“Human resistance to antibiotics could bring ‘the end of modern medicine as we know it’,” according to The Daily Telegraph. The newspaper says that we are facing an antibiotic crisis that could make routine operations impossible and a scratched knee potentially fatal. Similarly, the Daily Mail’s headline stated that a sore throat could soon become fatal.
The alarming headlines follow a new report by the World Health Organization (WHO , which set out ways to fight the growing problem of antimicrobial resistance (AMR . AMR occurs when infectious organisms, such as bacteria and viruses, adapt to treatments and become resistant to them. The publication specifically addressed the long-known problem of antibiotic resistance, where increasing use of antibiotics can lead to the formation of “superbugs” that resist many of the antibiotic types we currently have. It outlined a variety of measures that are vital for ensuring we can still fight infections in the future and described how other major infectious diseases, such as tuberculosis, HIV, malaria and influenza, could one day become resistant to today’s treatment options.
However, despite the future danger posed by antimicrobial resistance, the situation is not irretrievable. As Dr Margaret Chan, director general of WHO, said: “much can be done. This includes prescribing antibiotics appropriately and only when needed, following treatment correctly, restricting the use of antibiotics in food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines.” The report also highlighted successful cases where antimicrobial resistance has been tackled, demonstrating that we can safeguard the effectiveness of important antimicrobial medicines with dedicated, rational efforts.
Where has the news come from?
WHO has just published a new report (“The evolving threat of antimicrobial resistance - Options for action” that sets out a global strategy for fighting antibiotic resistance. It explores how over past decades, bacteria that cause common infections have gradually developed resistance to each new antibiotic developed, and how AMR has evolved to become a worldwide health threat. In particular, the report highlights that there is currently a lack of new antibiotics in development and outlines some of the measures needed to prevent a potential global crisis in healthcare.
This is not the first time WHO has set out such a strategy. In the 2001, WHO published its “Global strategy for containment of antimicrobial resistance”, which laid out a comprehensive list of recommendations for combating AMR. The current report looks at the experiences over the past decade of implementing some of these recommendations, the progress made, and what else should be done to tackle AMR.
What is antimicrobial resistance?
Antimicrobial resistance (AMR occurs when microorganisms, such as bacteria, viruses, fungi or other microbes, develop resistance to the drug that is being used to treat them. This means that the treatment no longer effectively kills or inactivates the microorganism. The term “antimicrobial” is used to describe all drugs that treat infections caused by microorganisms. Antibiotics are effective against bacteria only, antivirals against viruses, and antifungals against fungi.
The case of penicillin illustrates the AMR phenomenon well. When penicillin was first introduced in the 1940s, it revolutionised medicine and was effective against a wide range of staphylococcal and streptococcal bacteria. It was also able to treat infections that had previously been fatal for many people, including throat infections, pneumonia and wound infections. However, with increasing use of antibiotics over the decades, bacteria began to adapt and develop changes in their DNA that meant they were resistant to the actions of the once powerful antibiotic. These bacteria would survive and proliferate, which meant their protective genes would then be passed on to other strains of bacteria. As a result, new and stronger antibiotics had to be created to combat the resistant bacteria.
AMR is driven by many factors, including overuse of antimicrobials for human and animal health and in food production, which can allow microbes to adapt to antimicrobials they are exposed to. Poor infection-control measures, which fail to prevent the spread of infections, also contribute. In particular, the WHO publication reports what it describes as the five most important areas for the control of AMR, as recognised in its 2001 strategy:
surveillance of antimicrobial use
rational use in humans
rational use in animals
infection prevention and control
innovations in practice and new antimicrobials
How big is the problem?
As the report describes, AMR makes it difficult and more expensive to treat many common infections, causing delays in effective treatment or, in the worst cases, an inability to provide effective treatment at all. Many patients around the world suffer harm because infections from bacteria, viruses, fungi or other organisms can no longer be treated with the common medicines that would once have treated them effectively.
The report presents some startling facts on major infectious diseases worldwide:
Malaria: malaria is caused by parasites that are transmitted into the bloodstream by a bite from an infected mosquito. Resistance to antimalarial medicines has been documented for all classes of the drug, which presents a major threat to malaria control. The report describes that a change in national antimalarial treatment policy is recommended when the overall treatment failure rate exceeds 10%. Changes in policy have been necessary in many countries due to the emergence of chloroquine resistance. This means that alternative forms of combination therapy have to be used as first-line treatment.
Tuberculosis: in 2010, an estimated 290,000 new multidrug-resistant tuberculosis (TB cases were detected among the TB cases notified worldwide, and about one-third of these patients may die annually. Inaccuracies in diagnosis also impede appropriate treatment.
HIV: resistance rates to anti-HIV drug regimens ranging from 10% to 20% have been reported in Europe and the USA. Second-line treatments are generally effective in patients when the first-line therapy has failed, but can only be started promptly if viral monitoring is routinely available.
Common bacterial infections: various bacteria can cause infections within the chest, skin and urinary tract bloodstream, for example, and the inability to fight these infections appears to a growing problem in healthcare. Estimates from Europe are that there are 25,000 excess deaths each year due to resistant bacterial hospital infections, and approximately 2.5 million avoidable days in hospital caused by AMR. In addition, the economic burden from additional patient illness and death is estimated to be at least ˆ1.5 billion each year in healthcare costs and productivity losses.
What can be done about AMR?
The five key areas that the report highlights could tackle the problem of AMR are as follows:
Surveillance of antimicrobial use
Tracking antimicrobial use (in particular antibiotic use and looking at the emergence and spread of resistant strains of bacteria is a key tactic in the fight against AMR. This can provide information, insights and tools needed to guide policy and measure how successful changes in prescribing may be. This can happen both locally and globally.
AMR is a global problem but, at present, there appears to be wide variation in the way regions and countries approach AMR surveillance. This means there is a long way to go before it can be carried out worldwide.
Rational use in humans
Antimicrobials can obviously be important or even lifesaving in appropriate situations, but it is just as important to prevent unnecessary use of antimicrobials, which can lead to resistance. Putting this into practice worldwide is said to be difficult, but rationalising antimicrobial use has had a demonstrable impact on AMR in some cases.
Rational use in animals
Antibiotics are said to be used in greater quantities in food production than in the treatment of disease in human patients. Also, some of the same antibiotics or classes are used in animals and in human medicine. This carries the risk of the emergence and spread of resistant bacteria, including those capable of causing infections in both animals and people.
The problems associated with the use of antibiotics in animal husbandry, including in livestock, poultry and fish farming, are reportedly growing worldwide without clear evidence of the need for or benefit from it. There are said to be major differences in the amounts of antimicrobials used per kilogram of meat produced in high-income countries, and actions need to be taken by national and international authorities to control this.
Infection prevention and control in healthcare facilities
The hospital environment favours the emergence and spread of resistant bacteria. The report highlights the importance of infection-control measures to prevent the spread of microbes in general, regardless of whether they are resistant to antimicrobials. Many facilities and countries are reported to have progressed well since 2001, implementing many recommendations on infection control and prevention, although gaps and challenges still remain.
Innovations
Lastly, the report describes how innovative strategies and technologies are needed to address the lack of new antimicrobials being produced. As the report says, while antimicrobials are the mainstay of treatment for infections, diagnostics and vaccines play important complementary roles by promoting rational use of such medicines and preventing infections that would require antimicrobial treatment. So far, new products coming on to the market have not kept pace with the increasing needs for improvements in antimicrobial treatment. However, current challenges to new research developments can be both scientific and financial.
Can these strategies really stop AMR?
While AMR poses a significant threat to health in the future, the situation does not appear to be irretrievable. The WHO report and an accompanying press release highlight some examples of success stories over the past years:
In Thailand, the "Antibiotic Smart Use" programme is reported to have reduced both the prescribing of antibiotics by prescribers and the demand for them by patients. It demonstrated an 18–46% decrease in antibiotic use, while 97% of targeted patients were reported to have recovered or improved regardless of whether they had taken antibiotics.
A pharmacy programme in Vietnam reportedly consisted of inspection of prescription-only drugs, education on pharmacy treatment guidelines and group meetings of pharmacy staff. These measures were reported to give significant reduction in antibiotic dispensing for acute respiratory infections.
In Norway, the introduction of effective vaccines in farmed salmon and trout, together with improved fish health management, was reported to have reduced the annual use of antimicrobials in farmed fish by 98% between 1987 and 2004.
In 2010, the University of Zambia School of Medicine was reported to have revised its undergraduate medical curriculum. AMR and rational use of medicines were made key new topics to ensure that graduates who enter clinical practice have the right skills and attitudes to be both effective practitioners and take a role in fighting AMR.
How can I help?
There are times when antibiotics are necessary or even vital. However, as patients and consumers, it is important to remember that antibiotics or other antimicrobials are not always needed to treat our illnesses, and we should not expect them in every situation.
For example, the common cold is caused by a virus, which means it does not respond to antibiotics. However, people may expect to be given antibiotics by their doctor when they are affected, even though they offer no direct benefit and could raise the risk of bacteria becoming resistant. Furthermore many common viral and bacterial infections such as coughs, throat and ear infections and stomach upsets, are “self-limiting” in healthy people, which means they will generally get better with no treatment at all.
If, on the other hand, you are prescribed an antimicrobial, it is important to take the full course as directed. Taking only a partial course of an antimicrobial may not kill the organism but may expose it to a low dose of a drug which can then contribute to resistance.
Editor's Note: In 1919, canned ripe olives spread an outbreak of deadly Botulism to three states. Nineteen people died, almost half the deaths ever caused by food products commercially canned in California -- all killed in one outbreak. The incident remains one of the 10 deadliest outbreaks of foodborne illness in U.S. history. As part of a periodic series on historic outbreaks, Food Safety News recounts the 1919 Botulism outbreak.
A young Dr. Charles Armstrong, fresh from fighting the world influenza epidemic that came with the Great War, was ordered by U.S. Surgeon General Rupert Blue to his home state of Ohio on July 1, 1919 to provide assistance to the state health officer.
Armstrong, just 33, returned home from war just six weeks before a county club banquet was held for more than 200 people near Canton, Ohio. Fourteen of those attending the banquet became stricken by botulism poisoning and seven of those victims died.
The coincidence of Armstrong's assignment to help out in Ohio meant he who would go on to worldwide recognition as virologist with his 1934 discovery of the virus he named lymphocytic choriomeningitis (LCM .
For the California olive industry, this meant the botulism outbreak of 1919 was going to be thoroughly and definitely tied around its neck. With a total of 19 botulism deaths in three states -- that were conclusively linked to canned California olives -- made the outbreak one of the deadliest outbreaks in the U.S.
The California olive industry owed it existence to those first olive trees planted in the mission orchards at San Diego, San Jose, Santa Clara and others before the American Revolution. For 20 years, it had been commercially viable, but the 1919 botulism outbreak was an unmitigated disaster. California olives did not recover for more than a decade.
Other U.S. states -- where those mission olive trees would never grow -- were the market for California canned ripe olives and now botulism in a can from California made for a pretty sensational story.
To make matters worse, California olive growers were not helped by the fact that, after 1919, the botulism outbreaks linked to olives did not really end until 1924.
The 1919 outbreak left dead in three states: Ohio (7 , Montana (5 , and Michigan (7 .
It is Ohio that always gets the most attention, however, because of the Armstrong's investigation and the unusual circumstances he found at the country club. He found that at the country club event attended, which was attended by more than 200 people, the botulism was all contained to people who sat at one table, the chef and two waiters.
"The guests who became ill were all members of a party given by Mrs. I.W.G., of Sebring, Ohio, and had been served at a separate table which shall hereafter be designed as the Sebring table," Armstrong wrote. "The two waiters who attended this table and the chef were also affected."
Armstrong reported the banquet menu included: cantaloupe, turkey, turkey stuffing, tomatoes and mayonnaise, crackers, scalloped corn and pimentos, browned potatoes, green olives, celery and pickles, rolls, butter, ice cream cake, water and coffee.
But he found the Sebring table did not get the green olives, celery, and pickles. Instead, Mrs. I.W.G. provided ripe olives, chocolate candy, Newport creams and candied almonds.
In the Dec. 19, 1919 edition of Public Health Reports, Armstrong includes the seating chart for the Sebring table that also includes the location of the three plates of ripe olives. Five of those in proximity to the olive servings died including Mrs. I.W.G.
Botulism also killed the chef and a waiter.
By the time his investigation got underway, six of the cases "had terminated fatally," according to Armstrong. While no illnesses occurred among those at other tables, Armstrong interviewed 15 of those guests and he also conducted a full blown epidemiological study to exclude all the items on the menu.
Of the 14 people who were ill, all ate olives. "When the dead are considered, it is found in a general way that those who died first who ate the most olives," Armstrong said.
Among those who were recovering, he said those who ate the least suffered were less severe cases. Those who survived reported the olives did not taste right. Asked to describe it, they said things like the olives "bit the tongue" and "stuck to the tongue" or just said they were "not fit to eat."
Armstrong found the ripe olives came from a vacuum-sealed jar and concluded, "something had occurred to destroy the vacuum in the jar, for, in opening it, the lid is said to have come off easily without having been punctured and without the use of instruments." The lid was discarded, but the recovered glass jar "was not cracked or defective in any way."
One of the waiters did not think the olives tasted right, and near the end of the banquet, he took them to the chef to get another opinion. The chef ate two, unwashed, and was among those who died. One of the two waiters for the Sebring table and a guest, both of whom survived credited the amount of whiskey they drank that evening as possibility saving their lives.
Pushing on, the investigation found the source of the contaminated olives to be the Ehmann Olive Company, formed in 1898 by Mrs. Freda Ehmann. She started California's commercial olive industry and credited with establishing the modern California ripe olive industry.
She arrived in California as a widow in the 1890's when olive planting was peaking. She lost her first investment in a ranch called Olive Hill Grove and then turned her attention to perfecting a recipe for pickled olives and selling it to grocers.
By 1900, Ehmann Olive Company was running 90 vats at a large processing plant in Oroville, CA.
Dr. Judith Taylor, who wrote the book "The Olive in California," interviewed Freda Ehmann's grand-daughter who said her grandmother never could come to terms about the company's role in the 1919 outbreak.
USDA's Bureau of Chemistry did a study of Ehmann's glass and metal containers in 1920, finding both could look normal but still contain pathogenic organisms, including Clostridium botulinus.
California canned foods have been the source of about 40 deaths in other states, according to the California Department of Public Health. The California State Board of Health responded to the 1919 outbreak with emergency regulation of olive production on Aug. 7, 1920, requiring sanitation through the processing facility and mandating a thermal process.
Heat treatment for olives after cans or jars are sealed to sterilize contents completely was required. Immersion in water at 240 degrees Fahrenheit for 40 minutes was the rule.
California canned olives continued to poison people in some scattered cases.
The emergency regulations under the California Pure Foods Act and limited staff to enforce them were not enough.
California responded with the Cannery Inspection Act of 1925. Both the State Board of Health and the National Canners' Association supported it, which by then even favored federal inspection.
California's Food and Drug Branch today inspects 200 licensed canners where regulated products are packed. It's primary goal remains preventing foodborne botulism. Tests for retort operators to determine qualifications to operate sterilization equipment are critical.
Dr. Armstrong continued to serve in the uniformed U.S. Public Health Service until 1950, ending up as Chief of the Division of Infectious Disease. In Warm Springs, GA, a sculpture of his likeness is found in the Polio Hall of Fame. He is recognized for being the first to adapt and transmit the human strain of poliovirus to small rodents from monkeys, a key step in the development of vaccines.
As for Mrs. I.W.G., her death by Botulism was probably known to her friends and neighbors in Sebring at the time, but she remains known 87 years later only by those initials assigned to her by Dr. Armstrong.
WAYNE, N.J., March 14, 2012 /PRNewswire/ -- Bayer HealthCare Pharmaceuticals Inc. today announced that the U.S. Food and Drug Administration (FDA has approved a new indication for Natazia (estradiol valerate and estradiol valerate/dienogest ...
DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration Silver Spring, MD 20993 Larry Downey Executive Vice President, US Branded Pharmaceuticals Teva Pharmaceuticals USA c/o Teva Neuroscience, Inc. 901...
MONDAY, March 19 (HealthDay News -- The first generic versions of the once-monthly osteoporosis drug Boniva (ibandronate have been approved by the U.S. Food and Drug Administration.
“Human resistance to antibiotics could bring ‘the end of modern medicine as we know it’,” according to The Daily Telegraph. The newspaper says that we are facing an antibiotic crisis that could make routine operations impossible and a scratched knee potentially fatal. Similarly, the Daily Mail’s headline stated that a sore throat could soon become fatal.
The alarming headlines follow a new report by the World Health Organization (WHO , which set out ways to fight the growing problem of antimicrobial resistance (AMR . AMR occurs when infectious organisms, such as bacteria and viruses, adapt to treatments and become resistant to them. The publication specifically addressed the long-known problem of antibiotic resistance, where increasing use of antibiotics can lead to the formation of “superbugs” that resist many of the antibiotic types we currently have. It outlined a variety of measures that are vital for ensuring we can still fight infections in the future and described how other major infectious diseases, such as tuberculosis, HIV, malaria and influenza, could one day become resistant to today’s treatment options.
However, despite the future danger posed by antimicrobial resistance, the situation is not irretrievable. As Dr Margaret Chan, director general of WHO, said: “much can be done. This includes prescribing antibiotics appropriately and only when needed, following treatment correctly, restricting the use of antibiotics in food production to therapeutic purposes and tackling the problem of substandard and counterfeit medicines.” The report also highlighted successful cases where antimicrobial resistance has been tackled, demonstrating that we can safeguard the effectiveness of important antimicrobial medicines with dedicated, rational efforts.
Where has the news come from?
WHO has just published a new report (“The evolving threat of antimicrobial resistance - Options for action” that sets out a global strategy for fighting antibiotic resistance. It explores how over past decades, bacteria that cause common infections have gradually developed resistance to each new antibiotic developed, and how AMR has evolved to become a worldwide health threat. In particular, the report highlights that there is currently a lack of new antibiotics in development and outlines some of the measures needed to prevent a potential global crisis in healthcare.
This is not the first time WHO has set out such a strategy. In the 2001, WHO published its “Global strategy for containment of antimicrobial resistance”, which laid out a comprehensive list of recommendations for combating AMR. The current report looks at the experiences over the past decade of implementing some of these recommendations, the progress made, and what else should be done to tackle AMR.
What is antimicrobial resistance?
Antimicrobial resistance (AMR occurs when microorganisms, such as bacteria, viruses, fungi or other microbes, develop resistance to the drug that is being used to treat them. This means that the treatment no longer effectively kills or inactivates the microorganism. The term “antimicrobial” is used to describe all drugs that treat infections caused by microorganisms. Antibiotics are effective against bacteria only, antivirals against viruses only, and antifungals against fungi.
The case of penicillin illustrates the AMR phenomenon well. When penicillin was first introduced in the 1940s, it revolutionised medicine and was effective against a wide range of staphylococcal and streptococcal bacteria. It was also able to treat infections that had previously been fatal for many people, including throat infections, pneumonia and wound infections. However, with increasing use of antibiotics over the decades, bacteria began to adapt and develop changes in their DNA that meant they were resistant to the actions of the once-powerful antibiotic. These bacteria would survive and proliferate, which meant their protective genes would then be passed on to other strains of bacteria. As a result, new and stronger antibiotics had to be created to combat the resistant bacteria.
AMR is driven by many factors, including overuse of antimicrobials for human and animal health and in food production, which can allow microbes to adapt to antimicrobials they are exposed to. Poor infection-control measures, which fail to prevent the spread of infections, also contribute. In particular, the WHO publication reports what it describes as the five most important areas for the control of AMR, as recognised in its 2001 strategy:
surveillance of antimicrobial use
rational use in humans
rational use in animals
infection prevention and control
innovations in practice and new antimicrobials
How big is the problem?
As the report describes, AMR makes it difficult and more expensive to treat many common infections, causing delays in effective treatment or, in the worst cases, an inability to provide effective treatment at all. Many patients around the world suffer harm because infections from bacteria, viruses, fungi or other organisms can no longer be treated with the common medicines that would once have treated them effectively.
The report presents some startling facts on major infectious diseases worldwide:
Malaria: malaria is caused by parasites that are transmitted into the blood stream by a bite from an infected mosquito. Resistance to antimalarial medicines has been documented for all classes of the drug, which presents a major threat to malaria control. The report describes that a change in national antimalarial treatment policy is recommended when the overall treatment failure rate exceeds 10%. Changes in policy have been necessary in many countries due to the emergence of chloroquine resistance. This means that alternative forms of combination therapy have to be used as first-line treatment.
Tuberculosis: in 2010, an estimated 290,000 new multidrug-resistant tuberculosis (TB cases were detected among the TB cases notified worldwide, and about one-third of these patients may die annually. Inaccuracies in diagnosis also impede appropriate treatment.
HIV: resistance rates to anti-HIV drug regimens ranging from 10% to 20% have been reported in Europe and the USA. Second-line treatments are generally effective in patients when the first-line therapy has failed, but can only be started promptly if viral monitoring is routinely available.
Common bacterial infections: various bacteria can cause infections within the chest, skin and urinary tract bloodstream, for example, and the inability to fight these infections appears to a growing problem in healthcare. Estimates from Europe are that there are 25,000 excess deaths each year due to resistant bacterial hospital infections, and approximately 2.5 million avoidable days in hospital caused by AMR. In addition, the economic burden from additional patient illness and death is estimated to be at least ˆ1.5 billion each year in healthcare costs and productivity losses.
What can be done about AMR?
The five key areas that the report highlights could tackle the problem of AMR are as follows:
Surveillance of antimicrobial use
Tracking antimicrobial use (in particular antibiotic use and looking at the emergence and spread of resistant strains of bacteria is a key tactic in the fight against AMR. This can provide information, insights and tools needed to guide policy and measure how successful changes in prescribing may be. This can happen both locally and globally.
AMR is a global problem but, at present, there appears to be wide variation in the way regions and countries approach AMR surveillance. This means there is a long way to go before it can be carried out worldwide.
Rational use in humans
Antimicrobials can obviously be important or even lifesaving in appropriate situations, but it is just as important to prevent unnecessary use of antimicrobials, which can lead to resistance. Putting this into practice worldwide is said to be difficult, but rationalising antimicrobial use has had a demonstrable impact on AMR in some cases.
Rational use in animals
Antibiotics are said to be used in greater quantities in food production than in the treatment of disease in human patients. Also, some of the same antibiotics or classes are used in animals and in human medicine. This carries the risk of the emergence and spread of resistant bacteria, including those capable of causing infections in both animals and people.
The problems associated with the use of antibiotics in animal husbandry, including in livestock, poultry and fish farming, are reportedly growing worldwide without clear evidence of the need for or benefit from it. There are said to be major differences in the amounts of antimicrobials used per kilogram of meat produced in high-income countries, and actions need to be taken by national and international authorities to control this.
Infection prevention and control in healthcare facilities
The hospital environment favours the emergence and spread of resistant bacteria. The report highlights the importance of infection-control measures to prevent the spread of microbes in general, regardless of whether they are resistant to antimicrobials. Many facilities and countries are reported to have progressed well since 2001, implementing many recommendations on infection control and prevention, although gaps and challenges still remain.
Innovations
Lastly, the report describes how innovative strategies and technologies are needed to address the lack of new antimicrobials being produced. As the report says, while antimicrobials are the mainstay of treatment for infections, diagnostics and vaccines play important complementary roles by promoting rational use of such medicines and preventing infections that would require antimicrobial treatment. So far, new products coming on to the market have not kept pace with the increasing needs for improvements in antimicrobial treatment. However, current challenges to new research developments can be both scientific and financial.
Can these strategies really stop AMR?
While AMR poses a significant threat to health in the future, the situation does not appear to be irretrievable. The WHO report and an accompanying press release highlight some examples of success stories over the past years:
In Thailand, the "Antibiotic Smart Use" programme is reported to have reduced both the prescribing of antibiotics by prescribers and the demand for them by patients. It demonstrated an 18–46% decrease in antibiotic use, while 97% of targeted patients were reported to have recovered or improved regardless of whether they had taken antibiotics.
A pharmacy programme in Vietnam reportedly consisted of inspection of prescription-only drugs, education on pharmacy treatment guidelines and group meetings of pharmacy staff. These measures were reported to give significant reduction in antibiotic dispensing for acute respiratory infections.
In Norway, the introduction of effective vaccines in farmed salmon and trout, together with improved fish health management, was reported to have reduced the annual use of antimicrobials in farmed fish by 98% between 1987 and 2004.
In 2010, the University of Zambia School of Medicine was reported to have revised its undergraduate medical curriculum. AMR and rational use of medicines were made key new topics to ensure that graduates who enter clinical practice have the right skills and attitudes to be both effective practitioners and take a role in fighting AMR.
How can I do my part?
There are times when antibiotics are necessary or even vital. However, as patients and consumers, it is important to remember that antibiotics or other antimicrobials are not always needed to treat our illnesses, and we should not expect them in every situation.
For example, the common cold is caused by a virus, which means it does not respond to antibiotics. However, people may expect to be given antibiotics by their doctor when they are affected, even though they offer no direct benefit and could raise the risk of bacteria becoming resistant. Furthermore many common viral and bacterial infections such as coughs, throat and ear infections and stomach upsets, are “self-limiting” in healthy people, which means they will generally get better with no treatment at all.
If, on the other hand, you are prescribed an antimicrobial, it is important to take the full course as directed. Taking only a partial course of an antimicrobial may not kill the organism but may expose it to a low dose of a drug which can then contribute to resistance.
Del Monte Fresh Produce has withdrawn its threatened lawsuit against the Oregon Public Health Division and its senior epidemiologist, who with other public health officials last year traced a multistate outbreak of Salmonella infection to cantaloupes imported from the company's Asuncion Mita farm in Guatemala.
The news was reported by Lynne Terry of The Oregonian. She wrote that Del Monte Fresh Produce notified the state earlier this month that it would not go forward with legal action against William Keene and his department.
Del Monte Fresh Produce had announced its threat in a news release in August, claiming that "misleading allegations" had been made in naming the Guatemalan cantaloupes as the likely source of Salmonella infection that sickened at least 20 people, and sent three to the hospital. The case patients were from Arizona, California, Colorado, Maryland, Montana, Nebraska, Oregon, Pennsylvania, Utah and Washington.
Twelve of 16 ill people had reported eating cantaloupe in the week before they became ill, according to a Centers for Disease Control and Prevention report on the outbreak investigation. Eleven of those 12 people had purchased cantaloupes from eight different Costco stores and traceback information indicated the melons were from a single farm -- Asuncion Mita in Guatemala.
Del Monte Fresh Produce voluntarily recalled the Guatemalan cantaloupes on March 22, 2011 after it was notified of the epidemiological link between the melons the outbreak of Salmonella Panama infection.
But when the Food and Drug Administration banned further cantaloupe imports from the company's Guatemalan farm, Del Monte Fresh Produce sued the FDA and got it to back down on the import alert. It also claimed it was wrongly blamed for the outbreak.
Food safety experts and consumer activists predicted the case targeting Oregon Public Health -- recognized for its food safety leadership -- would not go far, but said they saw the complaint filed by Del Monte Fresh Produce as an attempt to intimidate public health programs across the country.
Dr. Katrina Hedberg, Oregon state epidemiologist, told The Oregonian that dealing with the tort claim had been time-consuming, so it was a relief when it was withdrawn and they could resume focusing on their job -- protecting the public's health.
The claim was unprecedented, Terry noted:
State epidemiologists investigate dozens of foodborne illness outbreaks every year and name the culprits to prevent more people from getting sick. No other company has ever filed a suit or threatened to sue Oregon over one of those investigations.
"There have been lots of outbreaks," Hedberg said. "Why some companies choose to work with public health and others want to fight it -- I can't answer that."
A Del Monte Fresh Produce spokesman declined to comment, telling Terry the company "does not comment on ongoing or closed investigations."
A woman 38 weeks pregnant was diagnosed with Listeria monocytogenes infection, and the New Jersey Department of Health and Senior Services is now warning the public not to eat any cheese products produced by El Ranchero del Sur of South River, NJ.
Lab tests confirmed L. monocytogenes in a sample of the company's Los Corrales Queso Fresco Fresh Cheese and Banana Leaf (code date 03/16/12 , according to a NJDHSS news release Thursday. The pregnant woman's Listeria infection was diagnosed March 2 at a New Brunswick hospital.
El Ranchero del Sur, based in South River, NJ, has agreed to recall its products and close its production plant. While the facility is inspected, all products and ingredients have been embargoed, state public health officials said.
According to the news alert, El Ranchero del Sur cheese products are found primarily in Mexican and Latin American grocery stores, restaurants, and other Hispanic food establishments under the name brands El Ranchero, Los Corrales, and Carnes Don Beto. The plant number 34-0013669 is marked on the label. All products are 14 ounces in weight, except for the Queso Hebra Oaxaca String Cheese ball, which is sold in 10 pound packages.
The state health department's Food and Drug Safety Program is requesting that local health departments check to ensure that El Ranchero del Sur products are removed from retail food establishments in their area.
According to the Centers for Disease Control and Prevention (CDC , Listeria infection can be passed to an unborn baby through the placenta, even if the pregnant woman is not showing signs of illness. Listeriosis can cause premature labor and miscarriage and, if passed along to a newborn, may result in sepsis or meningitis and be fatal.
In 1985, in an outbreak of Listeria infection that sickened 142 people who had eaten commercially produced soft cheese mixed with unpasteurized milk, 93 of the victims were pregnant women or their offspring. Twenty fetuses and 10 newborns died in that outbreak.
The CDC advises pregnant women not to eat soft cheeses such as feta, Brie and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Penela unless they have labels that clearly state they are made from pasteurized milk.
Sanuwave plans to run additional clinical trials of its dermaPace foot ulcer treatment after the FDA deems its initial submission insufficient.
Regenerative medicine firm Sanuwave Health (OTC: SNWV will run another clinical trial of its dermaPace foot ulcer treatment, after the FDA determined that its initial pre-market approval bid failed to meet its primary endpoint.
New trials may take up to 2 years before the company re-submits its device for FDA review, according to a press release.
A recent study, published in the journal Cancer Research, explains that dietary cadmium - a heavy metal long identified as a carcinogen which leaches into crops from fertilizers and when rainfall or sewage sludge deposit it onto farmland - can potentially increase a woman's risk for breast cancer, writes Christine Kearney for Medical News Today. Associate professor Agneta Akesson, from the Karolinska Institute in Sweden said in a recent press release: “Because of a high accumulation in agricultural crops, the main sources of dietary cadmium are bread and other cereals, potatoes, root crops and vegetables. In general, these foods are also considered healthy.” The 12-year study found that among 55,987 post-menopausal women, the one-third with the highest cadmium intakes were 21 percent more likely to develop breast cancer than the one-third with the lowest intakes. Among obese women, the study found no increase in breast cancer rates with higher cadmium exposures. The finding comes just three months after the Institute of Medicine ( IOM , a prestigious body of independent biomedical researchers, concluded that a host of other factors — most within a woman’s power to control, such as obesity and hormone-replacement medication — were the most important sources of breast cancer risk. The IOM had called it “biologically plausible” that estrogen-like pollutants promote breast cancers, but noted that evidence that they contribute significantly was inconclusive. By contrast, studies in human populations strongly point to fattening foods, hormone-replacement drugs, alcohol and cigarettes as having roles in boosting a woman’s breast cancer risk. A woman’s lifetime exposure to estrogen powerfully influences her risk. In animals and in laboratory tests, cadmium has been shown to exert estrogen-like effects more powerfully than other environmental pollutants, and so suspicion has fallen on the heavy metal as a possible promoter of breast cancer. “Cadmium is receiving a lot of attention these days because of its estrogenic properties,” Rudolph Rull, a research scientist at the Cancer Prevention Institute of California in Berkeley, told Melissa Healy of the Los Angeles Times. Both estrogen receptor-positive and negative tumors had the same risk increase at roughly 23 percent. Akesson said that women who consumed higher amounts of whole grain and vegetables had a lower risk of breast cancer compared to women exposed to dietary cadmium through other foods. “It’s possible that this healthy diet to some extent can counteract the negative effect of cadmium, but our findings need to be confirmed with further studies,” said Akesson. “It is, however, important that the exposure to cadmium from all food is low.”
American schools will soon be able to stop receiving the ammonia-treated ground beef product known alternately as boneless lean beef trimmings, lean finely textured beef, and--more derisively--"pink slime," the U.S. Agriculture Department ( USDA announced on Thursday. According to Michael Hill of the Associated Press (AP , starting next fall districts will be able to choose to continue receiving 95% lean beef patties that include the filler product, or fattier cuts of ground beef that is free of the ammonia-treated substance. The change in policy cannot go into effect immediately due to existing contracts, an unidentified USDA official told the news organization. "Though the term 'pink slime' has been used pejoratively for at least several years, it wasn't until last week that social media suddenly exploded with worry and an online petition seeking its ouster from schools," Hill wrote. "The petition quickly garnered hundreds of thousands of supporters" "The low-cost ingredient is made from fatty bits of meat left over from other cuts. The bits are heated to about 100 F and spun to remove most of the fat. The lean mix then is compressed into blocks for use in ground meat. The product, made by South Dakota-based Beef Products Inc., also is exposed to 'a puff of ammonium hydroxide gas' to kill bacteria, such as E. coli and salmonella," he added. The USDA told Hill that the agency, which is responsible for purchasing about 20% of the food used in school lunches across the country, "continues to affirm the safety" of the boneless lean beef trimmings. However, they said that they wanted to be "transparent" and recognized that schools wanted to be able to opt out of receiving the ammonia-treated lean finely textured beef. The controversy involves not just the beef itself, but also the use of ammonium hydroxide to treat the meat. The product itself, AFP reporter Robert MacPherson says, is "left-over bits of slaughtered cattle… that is mixed in a centrifuge" -- or as chef Jamie Oliver puts it, according to an article by Amy Hubbard of the Los Angeles Times, "all of the bits that no one wants." Once the beef products are mixed together, they are treated with ammonium hydroxide in a USDA-approved process in order to prevent E. coli and salmonella contamination, Hubbard said. International Food Information Council Director of Media Relations Steven Cohen told her that the substance had been reviewed and deemed safe by the Food & Drug Administration ( FDA in 1974, and that it is an additive used in other products, including cheese and chocolates. However, the Times reporter adds that it is also used as a "sanitizer in many household and industrial cleaners," which has led McDonalds and other restaurant chains to discontinue the use of the so-called "pink slime" beef products. Despite the USDA's announcement Thursday, Hill says that Maine Representative Chellie Pingree has asked Agriculture Secretary Tom Vilsack to immediately and permanently ban its use in schools. "The beef industry sent my office an email the other day describing pink slime as 'wholesome and nutritious' and said the process for manufacturing it is 'similar to separating milk from cream.' I don't think a highly processed slurry of meat scraps mixed with ammonia is what most families would think of as 'wholesome and nutritious,'" the Congresswoman said in a statement.
Stephanie Armour reports that next year U.S. schools can choose whether to sell beef that is treated with ammonia to their students. "Schools will have the choice of ground beef made without the pink slime, also known as lean finely textured beef, according to the U.S. Department of Agriculture [USDA]. The product is made of beef trim and treated with ammonium hydroxide to kill pathogens…The decision was made in response to requests from districts across the country and takes effect next school year…About 6 percent, or 7 million pounds, of the beef purchased this year by the USDA for the lunch program is the textured product…While the agriculture department and the Food and Drug Administration say the product is safe, critics object because they say it is unappetizing, made of inferior parts and may harbor pathogens like E. coli."
It's hard to know these days which way the proverbial worm is turning when it comes to shifts in drug policy. Election years tend to do that. Despite an historical turn of events in Central America which saw Presidents of drug trafficking nations come together to call for world wide decriminalization of drugs, in an effort to end the violence and corruption of the drug trade, the US continues to demur, absurdly claiming that the "War on Drugs" has been a success. Even stranger is Canada's recent announcement that they plan to follow the US model of a "tough on crime" approach to drug policy, which threatens to swell their correctional system in the same ways as in the US. Still, good news abounds with recent studies showing that LSD can cure alcoholism, psychedelics can cure PTSD, and cannabis smoking is not nearly as harmful as the prohibition governments claim. ~ CS
To liberalise or prohibit, that is the question. And to answer it the masters of live debate have joined forces with the masters of web technology to create a never-seen-before combination of Oxford debating and Silicon Valley prowess.
Prohibitionists argue that legalising anything increases its consumption. The world has enough of a problem with legal drugs like alcohol and tobacco, so why add to the problem by legalising cannabis, cocaine and heroin?
The liberalisers say prohibition doesn’t work. By declaring certain drugs illegal we haven’t reduced consumption or solved any problem. Instead we’ve created an epidemic of crime, illness, failed states and money laundering.
Julian Assange and Richard Branson; Russell Brand and Misha Glenny; Geoffrey Robertson and Eliot Spitzer. Experts, orators and celebrities who’ve made this their cause – come and see them lock horns in a new Intelligence?/Google+ debate format. Some of our speakers will be on stage in London, others beamed in from Mexico City or Sao Paulo or New Orleans, all thanks to the “Hangout” tool on Google+.
The web will have its say, and so can you at the event in London. Be part of the buzz of the audience, be part of an event beamed across the web to millions. Come and witness the future of the global mind-clash at the first of our Versus debates, live at Kings Place
The message is (or should be deeply disturbing. Shouldn't the USA be ashamed at having the world's largest prison system and highest incarceration rate (754 per 100 000 people ? The richest country in the world has so many of its citizens in prison that it can't afford to house them with even basic minimum medical care (more than half of all prisoners have mental health or drug problems . Prison overcrowding itself has become so terrible in California, that in May, 2011, the US Supreme Court affirmed a lower court order that California release some 46 000 prisoners because of the inhuman conditions under which they were being held. In the Court's words, “A prison that deprives prisoners of basic sustenance, including adequate medical care, is incompatible with the concept of human dignity and has no place in a civilised society.”
More women are ending up behind bars than ever. Between 1980 and 1989, the number of women in U.S. prisons tripled. And the number of women in prison has continued to rise since. In the last 10 years, the number of women under jurisdiction of state or federal authorities increased 21 percent to almost 113,000. During the same time period, the increase in the number of men in prison was 6 percentage points lower, at about 15 percent. The increase in women in the federal population was even larger- over 41 percent from 2000 to 2010.
Most women are incarcerated for nonviolent offenses. Over one-fourth are in prison for a drug offense, while 29.6 percent were convicted of a property crime. Addiction plays a large part in a number of women's property crimes, and a lack of available or appropriate treatment only serves to drive their contact with the justice system.
Stephen Vittoria is that rare commodity in Hollywood today: a filmmaker with a conscience. To be more precise, a filmmaker with a strong political conscience. After making two feature films,>Black and White& Hollywood Boulevard (1996 , as well as three feature documentaries:Save Your Life -- The Life and Holistic Times of Dr. Richard Schulze (1998 ,;Keeper of the Flame (2005 and the award-winning art house hit One Bright Shining Moment: The Forgotten Summer of George McGovern (2005 , a portrait of the South Dakota senator who tried to unseat Richard Nixon from the White House in 1972.
For his latest exploration into America's socio-political landscape, Vittoria joins forces with radio producer Noelle Hanrahan to bring Long Distance Revolutionary, the story of Mumia Abu-Jamal, to the screen. Born Wesley Cook in Philadelphia, Abu-Jamal made his name as a tireless writer and journalist during the racially-charged 1970s that often portrayed the City of Brotherly Love as anything but. With his intense coverage of the MOVE organization, a black empowerment group whose ongoing battle with the police and city hall came to a fiery end in 1985, Abu-Jamal become a constant thorn in the side of the city's powerful establishment. Things came to a sudden head for Abu-Jamal himself on the evening of December 9, 1981 when he was accused of murdering a Philadelphia police officer. He received a death sentence the following year, and has been on Pennsylvania's death row until early this year, when his death sentence was commuted to a life sentence in December, 2011.
Abu-Jamal's case remains one of the most controversial and heatedly debated in American legal history, with participants on both sides either protesting his innocence in the murder of Officer Daniel Faulkner or his absolute guilt with equal passion and more often, great vehemence.
At a recent conference of journalists at John Jay College, I raised an issue I have about language in the media: the frequent use of the word “felon” to describe a person who has been convicted of a crime.
“Felon” is an ugly label that confirms the debased status that accompanies conviction. It identifies a person as belonging to a class outside many protections of the law, someone who can be freely discriminated against, someone who exists at the margins of society.
In short, a “felon” is a legal outlaw and social outcast.
Scientific theories that addiction hijacks the brain have just increased the stigma that they were meant to stop. At least in the moralistic bad old days, addicts were still viewed as having free will. Here's an alternative to both of these no-win approaches.
Mind-altering compounds, such as LSD and psilocybin, stirred controversy in the 1960s. As the counter-culture’s psychedelic drugs of choice, the widespread use - and abuse - of hallucinogens prompted tougher anti-drug laws.
