When I was ten, my life was saved by antibiotics when I had pneumonia and pleurisy simultaneously. So this story has personal resonance for me.
It’s worth noting that 80 percent of the antibiotics used in the United States are used as a routine part of raising animals for meat, dairy, and eggs, on factory farms and other non-organic agricultural operations. That’s where the problem most urgently needs to be addressed. The private sector isn’t doing anything about it, which means it will require regulatory action at the federal level. The sooner the better.
The ‘post-antibiotic’ era is near, according to a report released today by the World Health Organization (WHO). The decreasing effectiveness of antibiotics and other antimicrobial agents is a global problem, and a surveillance system should be established to monitor it, the group says.
There is nothing hopeful in the WHO’s report, which pulls together data from 129 member states to show extensive resistance to antimicrobial agents in every region of the world. Overuse of antibiotics in agriculture — to promote livestock growth — and in hospitals quickly leads to proliferation of drug-resistant bacteria, which then spread via human travel and poor sanitation practices.
“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 twenty-first century,” writes Keiji Fukuda, WHO assistant director-general for health security, in a foreword to the report.
Perhaps the most worrying trend is the spread of resistance to carbapenems, the ‘antibiotics of last resort’, says Timothy Walsh, a medical microbiologist at Cardiff University, UK, who was an adviser for the report. “That’s taken us by surprise,” he says. “All of us are rather like rabbits in front of the headlights in how quickly this has taken off.”
The alarming collapse of the bee population in many areas appears to be due to a widely used class of pesticides called neonicotinoids. Should this be allowed to continue, it has the potential to wreak havoc on the world’s food supply, much of which is dependent on bees for pollination. No small thing.
At first, there had been concern that electromagnetic waves from increasingly ubiquitous cell phones might be the cause, or reduced resistance to mites or parasites, research failed to document a strong link. But with neonicotinoids, the evidence is now strong to the point of damning.
From the Harvard School of Public Health:
Two widely used neonicotinoids—a class of insecticide—appear to significantly harm honey bee colonies over the winter, particularly during colder winters, according to a new study from Harvard School of Public Health (HSPH). The study replicated a 2012 finding from the same research group that found a link between low doses of imidacloprid and Colony Collapse Disorder (CCD), in which bees abandon their hives over the winter and eventually die. The new study also found that low doses of a second neonicotinoid, clothianidin, had the same negative effect.
Further, although other studies have suggested that CCD-related mortality in honey bee colonies may come from bees’ reduced resistance to mites or parasites as a result of exposure to pesticides, the new study found that bees in the hives exhibiting CCD had almost identical levels of pathogen infestation as a group of control hives, most of which survived the winter. This finding suggests that the neonicotinoids are causing some other kind of biological mechanism in bees that in turn leads to CCD.
It’s tempting to do so, but whenever we attribute large health benefits (such as prevention of heart disease) to a single nutrient, the complexity of our physiology eventually calls the assumption into question.
Resveratrol, a substance found in the skins of red grapes, has become quite famous in recent years as the purported explanation for the apparent health benefits of moderate amounts of red wine. New research indicates that this assumption may be premature, and perhaps entirely mistaken.
Resveratrol — a substance found in red wine, grapes and chocolate — may not add years to your life, and it doesn’t appear to reduce the risk for heart disease or cancer either, according to new research.
“When it comes to diet, health and aging, things are not simple and probably do not boil down to one single substance, such as resveratrol,” said study lead researcher Dr. Richard Semba, a professor of ophthalmology at Johns Hopkins University School of Medicine in Baltimore.
The findings also cast doubt about taking resveratrol supplements, he said.
“Perhaps it brings us back again to rather tried and true advice of diet — Mediterranean-style — and regular aerobic exercise for healthy aging,” said Semba.
The report was published May 12 in the online edition of JAMA Internal Medicine.
Red wine and chocolate have been shown to have beneficial effects on health, and these benefits were attributed largely to a single substance — resveratrol. Resveratrol has been credited as being responsible for the so-called “French paradox,” in which even a diet high in cholesterol and fat can be healthy if it is accompanied with red wine, the researchers explained
If you know someone who is uncertain how the Affordable Care Act works and whether they qualify for subsidies under the exchanges, a good place to start is here, at a site sponsored by Consumer Reports and the Robert Wood Johnson Foundation. Click on the FAQ tab.
As health writer Maggie Mahar notes in her post about this site, “A great many young people don’t realize how little insurance would cost after applying the tax credit. Do them a favor, and find out for them.”
Tom Philpott has a post at Mother Jones today about a Consumer Reports finding that, surprisingly, certified organic (and therefore antibiotic-free) chicken has as many “superbugs” (antibiotic-resistant bacteria) as chicken raised conventionally with antibiotics. The finding is clear but the reasons behind it aren’t at this point.
What got me was that chicken samples labeled “organic” or “no antibiotics” (list of all brands tested here) were just as likely to contain these potentially deadly, drug-defying pathogens. Notably, organic and antibiotic-free chicken both carry substantial premiums over conventional—at my local H-E-B supermarket in Austin, organic boneless chicken breast is fetching $7.97 per pound—vs. $4.99 for no-antibiotic and $1.97 for regular.
My surprise wasn’t based on some romantic notion that organic food is cleaner. Bacteria develop the ability to withstand to antibiotics by being exposed to them regularly. US Department of Agriculture code forbids antibiotics in organic meat production, and the “no antibiotics” label means just that, and is also regulated by the USDA.
Eighty percent of antibiotics used in the United States are given to animals raised for meat, dairy and eggs. Nearly all are given routinely, with the intent of preventing disease in these farmed animals, rather than as treatment for sick animals. The remaining 20 percent are used in human medicine.
Public health officials fear that if antibiotic resistance continues to accelerate at its current trajectory, we may find ourselves in a post-antibiotic age in the near future. If and when this happens, many infectious diseases that were fatal or caused permanently damage before the invention of antibiotics will be much more difficult to treat, as was the case prior to the 1940s.
The routine use of antibiotics in animal agriculture is an area ripe for reexamination.
Consumer Reports looks at current practices and finds them alarming:
The number of children taking powerful antipsychotic drugs has nearly tripled over the last 10 to 15 years, according to recent research. The increase comes not because of an epidemic of schizophrenia or other forms of serious mental illness in children, but because doctors are increasingly prescribing the drugs to treat behavior problems, a use not approved by the Food and Drug Administration (FDA). And a disproportionate number of those prescriptions are written for poor and minority children, some as young as age 2.
Doctors are prescribing antipsychotics even though there’s minimal evidence that the drugs help kids for approved uses, much less the unapproved ones, such as behavioral problems. And to make matters worse, the little research there is suggests the drugs can cause troubling side effects, including weight gain, high cholesterol, and an increased risk of type-2 diabetes.
This pattern repeats itself throughout the medical system. A drug that may be helpful for certain severe cases is prescribed for vastly greater numbers of people. As we move down the severity scale, the risk-benefit ratio gets worse and worse. Milder cases (even assuming the diagnosis is correct) are those least likely to benefit from drug treatment and most likely to have a cost-benefit ratio that’s underwater.
This sums up the bizarre economics of the hospital business in the United States as well as anything I’ve seen. Oversimplification? Sure. But what a clarifying example!
With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.
On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
There is little science to how hospitals determine the prices they print on hospital bills.
“Charge master prices are basically arbitrary, not connected to underlying costs or market prices,” said Professor Melnick, the economist. Hospitals “can set them at any level they want. There are no market constraints.”
Prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say. The codeine that costs $20 and the bag of IV fluid that costs $137 at California Pacific are charged at $1 and $16 at the University of California San Francisco Medical Center, across town. But U.C.S.F. Medical Center charges $1,600 for an amniocentesis, which costs $687 at California Pacific.
The governors of Kentucky, Connecticut and Washington explain it clearly:
In our states — Washington, Kentucky and Connecticut — the Affordable Care Act, or “Obamacare,” is working. Tens of thousands of our residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted.
People keep asking us why our states have been successful. Here’s a hint: It’s not about our Web sites.
Sure, having functioning Web sites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state Web sites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs.
The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.
The cholesterol guidelines released last week are already poised to drastically increase the number of people prescribed statin drugs, and this calculator that the American College of Cardiology just unveiled will help people miscalculate their risk (substantially upwards, of course) even more.
This is beyond the beyond. Worth reading this whole article if you or a loved one are considering taking statins.
“[It] overpredicted risk by 75-150%, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment….. Miscalibration to this extent should be reconciled and addressed before these new prediction models are widely implemented. If real, such systematic overestimation of risk will lead to considerable overprescription.”
“Something is terribly wrong,” Dr. Nissen said. Using the calculator’s results, he said, “your average healthy Joe gets treated, virtually every African-American man over 65 gets treated.”…
In response to my op-ed in the Kansas City Star this week, I received a wide range of comments. Most were quite supportive. Others were, shall we say, less than enthusiastic about various aspects of the health reform law.
My reply to those commenters:
Regarding the questions you shared with me about the Patient Protection and Affordable Care Act …
The United States is the one nation in the developed world that has not made a decision as a nation to consider health care a fundamental right. The health reform law (Patient Protection and Affordable Care Act of 2010) is the first major step in that direction since the passage of Medicare and Medicaid in the 1960s. It has many moving parts because it builds on the existing flawed system rather than switching to a single payer system, as was done in varying ways in other nations. Some of those other countries maintained private insurance companies but only as nonprofit entities; others went all in with government as the sole payer and/or administrator. The United States is the only developed nation that has private insurers that have to answer to shareholders. I would argue that this is a bug, not a feature.
In my view, all systems have their own unique strengths and weaknesses. The pre-PPACA U.S. system has the unique track record of having the highest (by far) overall per capita health care expenses in the world at the same time that it has many of the worst health outcomes in the developed world. So we begin with a system that is highly problematic, and to cap it off also leaves tens of millions (50M?) uninsured, something does not exist in any of these other nations. Before diving into any particular strengths and weaknesses of PPACA, I think it’s critical to acknowledge that the system on which it seeks to improve is drastically flawed. On at least that one point, I would imagine that both proponents and opponents may agree.
Continued after the jump …