwarfs the crisis of global warming.  As Professor Sally Davies, England’s chief medical officer, recently shared with parliament members, “It is clear that we might not ever see global warming; the apocalyptic scenario is that when I need a new hip in 20-years, I’ll die from a routine infection because we’ve run out of antibiotics” (“Antibiotic ‘Apocalypse’ Warning”).  www.bbc.co.uk).

By the way, think twice when it comes to a hospital stay.  Currently between 5 to 10 percent of patients develop an infection.  90,000 of them die, up from 13,300 just back in 1992 (www.medicine.net).  The cost impact of infections is enormous at $20 billion annually and eight million additional hospital days (Centers for Disease Control and Prevention [April 2011]).

Now the World Health Organization warns that we’ve reached a crucial point in the matter of resistant microbes.  Consider the present situation:

Presently we’re down to just two antibiotics for treating MRSA and one of these isn’t very good.  (MRSA now exceeds AIDS in annual U. S. mortality.)

With highly prevalent gonorrhea, we’re just about out of remedy.

And then there are candida, malaria, tuberculosis, staph and even UTI’s, all of them exhibiting increasing insensitivity to antibiotics.

Like global warming, we’ve done a lot of this to ourselves.

1.  Antibiotics are overly prescribed or treatment isn’t fully carried out.

2.  Hospital staff don’t consistently practice good hygiene.

3.  Cattle are fed antibiotics to inhibit disease and encourage growth.

4.  We’re destroying our rainforests, with their potential for new antibiotic substances.

5.  Ubiquitous use of antibacterial soaps and napkins, etc, increasing germ tolerance.

6.  Increased travel to underdeveloped countries, raising the possibility of Superbug contagion.

Matters aren’t helped by the scourge of HIV and TB raging across Africa, largely due to patient mismanagement of medications.  In India, currently, there’s a new Superbug that’s made its appearance, infecting even the water supply in Delhi. Compounding its threat is widespread travel these days, and the bug’s recent appearance in North America.  The sad fact is that exotic diseases are potentially only an air flight away.

This is always the ultimate threat–that somewhere, somehow, a new infection source will emerge for which we haven’t any remedy.  As Dr. Davis Agus reminds  us, even in the context of his best selling The End of Illness (2011) with its vibrant optimism, “The swine flu scare that occurred in 2009 will some day be dwarfed by a real epidemic that will spread rapidly through virgin immune systems and kill millions in its path (as happened, for example, in the flu pandemic of 1918, when an estimated 50 million to 100 million people died” (p. 277).

As I write, a new TB strain has made its appearance in Papua and like AIDS in Africa,  is badly managed.  Experts fear it may soon defy any cure.

Of course there are optimists who argue we’ll come up with treatment solutions.  We always have.

The reality is we’ve very little time and the research isn’t promising.  As Professor Hugh Pennington of the University of Aberdeen bluntly puts it, “We have to be aware that we aren’t going to have new wonder drugs coming along because there just aren’t any.”

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