Antibiotic Resistant Superbugs Set To Wreak Havoc Under Trumpies

Superbugs exposed by special stain..

Imagine the U.S. in the throes of a massive superbug epidemic, perhaps MRSA or C. Diff. sometime in the next four years. It is possible, even probable, as Trump and his hired henchmen go about disbanding the Affordable Care Act, a point made clear by his appointment of Tom Price (R, GA) to the Dept. of Health and Human Services. This degenerate, Price, wants to not only abolish the Medicaid coverage for over 14 million but also remove the pre-existing conditions provision (i.e. that enables those with pre-existing conditions to get insurance under the ACA or "Obamacare"). In addition,  he along with Paul Ryan wants to replace Medicare with a "voucher" system where each person gets a small amount per year ($10k is often cited) to buy whatever insurance possible - and to cover all medical incidents, emergencies. If I'd been reduced to such a yearly voucher I'd have had to file for bankruptcy since getting cancer treatment 4 years ago and having gall bladder surgery (which came to $28,000 ) this year.

These dastardly moves would be bad in a normal environment but that's not the one we're approaching.  Nightmare superbugs, including c. diff.(which I'd written about before - that knocked Janice down in 2006-07 and hospitalized her twice) are on the rise and getting worse.  This is as antibiotic resistance rises, predicted to fell more than 2 million Americans this year, with 23,000 killed.

In Janice's case, by her second hospitalization in January, 2007, it was clear that the usual antibiotics were not stopping her c.diff - a severe bowel infection caused by the gram negative bacterium, clostridium difficile. By the time of the 2nd emergency room visit she'd lost over twenty pounds and one ER physician compared her condition to cholera. He shook his head and said in wonder: "It is a good thing she has Medicare and a good supplemental insurance. Without it, she'd have either had to fend for herself or be charged a lot of money for the ER visit."  The only antibiotic that finally rid Janice of her c.diff. superbug was the strongest then available, vancomycin.

We couldn't help but think at the time of others who might demur going to the ER, and thence spread the infection to dozens of people outside any controlled environment.  (In Janice's case, this second time around she had to be housed in a special separate, isolated room and those coming to treat her had to be specially outfitted.)

As I'd written about in a number of posts on mutation and evolution in 2010-11, bacteria like all living things evolve and adapt to survive.  Some develop cell walls that actually keep antibiotics out, while others pump antibiotics out when they get in. In other words, bacteria like c. diff. have developed many ways to deactivate or neutralize the action of these drugs.  As this resistance becomes ever more successful and adaptive, the superbugs get more virulent.

How serous is it? By mid-2015 the most powerful antibiotic used at that point was colistin. But in November of that year, specialists isolated bacteria that carried a single gene that made them resistant to colistin. In April of this year, the same gene showed up in bacteria in the U.S. According to Jean Patel based at the CDC and quoted in the recent AARP Bulletin (November, p. 31):

"And now we're beginning to get reports of bacteria that are resistant to virtually every antibiotic we have."

What are the political and health implications of these developments in the context of a Trump presidency? First, his anti-regulatory stance and advocated policies mean little or nothing will be done to staunch the widespread use of antibiotics, say in agriculture. This means that antibiotic resistance will continue to grow with each passing month.   This is especially worrying given that "approximately 80 percent of antibiotics sold in the U.S. are used in animals raised for food." (Ibid.)

Second, health care cuts, especially to Obamacare, will put millions of our fellow citizens at risk of infection - and infecting others. If their ACA insurance coverage or Medicaid is taken away, and they deem it too costly to seek care outside it  - they may well just try to sit out a bout of c.diff. diarrhea (going up to 20x a day) or a MRSA skin infection. The results could be catastrophic. As opposed to 23,000 dying in a year, 2 million infected, we could well see 200,000 dying each year and 20 million infected.  On the positive side, a recent survey conducted by the Kaiser Family Foundation showed that only 1 in 4 Americans favor repeal of the ACA. One hopes that these are mostly anti-government Trumpeters.

Third, Trump Co. may well gut or repeal Obama's $1.1 billion, earmarked earlier this year to fight resistant bacteria. This was a definite acknowledgement of just how serious the situation has become but its continuation is contingent on the generosity of the Trump administration. If they cut it completely, citing the need for more tax cuts for corporations and plutocrats, the antibiotic resistant battle may well be over.

One of the scientists quoted in the AARP piece, says at the end:

"I think everyone is finally beginning to recognize the deadly seriousness of the threat posed by antibiotic resistant bacteria."

Maybe, most of us do  - those who respect scientific facts and research. But those who invent facts on their own, like Trump and company, may not. In that case we are all likely for the high jump.


See also:

http://smirkingchimp.com/thread/richard-eskow/70092/warning-this-trump-hire-is-hazardous-to-your-health-and-not-just-your-medicare

Pills Made From Poop? Don’t Laugh!

It's no laughing matter to those 550,000 in the U.S. who at some point each year - come down with c.diff. or clostridium difficile infection. C. diff. now kills 14,000 a year and is ranked by hospitals as one of the top two or three 'superbugs' getting out of control. This is especially as there are now too many cases in the community itself, outside of hospitals.

What is c. diff.? It's a bowel infection but that barely begins to describe it. My wife got it back in December, 2006, after taking a prescription of amoxicillin for a stubborn sinus infection. But within a few days, the antibiotic had eradicated nearly all the 'good' bacteria in her gut, paving the way for a much less benevolent (indeed, vile) gut bacteria to take up residence. This was none other than c.diff. Related to the botulism and tetanus bacteria, this bug is described in med lit as a "gram positive, anaerobic, spore -forming rod which exists as a non-infectous spore (in the gut) and as an infectious form that can't exist long in the environment for prolonged periods." It was the latter form that we suspected got released from latent spores that created havoc in Janice's intestinal tract - causing gallons of fluid to literally pour out - in up to 22-25 diarrhetic releases per day.

Within days she had to be hospitalized on account of dehydration, whereupon she was put on an antibiotic called flagyl- 2nd ranked to the univeral powerhouse vancomycin. But then the bug got through it within a week, so, she was re-hospitalized and this time - and had to be administered vancomycin. This time, after the new course and being isolated in her own room, it finally worked. Most of those who die do so after being left with peritonitis, toxic megacolon, and peforation of the colon - from the violent expulsive force (which I pointed out to my wife - seemed to resemble cholera).

Since that bout of c. diff. infection 7 years ago, medical centers have scrambled for a treatment that doesn't require use of antibiotics - given how close we are to full antibiotic resistance. (See the excellent PBS Frontline series on this ). One of the first alternative measures was the use of 'poop enemas' - delivered uniquely to the victim - harvested from her family and bearing loads of good gut bacteria. At some point the enemas result in the bad guys being overwhelmed by the good, and the gut health restored to normal.

Now, thanks to Canadian researchers such as Thomas Louie at the University of Calgary, an alternative method has been developed where, instead of using enemas - the healthy variety of poop is administered via pills. Basically, it's being described as a "less invasive way" to get healthy poop into guts ravaged by the deadly c.diff. bacteria. So far, according to reports in the Canadian press, clinicians have treated 27 people succesfully after antibiotics failed to alleviate symptoms. This is huge news given a particularly virulent form of infectious c.diff. is all but indifferent to even vancomycin.

The process of extraction and preparation, according to Dr. Louie, isn't that difficult. A relative is first brought in and assorted stools obtained. Next, the material is processed in the lab to remove food, extract the bacteria and clean it. The residue is then infused into triple-coated gel capsule capable of surviving all the way into the gut. Be aware, as Dr. Louie points out, there's no stool as such left, only the necessary bacteria. The c.diff. victims thus are not technically eating poop, but instead just "stool bugs" after stools have been processed, diluted, cleaned. There are no smelly "shit" burps because the contents aren't released until they are well passed the stomach.

Louie has thus far found that 24 to 36 capsules are generally needed for treatment and patients can down them in one sitting. The pills thereby find their way to the colon and seed it with the healthy bacteria.

Don't laugh! This is all quite true, and the treatment had been announced two weeks ago at an infectious disease conference in San Francisco. This may well be the remaining life saver left for many more patients who contract c. diff.

For those who still wonder why I never got treatment for my severe bronchitis reported back in July (July 7 blog post) it was because I feared the use of antibiotics and the triggering of c.diff. I am certain I have the spores residing in my gut and that they've been there since Janice was ill - perhaps picked up by contact with contaminated surfaces, and then ingested with food - by hand. Who knows? At least now, I am not so deadly paranoid of getting c.diff. if I do have to take antibiotics at some future date.

Bad Cough for a Week? Don't Hightail it to the Doctor!

Around the last week of May, last year, I came down with some unnamed respiratory virus that mimicked the flu in almost every way except that I never had a fever. But I sure as hell had a hacking cough which my wife described as "sounding like the lungs were filled with fluid". Well, it got progressively worse over a period of ten-twelve days but I was determined not to run to my doc unless bloody stuff was coughed up or I could barely breathe. My concern was that if I went to the doctor I'd be prescribed amoxicillin or some other antibiotic, similar to what nearly killed my wife (with c. diff.) in 2006.

So I was determined to tough it out! Now, recent medical research news discloses that I did the right thing after all! According to a randomized trial published in  The Lancet Infectious Diseases there's little difference in the duration of lower-respiratory infections in people who took antibiotics and those who received placebos. Why? Respiratory illness manifesting as coughs, like flu,  are usually triggered by viruses—not bacteria—and thus are unaffected by antibiotics. Most often coughs and associated infections get better on their own.

In my case, it was roughly 16 1/2 days and the rasping cough had ended and I was out jogging and fast walking again! Was this too long? Hell no!

The authors of the Lancet study found that the average duration of symptoms reported in the medical literature was 17.8 days. That means my own cough distress ended more than a day earlier than the average duration.  The authors compared their findings to results from a poll of 500 adults,  asked to estimate how long they expected to be sick if their main symptom was a cough and they were not taking any medicine (under various scenarios with or without fever and with or without mucus). The polled sample said they expected the duration was about 7- 9  days. WRONG!

So, given their symptoms didn't end when they believed they should, these folks would have hightailed it to their doctors and asked for antibiotics, or would have been prescribed them by docs forseeing that patient expectation. So then, in another 3-4 days when their symptoms would have started alleviating they'd have wrongly attributed the outcome to the drugs when in fact it was the normal end of their illness.

This confirms for me why my decision not to jump the gun was the wise one.  As the authors of the Lancet article pointed out:

"This mismatch between patients’ expectations and reality for the natural history of acute cough illness has important implications for antibiotic prescribing,”

Well, yes, because then only in extreme circumstances should any doc worth his or her salt prescribe these drugs, which we are finding to be gradually become more useless as antibiotic-resistant strains of bacteria spread.   As the Lancet article authors put it:

"Patients should be told that it is normal to still be coughing two or even three weeks after onset, and that they should only seek care if they are worsening or if an alarm symptom, such as high fever, bloody or rusty sputum, or shortness of breath, occurs”

That's sound advice and I hope more people, especially in this flu season, also follow it. One thing is many more times dreadful than a "long" e.g. 2 1/2 week) cough, and that's getting c. diff.!

Why Isn't This Cancer Research More Widely Circulated?

Cancer is a scourge in this country, as I have noted in previous blogs. Though certain organizations want Americans to believe it's all on them - maybe 90% in terms of diet and other habits, the fact is virtually every form of cancer (breast, prostate, pancreas, liver, bladder etc.) is increasing because of the toxins in our environment. See also,

http://brane-space.blogspot.com/2012/02/cancer-industial-complex-biggest.html

Two particular cancers are especially prevalent: breast and prostate, with the latter killing nearly 12,000 men a year. Not stated, however, is the untold suffering experienced in the form of nearly 1 million unnecessary treatments, including biopsies, undergone each year by men whose physicians are hostage to the numbers....as in the PSA test. (For Prostate specific antigen).

These biopsies, especially, are not for the faint-hearted and the complications can be severe, with the ultimate being serious complications that require prolonged catheterization, being bed-ridden and extended hospitalization which can put the patient at risk for life-threatening hospital-borne infections such as c. diff. (clostridium difficile). Tens of thousands find even after the biopsies they're forced to wear diapers permanently because of the damage done via insertion of 12-15 pronged needles at once into the prostate (usually done through the rectum- but sometimes through the urethra or perineum) to extract sample tissue for analysis.

In the most mild after -effects, pain may last for weeks and males are warned by urologists against ejaculating - which may increase internal bleeding from the recently assaulted gland. As it is most are terrified because of the bloody semen that results when they do. This bloodiness can go on for weeks and makes even the most sympathetic spouse think twice about having sex, even if she wanted to. Condoms can help, but even the briefest sex ends up with the condom filled with blood. This is not exactly a turn-on, least of all for the guy!

Most of this is not passed on to the hapless male confronted with the prospect of a biopsy after his PSA numbers somehow go up. He's left to ponder his options and- what is worse - deciding whether to get this horrific procedure done (which is supposedly to his benefit), or betting the increased PSA (mainly now "PSA velocity" or the rate of increase in a specific time - say 1 year) is somehow anomalous and not cancer.

Medical author Shannon Brownlee, in her book 'Untreated: Why Too Much Medicine is Making Us Sicker and Poorer' (2007, p. 202) observes:

"The evidence suggests that PSA testing is not saving any lives, and even it is the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer.".

From reading many of the personal blogs of those who've endured this treatment, leading up to possible prostatectomy, this is not overstatement. Further, when Brownlee notes the PSA is "not saving any lives" she is referring to the actual numbers who benefit from the tests, or biopsies, relative to those that have them and receive zero benefit. The "saving rate" is actually maybe one guy for every 1,200 biopsies performed. The cost to benefit ratio is ....well, you figure it out!

Now, a recent contribution to the research promises to lend a more rational overtone and make it possible to at least reduce the numbers subjected to unneeded treatments and suffering up to and including resulting from major surgery and/or radiotherapy (the standard treatment in the latter case is called 'Brachytherapy' - in which dozens of tiny radioactive 'seeds' are inserted into the prostate gland and kept there over a specific time, to deliver a specific dose. I don't really think I need to elaborate on the side effects).

The research comes from Dr. Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, and was published originally in The Journal of the National Cancer Institute, February 24, 2011. Dr. Vickers and his co-author Hans Lilja, concluded that PSA velocity as a guideline would be unlikely to improve patient outcomes, adding, "we therefore recommend that organizations issuing policy statements related to PSA and prostate cancer detection remove references to PSA velocity."

Thus, this research is welcome information for those who may face a decision on whether to undergo prostate biopsy or not. Vickers and Lilja's point in their paper is that PSA velocity is not a good predictor of prostate cancer and, in the absence of other indications, such as a positive digital rectal exam or a high PSA level, there is no evidence to support prostate biopsy in men with a high PSA velocity. This is particularly so if the starting number isn't high already.
In his interview with the online journal Medscape, Vickers notes:

"What we've shown is that changes in PSA are not very important at all. The take-home message here is that if the patient doesn't have a high PSA to begin with and has a normal clinical exam, there is no reason to do a biopsy, even if the PSA is increasing."

In his interview, Dr. Vickers also pointed out that one of the problems with PSA velocity measurements is that velocity can be calculated a number of ways. According to him:

"There is no standardized method, and new ways of calculating it are continually being invented,"

Dr. Vickers added that a sudden rise in PSA is also not usually indicative of cancer, and "may be the result of an infection or other benign disease. It doesn't necessarily warrant a biopsy."

Now, why am I so invested? Because it's actually personal for me, having just received the results of a PSA test showing my number has nearly doubled in the past year. Have I hit the "chicken switch" and run to the urologist as originally recommended? NO. I asked for the test to be re-done and will take it again in about three months. Since the starting PSA level wasn't high as per Dr. Vickers' point, I am not going to panic irrespective of how the American Urological Association sees it (In the same article, other groups, such as the European Urological Association and the US Preventive Services Task Force, do not recommend population-based screening because of insufficient data on its benefits and harms.)

What we do know - based on recent cost assessments - is that nearly 30% of the $2 trillion odd costs in medical treatments are unnecessary. Nearly $4b a year is believed to accrue from unnecessary prostate PSA tests, biopsies and other treatments - later found to of benign causes or non-life threatening. (Two weeks ago, indeed, an article in the WSJ discussed how the AUA and its members have added incentives to ask for more tests, as "monetary incentives". Duh!)

As for me, I will bide my time. If the next test shows a further spike as opposed to levelling off or decrease, then I'll likely see the urologist. But even in that case will not likely schedule any biopsy unless the level is at 8.0 ng/ml or more. We will see.