A Chicago woman fell victim to Candida auris, a drug-resistant fungus
nytimes.com
nytimes.com
So ... let's suppose I care about slowing the development of drug-resistant fungi. As an individual, what can I do?
I basically buy into the claim that widespread overuse of antibiotic drugs in humans has caused an increase of multi-drug-resistant bacteria and I'm generally on board with limiting my own use of antibiotics (e.g. not asking a physician for an antibiotic prescription for a minor illness that is most likely viral). I'm not so sure I understand the literature on antibiotic use in livestock and I happily eat meat without thinking about what drugs the animals were given.
What should I do with respect to azole fungicides and my grocery-shopping decisions? I don't currently see strong evidence that buying food marked "organic" is better for health or the environment, but should this new-to-the-public-consciousness information about azole fungicide use in crops change my mind? Should I be trying to buy crops which were not made with the use of azole fungicides? What kind IS that -- are those fungicides on the permitted/proscribed list for things that carry the marketing label "organic" in the grocery store, and do certain farming practices end up using a lot more of this apparently irresponsible pesticide versus certain other practices?
I took a cursory look at this for about half an hour and could not figure it out, even after trying to understand primary-source literature from the past few years about C. auris and USDA rules. I also can't even tell if individual consumer-level actions make a difference, or if it's not worth trying.
Admittedly science reporting is really tough but it's a little surprising that nothing in the literature I could readily find clearly suggests what researchers think consumers should do differently (if anything).
I would avoid using non-organic citrus for zest. Conventional lemons and limes get covered in antifungal drugs before getting covered again in wax. So you probably don’t want to be eating the outside.
I, on the other hand, have an illegal supply of powerful antibiotics and antifungals sitting in my medicine cabinet. They're technically for fish, but do the math: there are only a handful of factories making these pills in the world, and the pills are indistinguishable. I don't feel guilty about it in the slightest.
There has been a fundamental change in the role of doctors and healthcare professionals in the past 30 years, and I don't like it. You can go to a doctor, and you can both agree that you have a certain infection, and the doctor will refuse to prescribe a drug which all parties know will cure the infection. I think that's a new development in medical practice.
So that's why I have fish medicine. Because when I'm sick for 3 weeks and still getting worse, fuck the greater good, I'm getting mine. And that's why you should take fish medicine, too: because as long as there are people like me, you're fighting a lost cause.
> doctor will refuse to prescribe a drug which all parties know will cure the infection
Mostly it's doctors saying "we don't know if this is viral or bacterial, and by the time the tests come back it will have cleared up", or they're saying "this is a self limiting condition with no long lasting effects and taking antibiotics will shorten the duration by only half a day".
That’s really not a thing that’s happening. You might find a doctor reticent to throw antibiotics at minor infections, but that’s because of their side effects rather than anything to do with antibiotic resistance.
In any case, even if there are a small number of people misusing antibiotics, it’s likely that the effect of their use in farming is far more harmful in the whole.
You must have a super weak immune system if that happens often. Which is a symptom of taking too much antibiotics / medicine.
> fuck the greater good
Individualism is the cancer of humanity, do your part.
https://newatlas.com/antibiotics-counteract-immune-system/52...
http://microbeminded.com/2018/03/31/antibiotics-immunosuppre...
Meanwhile in the more likely scenario where you don't catch MRSA, as others have said all you are doing is damaging your health.
Grow some of your own food so you can control what goes on it.
Reduce your use of harsh chemicals generally in life/at home.
Skip particle board furnishings. Stick to glass, metal, hard plastic and real wood.
Eat right and exercise as your first line of defense for your own health.
/2 cents
This is laughable. Growing your own food is a cute hobby, but if it was actually adopted at scale, the resource, energy and land costs associated with food production would go up by somewhere between 10-100x.
The current population of this planet could not and can not exist without modern agriculture.
I actually grew up on an old school farm and it took the land area equivalent of an apartment complex to feed our one family all year round. Tending to it was almost a full time job for 6 of the 12 months of each year. This is how people have been living for hundreds of years, the math is pretty well understood.
If you have anything better than a pair of op-eds to show that home gardening can be made 10-100x more efficient than it was a generation ago, I would love to see. My fruit+veg garden is a fun hobby and is quite large and healthy, but there is no way it could feed me for a year, never mind my family.
I'm well aware that the efficiencies of modern agriculture has allowed us to have more than half the global population living in cities for the first time in human history. This not only become true within my own lifetime, it became true within the lifetimes of my children.
None of which is really pertinent to the idea that there is value in having some food supplies outside the chain of industrial agriculture as a protective measure.
Last I heard, American gardens provided about 10 percent of America food. I didn't bother to mention that earlier because I couldn't find a source.
Ten percent of a nation's food is not insubstantial, even if is less efficient than industrial agriculture.
But I think a large home garden like mine could ostensibly provide 10% of my family's fruit/veg intake. It takes a nontrivial mount of work to maintain, it takes a lot of water and energy, and it takes ownership of a large piece of land, and I could have also subdivided the land and built a second house instead of that garden. Oh did I mention one fuckup with extreme weather pests or birds means you lose everything? Guess who was enjoying my first ever harvest of peaches? It wasn't me, it was the fucking cockatoos that raided it in less than an hour.
All of those opportunity costs to reduce my intake of harmful chemicals by 10%? That's laughable. No one is doing home gardening unless they enjoy it. The health benefits are a minor bonus that comes way down the list after real benefits like proper flavour.
I've spent time on an email list where the owner was growing food for their ill spouse in order to have control over everything that went into that food.
Not everyone does things for the same reasons you do them.
It makes a lot sense to me that like-minded individuals who don't like how how their food is handled should prefer a scalable method that doesn't break your back and takes advantage of modern efficiencies, and a way to handle excess supply so you're not wasteful. I can't see a vehicle going from house to house collecting tiny and disorganized surplus.
Plus, I'd rather see what a community plot could do rather than vs small home plots good for only growing mint tea, if even that.
If you want a human world that is resistant to drug resistant infections, you want a bunch of individual efforts to grow things in the kitchen window of their city apartment and in small container gardens on the balcony and in square foot gardens in the back yard. That's the correct antidote to the monoculture of indistrial agriculture.
Biological and genetic diversity is how you foster a world where one genetic variation of one infection cannot simply run like wildfire through the global population.
You want an intentionally inefficient system. The efficiencies of industrial agriculture are the problem. They are how we are creating these super bugs.
When they began creating tree farms, they came up with some German word that means "forest death" (or something like that) to describe the sickly trees you get from planting nothing but a single species of tree. It strips the land of the same nutrients over and over. You combat that with commercial fertilizer and commercial pesticides.
It is fundamentally not possible to simultaneously pursue both goals you espouse. You decry the variability in quality/quantity of hardest while claiming we can solve this on industrial farms. The consistency of yield that you seem to feel is the most important detail is the root cause of drug resistant infections developing.
If you want to stop crating ever more efficient super bugs that perform excellently well at eating people, then you need to intentionally inject more inefficiency and diversity into our food chain.
Furthermore, a community governing a farm can centrally plan out for ecological concerns, and they can actually measure and study their progress. A decentralised community is hoping the winds of fortune will coordinate them. A lot of this comes down to whether you trust the ability of a community to maintain control.
Also I know people who have a well-sized garden meant to actually make produce, but nobody would say it could remotely alleviate their food or lifestyle burdens. The time-sink is huge; they do it for the gratification of home gardening, not as a mitigation of food burden.
I assume you know some city people grow herbs and veggies in their kitchen window or in a container on the patio.
It also wasn't a suggestion that everyone on the planet must do this.
It's the same principle. Feed the livestock with antibiotics, be it for treating a disease or making them grow faster, and you'll eventually end up with multidrug resistant bacteria like salmonella and e coli in your food.
Looks like it managed to spread without much hindrance due to its immunity. Wonder just how common it'll get since it's so hard to get rid of.
Do you have any sources for these claims or is this tinfoil-hattery? What would be these "good reasons" for suppressing information? And if the information is unavailable, how do you know that "the cases are accelerating"?
The fact that it’s extraordinarily hard to eradicate is notable as well. One of the linked articles mentioned having to tear out ceiling tiles and flooring to get at it.
https://www.nytimes.com/2019/04/06/health/drug-resistant-can...
In January, the Centers for Disease Control and Prevention sent out an urgent public alert about a deadly bacteria, resistant to virtually every known antibiotic, that sickened more than a dozen Americans who had elective surgery at Grand View Hospital in Tijuana, Mexico.
But when similar outbreaks take place at hospitals on American soil, the C.D.C. makes no such public announcement. That is because under its agreement with states, the C.D.C. is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens.
https://www.nytimes.com/2019/04/08/health/candida-auris-hosp...
It's about malpractice, I'm sure.
From what I've seen, I gather that CDC is getting pressure from lobbyists for hospitals and nursing homes. Directly, and indirectly through the federal government and states.
https://www.nytimes.com/2019/04/08/health/candida-auris-hosp...
> Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.
> Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”
...
> C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.
I checked my old emails. There is zero mention of candida auris.
This appears to be fairly new and becoming very serious, from what I gather.
(Updated to say "antifungal.")
> a substance produced by or a semisynthetic (see semisynthetic sense 1) substance derived from a microorganism and able in dilute solution to inhibit or kill another microorganism
Bacteria and fungi are microorganisms, so antibacterial and antifungal agents are all antibiotics.
Edit: OK, upon reflection, some fungi are microorganisms. Others form filaments. Candida spp. can do either, depending on growth conditions. I'm not sure about Candida auris. There are references to colonies on growth media, but that doesn't necessarily mean filaments.
Anyhow, fungal infection is bad news, often systemic, hard to eliminate.
It's probably difficult for it to infect people from skin contact.
https://today.oregonstate.edu/archives/2010/mar/fungi-can-ch...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095543/
https://www.sciencedaily.com/releases/2006/10/061021115712.h...
[0] https://www.nytimes.com/2019/04/06/health/drug-resistant-can...
Hopefully the bacteria wins and we can create a new antifungal from the results.
Do you live in the USA?
I can't believe "going to the doctor" can still be a problem, unless you're in war zone or one of the worlds' poorest countries but that doesn't apply to the US, does it?
When I read "black seed" in the comment I guessed it might be Nigella seeds, which are sprinkled atop pides in the local middle-eastern bakeries, adding a lovely piquancy to the bread.
(none of this is to say it's not effective, just that it's unlikely western doctors would do this based on current clinical evidence)
What would be unethical about instead offering an experimental antifungal treatment that had not been clinically tested or verified? When you have a fast-acting terminal disease and are capable of participating in informed consent, seriously, what's the worst that can happen?
Note than many of the barriers are political. For example, we want to use clinical date from the EU, but the GDPR law makes working with the data extremely challenging. Previously, I worked with GA4GH which is trying to get consent forms changed to allow more aggregation of clinical data to be re-used outside of the original trial (metastudies on millions of patients) but it hasn't really gained a lot of adoption.
Other barriers are financial- there are a lot of incumbents who make a lot of money without making the system significantly better (I think of the major EHR companies here, especially Epic, but many drug makers and medical device makers fall in this category too).
Even within the reasonable constraints on ethics, the field could do tremendously better but there is no political will to make it so.
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“Garlic has long been considered a powerful natural antifungal,” said Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at Hackensack University Medical Center in New Jersey and a pediatrician at the Whole Child Center in nearby Oradell. Dr. Rosen pointed out that studies have found garlic effective against a number of fungal infections, including those caused by Candida and other common pathogens.
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Here's the supporting study: https://www.ncbi.nlm.nih.gov/pubmed/12174037?itool=EntrezSys...
And conclusion: "Fresh garlic extract has a greater efficacy than garlic powder extract as indicated both by its effects on morphology and inhibition of growth."
It likely was not used in this case. A doctor friend of mine once told me that American doctors try to err on the side of doing things they could defend in court if sued for malpractice. Remedies of this sort probably fail to meet that standard.
I do personally know someone who served as "patient zero" in a clinical trial years ago trying to marry Western cancer treatments to non drug approaches, like diet. They lived when they should have really died. But I haven't heard of anything further coming of that initial study.
> Did anybody tried to apply blackseed and garlic light deep - fried coconut oil concoction? Just curious, sharing as it is our sub tropical Assam-Burma jungle traditional remedy for anything and everything fungal infection since time immemorial.
To be less sardonic, it's an unreasonable question because it has zero scientific basis. I've had naturopathic family members attempt to give things to children that were definitely not safe in any shape or form.
But I will not stand for people recommending alternative medicine for absolutely everything. I already had to deal with a family member doing just that, forcing random concoctions of nonsense onto a family member suffering from cancer and attempting to divert them from actual treatment. Especially when they act like they're better than doctors and can't back up their recommendations with anything remotely resembling research.
Within that context, you're the one being disingenuous by likening it to diverting people from actual treatment and trying random concoctions for cancer treatment.
I totally agree. The anti-vaxxers, for instance, are incredibly dangerous not just to the health of individuals, but to modern civilization.
My point is that just because something is a folk remedy, or predates the invention of the scientific method, doesn't mean it's inherently without value. Rigorous scientific studies can and should be done on these sorts of things—I don't think anyone should blindly accept a folk remedy, especially one contraindicated by proper research.
But there is a certain dismissiveness amongst many folks like us of anything not invented by the pharmaceutical industry that may do us all a disservice.
I don't think that's true. The cures don't need to be invented by the pharmaceutical industry to be taken seriously. But they do need to be studied and commercialized by the pharmaceutical industry to be taken seriously.
How could you take seriously a pharmaceutical product which is rejected by its own industry? Obviously it's not commercializable in an honest way if that's the case, or someone would have done it by now.
For context, aspirin and quinine both come from plants (trees in both cases, iirc). Capsaicin, the active ingredient in hot peppers, gets used as the active ingredient in over-the-counter topical arthritis medication.
Due to the hot, humid climate, jungle cultures deal excessively much with fungal infections. IIRC, quinine was a traditional treatment for malaria well before Western medicine discovered it. My recollection is this id how Western medicine learned of it -- from locals who knew it as an effective remedy.
Last I checked, malaria was becoming resistant to synthetic derivatives of quinine. Such strains were still treatable with actual quinine.
There's certainly plenty of BS in the traditional medicine world, but there may be a lot of remedies lurking right under science's nose.
[0] https://www.smithsonianmag.com/smart-news/nasty-medieval-rem...
Out of the tens of thousands (hundreds of thousands?) of medieval so-called remedies it turns out _one_ is accidentally useful.
It would be more surprising if absolutely none of the remedies were useful. You'd expect at least one or two hits just from chance.