‘Superbug’ scourge spreads as U.S. fails to track rising human toll
reuters.com
reuters.com
Deathcerts is an interesting dataset. It's not the only one.
Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked.
There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent just HOW resistant a particular bug is to a standard battery of antibiotics, broken down per antibiotic.
That data is transmitted from the labs that performed the test to the state health department where it is analyzed.
Fascinating article, but there's NO WAY that Reuters had that much contact with state public health folks without being aware that they track lab results. Misleading!
Edit: elaborated about the susceptibilities results.
I ask as someone who is quite a novice when it comes to knowledge of what is the expected reporting requirement: That subhead is a blanket assertion, but when applied to the death-by-MRSA issue, do the public have access to accurate, up-to-date information? If not, isn't that assertion partially correct?
The reason they said doctors don't put it on death records is because they dont always want to wait the 2-3 days it takes to get results back from the labs. So it makes way more sense that the labs record the bugs. Instead of doctors in the field.
Those are the people who are trained to detect the bugs... so they should be responsible for tracking them. I presume they could get indications from the doctors on whether the patients died as well.
Couldn't the doctors update death records after-the-fact? If they found out afterwards what the actual cause of death was, they should really being recording that.
This creates two obvious results. 1) suppression of legitimate claims from relatives, and 2) suppression of valid concern and pressure for govt action such as increased research funding.
How is this good?
Actually I have all sorts of examples of the above, but the point is that oftentimes the data is "corrupted" on the way to the collection point(s). Anyways, the executive (VP of some bullshit) got his walking papers and funnily enough, no more reportable line infections that didn't come from lines.
So at least sometimes there are happy endings, sort of...
Reporting incorrect data can be worse than reporting nothing at all. Here are the guidelines: http://www.cdc.gov/nhsn/pdfs/faqs/faqs-v-6_clabsi.pdf
CLIs are only supposed to be reported when the central line can reasonably be implicated as the vector and the blood is the primary infection site. Neither was established.
As far as cleaning up procedures, there will always be room for further improvement, but that's no reason to accept a $2 million fine (which still had to be paid) as a cost of doing business when the "root cause" was incorrect reporting.
I don't think hospitals have any motivation to hide antibiotic-resistant infections ("superbugs") specifically. HOWEVER, the motive to hide hospital-acquired infections[0] is clear!
Here's some mud in the water: what's the difference between a HAI with some bug that is easily killed by antibiotics vs. an antibiotic resistant bug?
As for "tracking it in secret", that's one way to put it, but it will cloud your thinking. :) Your own medical records--specifically blood test lab results--have your name, address, and phone number on them. Consider replacing the word 'secret' with 'private' and re-working the whole thought.
It's the hiding it in public records such as Death Certificates, information given to the family, and performance statistics that I find suspicious.
Then you agree with the article that "the motive to hide hospital-acquired infections is clear".
Uhh... That's kind of a huge problem.
> There’s also a powerful incentive not to mention a hospital-acquired infection: Counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.
I stand by my assertion that nobody is trying to "hide" the "superbug" problem.
The human tendency to not self-report failures is a thing. But it's not some kind of biohazard conspiracy.
And one more thing about the death certificates...
> In a statement emailed to Reuters, Frieden said:
> "While death certificates provide helpful
> information, the unfortunate reality is that they
> don't provide in-depth clinical information."
But the article sure makes it sound like hospitals are hiding MRSA-related deaths, since MRSA infections are often "hospital acquired". And we all agree that hospitals would have an incentive to hide these numbers.
And the apparent under-reporting seems to indicate that this is in fact what's going on. This sounds like a problem! Thanks a lot, dishonest hospitals!
http://depts.washington.edu/labweb/Divisions/Micro/antibiogr...
This shouldn't be surprising. Imagine if Reuters wrote an article that said:
- Everyone acknowledges that superbugs are an issue
- Hospitals are doing their best with their limited resources, but overall are capturing a good deal of data
- The data systems are old, but the CDC can get the data and with some manual work process it, but it takes time
- Everyone agrees that more could be done, but they also agree it's complex and nothing is perfect.
No one would read the article!!
Why Not? They said it was a YEAR LONG investigation...
Specifically regarding tracking cause of death:
Not every disease or condition is "reportable". Each state maintains a list of reportable diseases. When a hospital/lab (hereafter: facility) encounters a disease on the list, then they are required to report it.
State health departments will open investigations in various circumstances. You've seen events like e. coli outbreaks in the news--those always precipitate an investigation. There are also investigations associated with individual infections, i.e. every case of tuberculosis.
If a patient involved in an investigation dies, public health will find out.
But, if a patient dies from (because of) an infection that wasn't on the reportable list, then public health won't know the cause of death unless it is on the death certificate. Just like the article says!
Regarding tracking the susceptibility of bacteria to antibiotics (superbugs):
Any sample that is tested for antibiotic susceptibility is reportable. The results of that testing generally include the specimen source, but don't include why the test was ordered (i.e. because some person has sepsis and might die) and certainly there's no (deliberate) relation between this data and cause of death.
> As examples in this article show, superbug infections are often omitted from death certificates. But even when they are recorded, NCHS can’t feed that information into vital statistics: The World Health Organization (WHO) classification system the agency uses lacks mortality codes for most drug-resistant infections, though it has codes for more than 8,000 other possible causes of death.
> The CDC added codes for use in the United States for terrorism-related deaths a year after the Sept. 11, 2001, attacks. It could do the same for deaths from drug-resistant infections. Officials told Reuters the CDC is instead working to incorporate the codes into the WHO’s next revision of the international classification system. The revised system is expected to be completed in 2018 but not fully in use until the 2020s.
The problem of inconsistencies in death certificates have been around since, well, the history of death certificates: http://www.newyorker.com/magazine/2014/04/07/final-forms
As far as the "old" crowd -- who gets sick most often?! It certainly isn't strapping young men and women, not in any hospital I've ever been in outside of a war zone.
Antibiotics are not used for healthy livestock in many countries. The US is a very notable exception.
It comes down to cutting costs. In the US, it's not typical to clean the facilities between batches of animals like chicken. This mean that the new batch would contract any bacteria left behind the previous animals. It's not even that big of a cost, I'd call it borderline negligence.
I agree with you, this practice should end. Giving antibiotics to livestock at all is harmful and it should never be done as a precautionary measure.
On smaller farms, isolating or just killing the sick animals would be fine but that will not work in industrial scale.
So yes, it's about costs, but not for the reasons you cite.
But that's irrelevant, it's a cost cutting measure with harmful consequences to the society as a whole. The regulations and producer prices should be adjusted to make small to medium scale farming profitable and stop the antibiotics madness.
Was it a superbug? Dunno, and nothing in her medical record leaves any indication that it might have been, the world just moved on.
Part of the problem is the sheer volume of such cases -- where did the infection come from? Why did it get worse so fast? Was it bacterial, viral, fungal? The diversity of microbial life on earth is so vast, and the rate of evolution so quick, that any one center is going to be hard pressed to keep up just cataloging new strains, let alone figuring out what sequence of drugs to try.
This is why it is a national tragedy (at least in the US) that we don't put more emphasis on funding the CDC. Other countries do better or worse, and particularly some states like Minnesota do a lot more. But I can reasonably guarantee that the possibility of humanity being devastated by an easily transmitted bacterial or viral vector is greater than anything a YF-22A is likely to ward off. A centralized repository and clearinghouse can do so much more than any one center, even the richest hospitals, because it can (in principle) see everything at every center. Just needs enough funding and oversight to get the job done.
I recognize that nothing can bring your MIL back, but perhaps if the CDC were given a bit more respect (instead of being a political football to defund abortion and legalize Confederate flags, as at the present), you might have some answers and the next person in that situation might pull through. No guarantees in life, but it seems like a higher expected return on investment than many government priorities. JMHO.
Sorry for your loss, and the open questions around it.
[1] https://www.amazon.com/Complications-Surgeons-Notes-Imperfec...
In the US, the problem is mostly pig and cattle feedlots that rely on antibiotics to keep the animals from being sickened but he crowding. Naturally, there is no proof that superbugs are coming out of the feedlots, because the feedlot owners do not allow any sort of sample collection by scientists.
Now comes the GOP with the "ag-gag" laws, which don't just ban sneaking into these feedlots with cameras. They also ban the smuggling of manure samples from the feedlots.
This is the GOP's war on science: they literally criminalize it.
If someone wants to walk into your private property and research your operations, you should have the right to tell them to beat feet. If there is a legitimate public interest then the government should create an inspection scheme; there probably should be one but that's a separate debate. But allowing guerilla espionage by activist groups is not an acceptable alternative.
===================
Replying to swashek below since I'm rate-limited: what are you talking about "thought crime"? None of the laws here concern thought or the freedom to publish your thoughts. They ban conducting suriptitious investigations on farms, which necessarily involves either trespassing or deceit in gaining access (e.g. an activist getting himself hired as an employee)
Even as a country of laws (which I support), you still have to be able to admit that said laws are absurd when they are, in fact, absurd. This goes beyond absurd and endangers the populace. You seem more interested in ensuring that we definitively prosecute thought crimes rather than work to change the system which, at face value, appears to place the government as accessories to the wrongful deaths of many of its citizens (keeping focus on this particular topic). As such, doesn't OP have the right to criticize and suspect the government, especially when the government is ostensibly blockading one of those "inalienable rights" of "life ..."
Keep shilling, though!
I don't think that the person you're replying to is suggesting that the law should remain as-is. Rather, he's suggesting that the law should be modified via the established political processes for doing so. I'm not sure where you're getting the "thought crime" thing -- even if he supported the ag-gag laws, it wouldn't be thought crime to say so, and he wouldn't be accusing others of thought crime by saying so. This is simply called a "disagreement". It doesn't need to be dramatized.
Of course OP has a right to criticize and suspect the government. Who said he didn't? That doesn't mean OP has the right to disregard property boundaries or to enter a private premises under false pretenses, even if the stated intent is to "prove antibiotics in farm animals are causing human superbugs".
If one believes that the local trespassing laws should be modified to accommodate persons acting in this particular public interest, he should contact his local representatives, or, alternately, run against them and lead the charge himself.
It is probably much easier to convince someone in one of the several government bureaucracies to open an investigation than to get a special exception to trespassing laws codified.
It was legal for the entire history of the Republic, albeit it was also grounds for civil litigation.
The GOP decided to criminalize it.
I'm fine with an operation banning employees from filming, for example, and employees getting fired for doing so, or for arresting people for trespassing.
The laws referenced by the OP go further, though, to criminalize recordings that were taken by individuals who were allowed on the property by the owner, and who were documenting what happened. In my opinion, owners have the right to fire employees who violate their policies, and to sue former and current employees for libel, but not to sue former and current employees for distributing recordings of things that actually occurred, when there's no reasonable expectation of privacy (which almost by definition is impossible in a workplace, except for maybe things like medical settings).
I agree with you, though, that if there's a public health interest, the government should create laws regarding that, or at least give authority to DPHs to do that.
If this is really a public rights issue and lets assume the entirely of the GOP has been paid off, from POTUS to dog catcher, then where is the Democratic response? Oh right, it doesn't exist, because this is a non-issue outside of extremist views. Its trivial for any political group to start a case and get it to SCOTUS if they believe any of this is unconstitutional. Its trivial for law enforcement to get warrants against these farms if they're violating the law.
I do understand the controversy here, but I think in the end, whistleblowing will always come with some risk. Its a little naive to think it doesn't. I think most people are okay with that because casual whistlblowing becomes office politics, meaningless outrage politics, and endless bikeshedding. There should be a high threshold for exemption to the laws that guarantee our freedom and rights.
So Upton Sinclair was wrong to go undercover to gather material for his book The Jungle?
In case you're not aware, until the 80's, American law practically encouraged a level of industrial espionage, because it discouraged reliance on trade secrecy and therefore encouraged the dissemination of knowledge. And yes, because it enabled undercover investigations of wrong doing, both the illegal and what ought-to-be illegal.
To the extent that there is a valid right here, how is regular, generally-applicable civil and criminal trespassing law an insufficient vindication of the valid rights at issue so as to require special additional "ag-gag" laws providing additional privileges to a particular industry?
>That's the government's job, not private activists Sure, maybe it is the government's job technically. Unfortunately, that doesn't always work. In addition to the above, many governement oversight programs are underfunded or have had their power legistlated away. On top of all that, companies aren't always upfront with letting an inspector see the normal daily operations.
Ancedotes I worked as a CNA in a nursing home. They were commonly understaffed. This is fairly common with nursing homes in the state I was in. There was a state agency that checked such things, but it seemed the nursing homes always had a notice when they were going to visit. Suddenly, they had a lot of manditory and voluntary overtime available and stuck to the rules. If the visits were sporadic, more often, and they checked things like logs and historic staffing levels, I'm guessing this would change. I think the only way to get this improved would be for enough private activists to gather evidence from many different places and get state laws changed after making a public outcry.
Ancedote 2 I worked in a food factory for a day or two. Now, they were horrible employers for various reasons, but the facility was clean and there was a lot of focus on meeting food prep safety guidelines. In fact, there were USDA employees assigned to that factory, and they could not run without it. Actual oversight. But food factories might not have been like this had it not been for private activists, and it still isn't perfect. One still hears horror stories in small towns with a meat processing plant, for example, but I have no clue if they are true or not.
Taking a broad view, I disagree. Everything the government is permitted to do is (or at least should be) ultimately by consent of the governed. Anything that is the government's job is only their job because the governed delegated it to them; it is the job of the governed first, delegated to the government. It is private activists' job; the government has simply been tasked with it.
I believe the governed have a moral duty to take back any such job when the government proves unable to properly execute their duties.
The line of "unable to properly execute" is, unfortunately, enormously open to interpretation. Morality isn't easy.
Farmers are few, people who get diseases are many. Shouldn't be too hard.
- Sir Alexander Fleming
The nightmare scenario is medical science gets rolled back by a century as non-trivial infections return to being a death sentence.
I know it's not, we reap the benefits in lower food prices, but does beef really need to be cheap enough we can eat it 7 days a week?
No it is. The total cost to society has to include healthcare costs as well. Saying, 'This lowers our cost at the dinner table' is only looking at part of the equation.
Never mind that people don't eat dinner together which is a by product of having super cheap convenient packaged calories available. Eating as a family increases child development significantly, it's like the cheapest thing you can do to give kids a good start.
Never mind that we don't really need nearly as much corn as we produce. When the farm bill came out and started picking agricultural winners, we turned garbage farm land into prime producers of a crop that we don't need. Then we added tariffs to sugar imports, then we put corn into everything, providing a cheap source of calories and diabetes, heart disease, perhaps cancer (most of the links here are still from correlation and haven't been proven as causation). Corn moved from a side dish to being in everything you eat unless you are cooking all (most) of your own food.
We have the (possible) super bug issue from our meat sources.
It takes like 50 gallons of water to grow an avocado but we do that anyways because irrigation water is subsidized in many states even as we start to drain our reservoirs.
It takes 2 calories of fossil fuel to make one calorie of food. We do this because it's still cost effective because of subsidies.
The whole picture makes it look not quite as cheap, we've just pushed the cost into other categories to hide it.
I think "we do this because we can't eat fossil fuels no matter how many calories they provide, so trading total energy content for ability to serve as food is valuable, independent of subsidy" would be more accurate.
"Concentrated benefits, dispersed costs." Farmers are highly organized and vigilant in defense of their subsidies and regulations, whereas sick people are not similarly organized and the policy connection to their condition isn't obvious. Concentrated benefits are what create special interests, which by their nature put their own interest ahead of the national interest.
- Constantly feeding livestock antibiotics makes them grow bigger. The mechanism for why this happens is not understood (but who cares because bigger livestock means more money).
- It is costly to deal with an animal after it gets an infection rather than just being preventative.
- Farmers are scared about diseases sweeping through their herds and causing issues where they are forced to kill the whole herd (e.g. mad cow disease -- though antibiotics don't prevent prion diseases).
It's a harmful practice and should be outlawed. Even if it means paying more for your food.
I am sure that farmer's would rather risk their livestock than risk their children or grandchildren.
I think the only way this practice can exist is when people do not understand or are coerced into doing it. Many of the largest farms just have people following rote instructions and not actually understanding what is happening.
Let's compare to an easier to understand industry, think about fast food. The people in the kitchen at a McDonald's don't need to know how to cook, they follow the instructions and put uncooked meat in a machine and food comes out of the machine. If that process killed kittens somehow the McDonalds worker would never know.
I suspect the near minimum wage workers manning livestock farms and farmers that might not have the benefit of a full education, simply don't or don't accept that antibiotic abuse creates a breeding ground for something will kill some of their children.
you're kidding right? sure economical impact today vs. theoretical risk to grand/children tomorrow - Nov 8 will show how many people and of what demographics what choice would make, and I'm somehow sure what choice the farmers would make :)
When the discussion is calm enough, they do largely agree that they wouldn't do anything harmful to their children or their farm's legacy. The just don't think global warming is real so their low mpg cars don't contribute to harming their farm.
Combine this with the fact that people defending a stance often become emotionally entrenched and likely they will continue to believe global warming is not real until they can no longer plant corn. Then once that emotionally devastates them, or some similarly life shattering cognitive dissonance destroying event occurs, they can take a look with fresh eyes.
EDIT - I know this is mostly about glbobal warming and the original discussion related to antibiotic resistance, but largely the resistance is from uneducated super-conservative people with a fundamental religion and a fundamental distrust of science. I really see these two problems as two sides of the same coin.
How about having the mainstream media news talk about it, and then some kind of general vote on whether "ag-gag" laws should be repealed immediately?
You think the public might support the idea?
Of course. It would be simple to get it repealed with massive public support and outrage. So why don't they do it?
Might it be that shafting the general population is a bi-partisan effort after all, just like with SOPA / PIPA / CISPA / NDAA / TPP / TTIP and so on ad infinitum?
Basically, yes.
> How about having the mainstream media news talk about it
The "mainstream media news" doesn't work for the Democratic Party (in fact, it mostly is owned by corporations that preferentially support the Republican Party, though people tend to get confused by studies showing that workers in much of the media lean Democratic, as if firms were directed by workers rather than owners.)
What states are you referring to? Most of these laws that were introduced in the 1990's have all been deemed unconstitutional in the states where they were passed. Not to mention, any other states that have attempted to pass these laws have failed.
I'm sure you enjoy demonizing the GOP, but I don't see much merit in your argument if there are no states where these laws are currently in effect and nobody has been successfully convicted of violating these laws.
[1] http://www.foodsafetynews.com/2015/12/idaho-appeals-federal-...
https://foodpoisoningbulletin.com/2016/wyomings-ag-gag-law-d...
New Study Finds “Ag-Gag” Laws Erode Trust in Farmers - http://modernfarmer.com/2016/03/ag-gag-laws-erode-trust-farm...
"In the bed of a truck that they parked on county roads adjacent to ten Lubbock-area feed yards, they set up small, generator-powered vacuums. On a number of windy days, they collected upwind and downwind air samples. The results confirmed their suspicions: downwind, they found antibiotics—specifically tetracycline—present at significantly higher levels than in the upwind samples. Yet as they dug deeper, they discovered something even more worrisome. Along with the antibiotics, they found another hitchhiker: remnants of bacteria that had acquired a gene that made them resistant to tetracycline." (1)
The article also describes the pushback from the CFA (Cattle Feeders Association)
(1) http://www.texasmonthly.com/articles/when-the-dust-settles/
http://magarshak.com/blog/?p=93
It's the flipside of the factory farm and overprescriptio fiascos. Yes, those are bad, but we haven't discovered new types of antibiotics for decades... and many diseases get far less attention, because of patents and silos. Even researchers working as a result of public funding are snapped up by big pharma once they make a discovery which then acts as a parasite on the public money.
Science progresses when anyone, anywhere, can contribute. Same with open source. It is the reason Wikipedia is larger than and just as accurate as Brittanica or any other encyclopedia. It is the reason Android runs on so many phones, and Linux runs on toasters. It has given us everything from WebKit to Wordpress and created a massive amount of solutions for the LONG TAIL instead of just boutique drugs.
It took 30 years to discover a new antbiotic type:
http://www.telegraph.co.uk/science/2016/03/14/first-new-anti...
More people studying eg human bacteria in the nose will find cures if they are unencumbered:
http://www.nature.com/news/the-nose-knows-how-to-kill-mrsa-1...
We need patentleft! All that phage therapy etc. shouldn't be controlled the way monsanto controls agriculture now.
It seems like this is a problem nanotech could possibly solve. Microbes won't have much time to build up resistance if we can go after them directly.
http://www.scientificamerican.com/article/nanotech-drug-resi...
http://www.spiegel.de/international/germany/combating-deadly...
However I think there is a basic difference in approach. Hospitals in europe are usually uber clean, everything is desinfected and there is a small army of cleaners. My impression from US is that McDonnald was cleaner than hospital.
Second difference is post-operation treatment. People in weakened state are left in hospital for a few days for monitoring. With broken immune system (after chemotherapy) you get into strict hermetic isolation. In US leukemia patients go to hotel after treatments.
I'm really interested in this. Where were you? Because my impression of the US is that they are very thorough on the small stuff … because they can pass the bill on to someone for taking precautions, whereas they can be sued for not taking them.
Really, unless the alternative is death anyway, you're pretty well advised to stay away from hospitals.
Patients are screened for MRSA if they are being admitted for surgery, cancer and a number of other risk groups, or have had MRSA previously.
Now, E.Coli with MCR-1 is also spreading, isn't it?
MRSA can be treated with a number of different antibiotics, including vancomycin, daptomycin, linezolid, Bactrim, and clindamycin to name a few. Teixobactin is not yet on the market or approved for use in humans.
My dog was recently diagnosed with MRSP (methicillin-resistant Staphylococcus pseudintermedius) urinary track infection.
Having mostly avoided the vet for the duration of his life (being that he was healthy) I have no idea how this happened.
Even long sleeves can be the enemy.
I know superbugs are different but the concept is the same.
You might want to read about Community Acquired MRSA.
http://www.phac-aspc.gc.ca/id-mi/camrsa-eng.php
http://wwwnc.cdc.gov/eid/article/8/6/01-0313_article
> To estimate the proportion of community-acquired MRSA, we analyzed previous hospitalizations for all MRSA-positive persons in Finland from1997 to 1999 by using data from the National Hospital Discharge Register. Of 526 MRSA-positive persons, 21% had community-acquired MRSA.
Also from the paper you quote: Based on our study, the proportion (21%) of community-acquired MRSA was relatively high in Finland.
Completely untrue. I personally know of 2 incidences: My cousins child carries MRSA. He doesn't get symptoms, but the rest of the family has to be extra diligent about picking it up from him.
The second was a lady I worked with. She got what she thought was a spider bite on her upper leg, somewhat near the groin region. When it wasn't healing and looking worse, she went to the doctor. Turns out, it was MRSA. She had the same misconceptions as you, so she asked the doctor how she could have possibly gotten it. Turns out, in a miriad of ways, but judging by the location she probably had contact with it on her hands, and then touched her leg when she used the restroom. He suspected it got in through a small cut from shaving, actually. I know for a long while, she washed her hands both before and after using the toilet in public, and was on different antibiotics for some time.