Update: We’re going live in 3…2…1
Just a quick heads up. I’ll be talking at 5 Eastern Time today with Maryn McKenna, aka Scary Disease Girl on Virtually Speaking Science. You can listen, but if you’re a virtual kind of person you can also head over to the open air theater in Second Life see Maryn’s magnificent avatar with its gloriously purple hair. (One commenter compared the shade to Beaujolais Nouveau, but I’m not so sure.)
McKenna is a science and medicine writer who has focused the last several years of her career on the truly vexing and terrifying issue of antiobiotic resistance, focusing on the scourge of MRSA: methicillin-resistant Staphylococcus aureus, or drug-resistant staph. She blogs at Wired.com, under a title shared with the book — Superbug — that will be the leaping off point for our conversation.
So check it out, if not synchronously, then via the podcast, available either at Blog Talk Radio (from about midnight tonight, I think, though it may be tomorrow), via the RSS feed, or as found within the greater Virtually Speaking iTunes podcast.
Just to give a tease of the conversation — we’ll start by talking about the great squander: how, some 75 years into the antibiotic era, we’re on the verge of destroying what had once seemed to be a truly transformative gift, a way to salve so much human suffering…and we will start to look at the reasons why. High among them will be the area Maryn’s focused on a lot since publishing Superbug, the use of antibiotics in agriculture in a non-therapeutic situations — that is, not as a response to an infection, but either as a prophylactic, or simply to fatten up livestock before slaughter.
There’s been some news over the last week that makes this issue genuinely hot, but the most interesting aspect of it, to me, is the way agribusiness and their congressional allies (on both sides of the aisle, alas) have simply changed a few of the nouns and then copied the denialist playbook written for the tobacco wars, and updated for use in turning the threat of climate change into a world-wide conspiracy of fanatical socialist-facist greens.
Which is to say, as readers of this blog know, the transformation of science from a source of public knowledge into a post-modern body of jargon to be manipulated by those with the biggest and most sophisticated megaphones, is literally killing us — as we will discuss in a bit.
Oh — and one more thing. One of the key threads to emerge from Maryn’s work is just how badly we are served by the fragmentary system of health care delivery that we now have, that the GOP wishes to preserve, and that Obamacare goes some way to repair. The lack of uniform systems of electronic charts, the failure to disseminate key medical knowledge outside of its silos — sometimes single hospitals, or even single services within hospitals — the inability to construct a truly national system of health care knowledge and the dissemination of best practices (Death Panels!) all have contributed directly to the deaths of kids, grown ups, grandma and grandpa from preventable or much earlier-treatable MRSA infections, as Maryn has documented — and much else besides. Remember: when our friends who decry the fascism inherent in public regulation of a public good seek to repeal without replacing, they are advocating a policy choice that will kill people. This is a known, predictable consequence of any swerve to the status quo ante. In other circumstances, taking actions that a reasonable person understands will lead directly to the deaths of others has a name, and the people who do so have names to. Now we call them GOP Presidential candidates. Just sayin.
Just the cheery kind of conversation that will set you up for a truly heroic cocktail hour. May I recommend either one of these…or, maybe, doses by mouth of this concoction, repeated as necessary.
Image: Barent Fabritius, The Slaughtered Pig, 1656
catclub
Are other nations (with more nationalized healthcare) dealing with MRSA and similar better than we are?
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Is that because of their healthcare systems or other reasons — better educated food consumers comes to mind.
Valdivia
Sorry to go OT right off the bat but WTH is up with Toobin. He has been screaming like a crazy person giving not really analysis of arguments at the Court but total hair on fire predictions. ScotusBlog has such a different take I am beginning to think he is just making the drama so he leads every newscast.
JCJ
Tom, do you know if practice guidelines are widely utilized. I am a radiation oncologist and my partners and I as well as most of the medical oncologists and surgeons I work with follow the National Comprehensive Cancer Network (NCCN) guidelines pretty closely. This is not because we are abdicating our responsibilities and hiding behind the guidelines, but rather because they are evidence based. In my view if you are not following the guidelines you had better have good supporting literature. Insurance companies don’t object if there is level one evidence supporting your position as well. I am in the bubble of my specialty so I have no idea if other such guidelines exist outside of oncology or how well they are adhered to.
beergoggles
Speaking of HCR and scary diseases, I was reading the amicus brief highlighted in this post from Lambda Legal and it seemed like a nifty way around the mandate by saying it’s required for non-discriminatory access to healthcare.
middlewest
I just started Merchants of Doubt, based on your recommendation, and it begins with this amazing Scalia quote:
We’ve got trouble.
Tom Levenson
@JCJ: I’ll put the question to Maryn, who’s really the expert here. Sadly, though, just from the evidence she provides in her book, it’s clear that guidelines on really elementary stuff — hand washing, for example — need constant eye-balls on vigilance and enforcement/encouragement. The other problem is that even when physicians know the guidelines — say, on avoiding overprescription of antibiotics, other pressures weigh more heavily: patient demands, the need to move folks through the office quickly, simply inattention or ignorance of the details of a resistant outbreak (which evokes useless scripts until the organism and its resistant profile is konwn)…and so on.
@catclub: Again, Maryn knows this stuff way better than I, but one of the signal case studies in her book is the way the Dutch (and many European countries) have done a much better job than we have in controlling especially hospital based MRSA outbreaks. The methods are transferrable: she also documents successes in individual facilities or hospital chains over here.
Steve
@Valdivia: I don’t doubt he really believes what he is saying, but Toobin is a very excitable guy in general. You can take his opinion as just one data point among many.
Roger Moore
@JCJ:
Not a doctor, and don’t even play one on TV, but my best guess is that this kind of thing varies tremendously. Some specialties are going to involve complex, technical stuff and require a lot of collaborative work, and the doctors there are going to care a lot more about the latest science. Some specialties are going to involve lots of drug pushing by Big Pharma and are going to be driven by all the latest marketing. Some doctors are going to be careful and want to follow the best available guidelines and some are going to be cowboys who don’t trust anything but their guts.
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On top of that, some specialties are going to attract cautious rule followers and some are going to attract cowboys. (I’m sure you can think of some fields that fit in either category.) Some hospitals may push a collaborative approach, which will tend to tamp down individualism and encourage relying on evidence, while others will give doctors more power to practice as they see fit. The result will be a huge variability from field to field, from hospital to hospital, and even from doctor to doctor.
Villago Delenda Est
@middlewest:
Scalia is definitely not a scientist, because he’s got the mistaken notion that he knows everything there is to know. Scientists are quite adamant that there’s a hell of a lot they don’t know, and they’re seeking to shed a little light on that vast body of the unknown.
KS in MA
Please thank her for (among those other things) taking on the issue of antibiotics in livestock/agribiz– it’s hard to overstate its importance.
Anoniminous
Been known for a while. The SO was researching and finding Antibiotic Resistance Transfer Affects in the mid-70s.
catclub
@Tom Levenson: Thanks!
liberal
@Anoniminous:
Yeah, this is pretty old news.
What I’m curious about is how quickly new classes of antibiotics were dumped into animal feed after their discovery.
eemom
@Valdivia:
You would be 100% correct in that thought.
Fuck him and that twerp Serwer with a closet-full of asiangrrls rusty pitchforks.
I listened to part of the argument yesterday. They, and anyone else who thinks that anything any of the Justices said tips their hand as to how they’re going to rule, are categorically Full. Of. Shit.
Roger Moore
@Tom Levenson:
One of the truly depressing things about hospital acquired infections is how much of the solution is based on cheap, low tech hygiene stuff: hand washing, keeping surfaces clean, changing gowns between patients, etc. This is stuff that we learned in the 19th Century but have neglected because we assumed it wasn’t important anymore. It’s depressing that we’re having to re-learn all this really basic stuff.
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It’s not exactly the same thing, but one of the researchers in my department is working on pulmonary fungal infections in immunocompromised cancer patients. One of the key points of infection is when a patient gets out of the hospital, goes home, and kicks up a ton of dust cleaning all the stuff that’s been neglected while they were in the hospital. The simple and very cost effective solution to this is to hire a maid service to clean the patient’s house just long enough before they’re discharged that any dust kicked up by the cleaning has had a chance to settle when the patient gets home. It’s the whole “ounce of prevention” thing written large.
Valdivia
@Steve: totally Steve. What needles me though is that he is the one determining how it gets covered. I heard his quote everywhere in the tv news last night. I am sure tonight it will be the same.
@eemom:
this is why I decided to read ScotusBlog before anything else. I hate the fucking vapors these guys get.
elmo
I’m blessed with both good luck and overall good health, so I don’t visit doctors often. One visit, though, was terrifying: I somehow developed a MRSA infection inside my right nostril, and the doctor was quite serious in his no-holds-barred approach to killing the motherfucker before it could spread up into my sinuses.
And they apparently can go dormant for a while and then crop back up again, because I’m supposed to continue to pay attention to any unexplained soreness. That shit is nothing to mess around with.
jibeaux
@eemom: Well, I for one am going to go ahead and put Scalia talking about the broccoli mandate and the Cornhusker Kickback as subtle, subtle clues as to his leanings.
eemom
@Valdivia:
Yes, SCOTUSblog is written by folks who watch the Court ALL the time, not just when the case of the century comes on, and who don’t make a living off sensationalist hysteria.
Anoniminous
@liberal:
Excepting the latest generation, new antibiotics have been added as soon as mass manufacture dropped the cost. This is a major reason we are finding multiple drug-resistant strains of common bacteria. Another other major reason is India sells antibiotics Over the Counter and people there take them until they start feeling better, which means a full course is not taken, giving the bacteria a chance to evolve.
Fun Fact: bacteria can transfer genetic material twixt All and Sundry all bacteria, everywhere, so they can be considered one species and a heck of a lot of sub-species each specializing in varying ecological niches: like nuclear reactor cooling ponds.
GregB
Toobin is coming across as the Nancy Grace of Supreme Court analysts.
meander
Another intersection between health care and food is the viciously anti-entrepreneurial nature of the health insurance system in this country. Suppose you want to go out and start a farm, or a company that makes baby food from organic vegetables, or a local butcher shop, or a food truck. Good luck getting reasonably-priced insurance if you don’t have a spouse that can cover you…
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A national health-insurance/health-care system would make it so much easier to start businesses. That is, would increase freedom in some ways.
Martin
@elmo: Yeah, about 8 years ago or so I had a sinus infection that they couldn’t beat. 3 weeks of fevers. Lost hearing completely in one ear for a week and a half, and most of it in the other. Lost the ability to speak for about half a week. In that last week they threw the kitchen sink at it and knocked it out, but they said afterword that if that hadn’t worked, that likely would have been it for me – it would have gone straight up into my brain and taken me out. I think I was on antibiotics for 7 weeks or so.
I did lose about 20 pounds, though, so it wasn’t without its benefits.
Studly Pantload, the emotionally unavailable unicorn
TOTES off topic, and REALLY small taters, but I’ll just toss in that commas would suffice where there are semicolons in the title to this entry. Semi-colons would be appropriate, though, if the title ran something like this: “Scary Diseases, Which Are a Bitch; Agribiz Denialism, Which is a Bigger Bitch; and Why We Need Health Care Reform.”
Note that I am not a grammar Nazi, and have been known to accidentally plug in a “their” when “there” is called for, etc. It’s just that semi-colons are such poorly understood critters in our society (I did not catch on to their actual purpose until I was in my 30s) that I feel the need to come to their aid when they’re used in any manner not as intended.
Feel free to carry on with the more important subjects at hand, here.
Valdivia
@GregB:
For the win!!
Tom Levenson
@Studly Pantload, the emotionally unavailable unicorn: I’m a semicolon maven (though continent, fortunately). I used them here deliberately — to imply exactly the kind of larger comment you write explicitly.
Sometimes grammar is there to bent for effect.
catclub
@meander: “That is, would increase freedom in some ways.” … but not in ways that raise profits for giant insurance companies.
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My peeve is that GM’s pension and healthcare nightmares would be essentially SOLVED by national healthcare systems, but they continue to oppose it as reflexive GOP businessmen.
Studly Pantload, the emotionally unavailable unicorn
@Tom Levenson:
Ah. Noted!
Violet
@meander:
I was just having this EXACT conversation with a massage therapist who had to apply for extra insurance to cover an operation she desperately needs for a congenital issue. I told her she needs to check with her insurance agent as to what might happen to her coverage if the Supreme Court declares any or all of the healthcare law unconstitutional. I suggested she might go ahead and get that surgery in the window before the rule on it in June so that there aren’t any unexpected issues. She had no idea it was even in front of the Supreme Court. SIGH. People are SO UNINFORMED.
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Back on topic…please thank Maryn for her work, Tom.
@Tom Levenson:
I haven’t read her book, but does she discuss the issue of dirty white coats and ties that male doctors wear that transfer infection? Ties are not cleaned very often and because they are likely to come in contact with a patient if the doctor leans over the patient, they can be vectors for transferring infection. I’ve heard of family members/patient advocates who request/require all doctors to take off their ties and change white coats before entering the patient’s room.
Tom Levenson
@Violet: Alas, ties were not mentioned…I’ll try to remember to ask.
Anoniminous
General Recommendations:
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1. Do not go to a hospital except for absolute emergencies or absolutely required procedures.
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2. Get your ass out as quickly as possible.
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Medical care facilities are a hot breeding ground of antibiotic resistant pathogenic bacteria and some very, very, nasty viruses. A recovering patient is safer from these thingies at home.
S. cerevisiae
If science conflicts with their ideology then science must be wrong!
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Same tune they have always been playing.
Calouste
@meander:
That all sounds good and well, but you realize that has the thread of social-economic mobility in it? People might suddenly start running their own restaurant instead of being a wage slave at McDonalds. Can’t have that. And they might even start hiring people, and that is a priviledge exclusive to the job creators class.
Violet
@Tom Levenson:
Here’s a 2008 NYT column on clothing and infection transfer, including ties: http://www.nytimes.com/2008/09/23/health/23well.html. There’s a bunch of stuff out there if you search. Just about everything can be a vector. I’d be interested in her take on it. Alas, I’m not going to be able to listen live and I’m terrible at remembering to download podcasts. I think I’m going to buy her book, though. I’d heard of it and forgotten about it. Thanks for bringing it to our attention.
Woodrowfan
ewwwww, you actually found a graphic worse than Tbogg’s Michelle Malkin Cheerleader video.
Face
Are you at least willing to admit your “8-1 in favor of upholding” was wildly inaccurate, such that we may now doubt your other Shut Up You Dumbass NonLawyers(TM) statements? Am I full of shit to catagorically say that Scalia, Thomas, and Alito will not vote for this?
I mean, for someone who just couldnt wait to slam us peasant un-attorneys, you’ve been just as wrong as you claim we are. Just sayin, mirrors and all that.
samara morgan
the free market is an ecophagy, levenson.
its going to eat the world eventually.
factory farms and cheap fat are going to kill us before super bacilli ever will.
that is why conservatives oppose HCR…because behavioral economics pared with nutritional education will wipe out their profit centers.
Sloegin
@31 I’d add an addendum to those recommendations;
You can pick up superbugs anywhere, for nearly no damn reason at all, not just at hospitals.
Woke up one morning, leg was sore, pinkish, and warm to the touch. About 2 hours of thinking ‘should I go to the ER or not?’ Thought it might have been a blood clot, turned out to be a Staph infection chewing the skin on my right leg and headed towards my torso.
Gallons of intravenous and antibiotics (and a scare when a surgeon consult was brought in when things started getting really hairy) later, plus about 2 weeks of hospitalization and 6 weeks off from work… and walker, and cane etc.
Sometimes you need to get your ass *in* as quickly as possible.
Martin
@Face: Admit what? No decision has been handed down. And the later voices are now suggesting that the 4 justices to the left will simply make an argument to the other 5 regarding suitable limiting factors to the regulation of commerce, win over at least 2 of them, if not 3-4, and hand down a strong decision upholding the law. That’s exactly what happened at the DC appeals court. Even Scalia is skeptical that anything they strike down can be re-legislated, so they don’t get an easy out there.
Studly Pantload, the emotionally unavailable unicorn
@Martin:
Huh? Wouldn’t that be a feature, to him, rather than a bug? Or, m’be I’m missing the intended point?
elmo
@Sloegin:
Jesus, that’s terrifying.
Face
@Martin: If you think there’s a snowballs chance in Phoenix that Scalia is voting to uphold, I really really want some of what yer smoking. Bringing broccoli into the official transcript was as close to a “fuck you Dems” as he’s allowed to say.
JPL
Tom the interview was so informative, although it was scary.
katie5
Don’t diss post-modern. It’s true that you can go down the social construction rabbit hole too far into everything being utterly relative but post-modernism has opened science and society up to non-traditional voices. Web 2.0 benefits from this. Even if we didn’t have post-modernism, the guys with the megaphones could still use the concept of scientific uncertainty against us.
eemom
@Face:
I said 6-3, 7-2, MAYBE EVEN 8-1. If you’re going to spend your life hanging on my every word, at least get it right.
And that was proven “wildly inaccurate” two days later how….? Because a couple of know-nothing hacks are running around doing the Chicken Little?
And yes, you’re full of shit to categorically state what any of them will do. Except for Thomas, and there you just got lucky.
eemom
@Face:
You know, Scalia may be an evil scumbag, but one thing he isn’t is an idiot.
You, on the other hand…
Anoniminous
@Sloegin:
Caveat: me no Doctor
Your situation fell under #1.
Most staph infections can be halted with topical antibiotic creams. Get the Staph aureus (aka MRSA) strain and things, as you say, get hairy.
joel hanes
As I understand it, the economic incentive structure as perceived by the pharma companies looks like this :
We have $1B to spend on drug development.
new antibiotic :
Patient takes between 10 and 40 doses for complete cure,
maybe ten times in lifetime.
Avg. total lifetime doses per patient : around 250
Maximum we can charge for a dose : around $50
Maximum lifetime revenue per patient : $1,250
new drug for widespread and chronic condition such as
high cholesterol, high blood pressure, depression :
Patient takes 1 to 4 doses per day for rest of life
Avg. total lifetime doses per patient: around 7,000
Maximum we can charge for a dose : around $5
Maximum lifetime revenue per patient $35,000
and that’s why you see continual TV ads for cholesterol, blood pressure, gastric acid, and depression drugs,
but research on new antibiotics lags.
joel hanes
@joel hanes: Anyone know how to get blank lines in this Brave New World of commenting ?
Can I use the pre tag ?
Sloegin
@41, It was definitely that; so beyond freaked out you slip into a completely automatic mental zone.
@47, Aye, definitely falls under #1. Here’s the freaky thing. I didn’t have a skin break. No identifiable cut, outbreak, sore, or lesion. Doc’s best guess was maybe some minor athlete’s foot that let the Staph pass through.