Wednesday, November 09, 2005

Why Are We So Bent Over Bird Flu?

AntibioticResistance.jpg

This quarter I have my chemistry students doing oral presentations. I do this for a number of reasons, to wit: 1. It's good practice for them, though many don't appreciate this at this point in their lives. 2. It breaks the routine for the kids in general. 3. It provides a grade buffer, i.e.
they get to do something definitely more left-brained focus in a class that's decidedly right-braincentric. My only requirement for the presentation is that they focus on a science specific topic, it doesn't have to be about chemistry, they can choose literally from the entire panoply of science related topics that you find out there. It's interesting to see what they'll get up to talk about, but one of the more popular and persistent topics is bird flu. It's very clear that bird flu is on the minds of the average teenager in America, and there's no small measure of fear associated with this. What gets me is how this has turned into something to be fearful of when it's killed less than 500 people so far. This is due in no small part to the media reporting on this regularly of late, and what becomes readily apparent is that the media fuels this fear without the least bit of concern regarding whether it really knows what it's talking about, or whether it's really giving the right focus on the right topic, vice the one that plays to the crowd, like Bush's new flu initiative ... oppps, I'm getting ahead of myself here.

Ok, maybe there can be a pandemic, we'll have bird flu sweeping across continents and millions will die. But it seems more and more likely that this is not the likely scenario that we can expect to unfold here. No, it seems that the genetic make up of this particular flu is quite a bit different from the variety that did a number, to the tune of between 25 and 50 million people (500,000 here in the U.S.) on the planet back in 1918, and it's not likely that this flu will become a virulent viral wildfire. Oh well ... but The Economist, where I stole the above picture from, writes about something we should be bent about in The struggle against superbugs. Here we meet MSRA, or methicillin resistant Staphylococcus aureus which is the antibiotic resistant staphylococcus bacteria which lurks in the inner, and apparently a few of the outer recesses of America's hospitals. Every year some 2 million folks are infected with this lovely example of evolutionary efficiency, and of that number about 90,000 a year die. Yep, that's 90,000 - multiply that by 5.5 years and you almost, not quite, beat out the 1918 pandemic. There are two reasons for this, one mundane and infuriating, the other an unfortunate byproduct of our capitalist way of life in this country, though if there were a $1 billion infusion into this problem, with $7 billion long-term as Bush proposes for bird flu vaccines, well I think we'd have this one licked. Here we go with the reasons:

1. American hospitals are piss-poor at monitoring for the bug and strictly enforcing precautions against it. It turns out that not ALL hospitals have this problem, our friends in Finland, Denmark, and the Netherlands have much lower incidences of infection because they take this issue seriously. It's not that the bug evolves any less virulently in those countries, it's just as nasty there as it is here, but there they take it seriously. What's the main deterrent against MSRA? Scrupulous hygiene - "Gee doc, did you wash those hands after you used the toilet?" Why don't we ever see signs in hospital restrooms admonishing the staff to wash their hands after every use? Hmmmmm ... well, they're mostly college graduates so we likely assume that they don't need reminding, in spite of the fact that they'll more likely be responsible for killing someone than the guy who handled my chef salad; go figure.

2. Drug companies aren't hot on creating new antibiotics, mostly because the big money is in long-term drugs like those for high blood pressure, heart disease, AIDs, etc. The money just isn't in few shot Charlie antibiotics. Of the 506 drugs in development last year only 5 were new antibiotics, in spite of the fact that there are more and more bugs out there that simply aren't
responding to the antibiotics we now have. Ok, the logic of the market dictates what drug companies will do, I understand that, but shouldn't 90,000 people cause someone to go, "Whoooooooooa, we have a problem here, and bird flu ain't it!"? I guess not.

It amazes me, really it does. So many of us are all gaga over bird flu, scrambling with some huge money to do something about being prepared for it, yet right now if you went to the hospital to have a hang nail removed you could die from MSRA, or maybe some other interesting little microbial agent of death and bodily destruction, all because we can't quite seem to get our priorities straight, and we can't get medical establishments and those working in them to take this stuff serious. Sometimes you just gotta love it ...

10 Comments:

Anonymous Anonymous said...

The reason no one is worried about staph infections is because the American Medical Association has succeeded in hiding all evidence of staph infections, as well as evidence of everything else that goes wrong in hospitals, including incompetent doctors.

10:03 PM  
Blogger "Ms. Cornelius" said...

I was talking in class the other day about these new drug-resistant "bugs" and I was urging my kids to always finish their antibiotics when they start them and so on. Long story short, one of my kids called me over and told me about how she had an infected sore on her arm for weeks, and offered to let me see it (I turned down her kind offer). I urged her to see the doctor, and she actual DID-- especially when I threatened to call her mom right then. She was hospitalized the next day and surgery had to be performed because her wound was infected with drug-resistant staph. The school nurses later told me they had told her to see her doctor for days.

My student finally came back from her hospital stay and told the other kids her story. We joke about my omniscience, but I think a valuable lesson was learned.

11:14 AM  
Blogger James said...

Ms. Cornelius,

Wow, what an excellent story, thank you for taking the time to share it.

First, we never know when we're going to intersect in some kid's life - it's crazy how something you say or do can trigger something that can make a huge difference in a student's, and sometimes our own, lives.

Second, this should be making people far more concerned than obviously they are. They're all worked up over some bird flu that will likely not make much of an impact here or anywhere else, but staph, something that's everywhere and beating out all the antibiotics we come up with, doesn't cause any concern. Here you have a student running around with an infection for days and it turns out it was potentially deadly - incredible. I have to wonder if Mr./Ms. Anonymous who posted before you isn't keyed into a big part of the problem: Why isn't the AMA making this a major issue? We're supposed to get worked up over health costs and malpractice tendencies, both legitimate concerns, but not as apt to kill you (unless you're poor) and not nearly as fixable as a large infusion of money to encourage drug companies to concentrate on this would be.

Again, thanks for sharing!

1:11 PM  
Blogger JM O'Donnell said...

You should also note that there is a third reason for the development of antibiotic resistant organisms. The rampant feeding of antibiotics (particularly analoges of medically important human antibiotics like vacomycin) to farmed animals like poultry, pigs and cattle has increased antibiotic resistance. As bacteria are so happy to spread their genes around, once you get resistance in one organism it can spread to others.

This is largely the reason why we are starting to see multiply resistant bacteria in the community now. Community aquired VRSA (Vancomycin resistant Staphylococcus aureus) is believed to have originated from aquiring resistance genes from Enterococcus faecalis species. These organisms originally obtained their genes from farmed animals fed medical analogues of vancomycin like avoparcin.

So yes, I agree somewhat with your thesis that these bacteria produce a considerable (and growing threat). Bird flu however, presents the threat of a rapid and sudden epidemic that organisms like MRSA are largely incapable of. MRSA is lethal primarily in the situation where it is inundated with antibiotics that select for its growth and destroy its competitors. Bird flu would have no such restriction.

10:12 AM  
Anonymous Anonymous said...

I agree with you that MSRS is indeed a problem and yes, it STARTED out as a problem in hospital patients. Having been the chairman of my hospital's infection control committee I can tell you that there has been a significant change over the years due to the overuse of antibiotics.

Twenty years ago over 90% of MSRS cases were nosocomial or hospital acquired as you say. Now, it is just the opposite. 90% of the MSRS cases come TO the hospital already infected with the resistant staff. It is now a community acquired infection. You actually get it more easily in the community now than in a hospital. Great strides have been made in education, implementation of universal precautions and in detection of MSRS. True hospital acquired infections are lower now than ever.

10:36 AM  
Blogger James said...

For Anonymous number 2: An interesting take on where the bugs are coming from, but your position doesn't quite seem to jive with what the Economist tells us about the difference between the rates of infection in our hospitals as opposed to those found in those of hospitals in the European northern climes. Surely they're dealing with the same problem we are, yet their rate of infection is considerably lower, why is that?

11:52 AM  
Blogger James said...

JM: You're absolutely right, the overuse of antibiotics in livestock and poultry is borderline criminal in my mind inasmuch as it decreases the overall drug efficacy, the only rationale for using them is to increase the weight of the animals, it then introduces these drugs into our food supply with consequences that seem to now suggest tangential problems, and what's worse, this problem was highlighted by my microbiology instructor in college some 25 years ago and here we still have it; incredible.

I don't entirely agree with your take on the virus. The evidence seems to suggest at this point that the pandemic potential for this thing is low, its DNA breakdown does not suggest the 1918 virus (which of course suggests a new range of problems), and less money can likely be spent more smartly by helping poorer countries contain the virus, something this administration isn't particular big on for many ideological reasons.

The fact is that the government could run interference for drug companies and provide financial inducements to facilitate and strongly encourage the development a wider range of antibiotics. Of course there are other possible avenues, immunologically focuse for example, but they're hypothetical by and large. Antibiotics are a real solution for now for bugs that are getting ahead of the drug curve and that should never happen, and certainly should never have been allowed to get to the point where 90,000 people a year are having die for this shortsightedness.

12:02 PM  
Anonymous Brad Warbiany said...

Good post. I found it through the Carnival of the Vanities and linked it here. I likewise can't figure out why everyone's worried about Bird Flu (just like when they were worried about SARS or West Nile Virus or Mad Cow or getting Cancer from their cellphones or countless other "crises") when they're probably more likely to die in a fiery car crash on their way to work in the morning. I wrote a post last night after reading Michael Crichton's "State of Fear", going into this very thing.

Luckily, though, I never go to hospitals, so I'm not worried about MSRA either :-)

5:42 PM  
Anonymous Marie, RN said...

My son recently aquired MRSA (probably from the locker room at his school). I noticed these lesions on his arms and legs that had crusted over and assumed he was getting them from football. One day he could not walk and I looked at his knee where I noted a large pustule with a necrotic center. He was feverish and in quite a deal of pain. The cultures grew out MRSA that was resitant to all oral antibiotic options other than Zyvox which cost $2,000.00 for a 10 day supply. The other option would have been IV antibiotic therapy. Luckily for us, we have insurance that paid for 90% of the cost. After a week of missing school and daily wound packing, he seems to have recovered, but there is still a fear that he may trasmit it to someone else as he is colonized for life, or that he can reinfect. I called the school nurse to have her send out info to all parents to screen thier children and her response was "We don't want to cause a panic." My son could have lost his leg secondary to osteomyelitis! I got the word out to all the parents I could and so far four other moms have told me that their son's have been diagnosed with it too. They are all football players with my son. Coincedence? Not likely. A word to the last guy who posted a comment....You don't have to go anywhere near a hospital to get this stuff!

12:44 PM  
Blogger James said...

Marie, You'd likely get something out of the following article that ran in last week's U.S. News & World Report:

http://www.usnews.com/usnews/health/articles/060109/9resist.htm

It adds a bit more to the pot with regard to how much of a problem there is with resistance with bacteria and recommends that the govt gets involved with providing inducements to the pharma industry to increase work on these drugs vice the new Clariton or Prilosec.

I have a hard time understanding how someone's "Colonized for life" with a deadly bacteria - we're colonized with harmless bacteria, in fact need to be, but if the bacteria is harmful it seems to me that eventually it'll kill its host. I didn't think bacteria were like viruses, which can lay dormant as the chicken pox or herpes virus does.

Anyway, whatever the points regarding hosting bacteria, your point with regard to everyone wanting to hush this up is on target - it's better to not talk about the problem than it is to try and fix it, which of course would take money, some aggravation, and likely scare some people, but it seems to me that it'd be worth it if we can avoid a major outbreak of a resistant bacteria that would needlessly do lots of damage.

10:04 PM  

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