Minority Report 2: “Pre-Disease”

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KENNEDY SPACE CENTER — This coming Saturday morning at ten o’clock, our friend Staphylococcus aureus will find itself buckled up inside a Dragon Spacecraft about to be launched some 250 miles into space so it can dock at the International Space Station (ISS), shown above.

The U.S.- Russian-manned ISS, which orbits the Earth 15 times a day at a speed of 17,000 mph, serves as a cutting-edge science lab because of its near zero gravity environment — the one where you see astronauts floating around the spacecraft like it’s a Disney ride.

As it turns out this microgravity environment is thought to have a pronounced effect on microbes: that it accelerates their rate of growth and reproduction, and therefore their (genetic) mutation rate. Accelerating an organism’s growth rate is a way of fast forwarding into the future, as if you were aging, say, a human, 20 years in just 365 days.

The idea is to place the Staph into that environment, under experimental conditions, and watch what it does. Specifically, to record all the different ways that Staph becomes resistant to an antibiotic as it morphs into Methicillin-resistant staphylococcus aureus (MRSA). You keep at it until you’ve mapped all of the various pathways Staph bacteria take on their road to resistance, in all its forms.

What the finished resistance map gets you is the ability to predict the future. It goes like this. Imagine, for example, that Big Louis comes to town to stick up a bank. He holes up at a local dive from which he cases the joint, decides when to strike, chooses a weapon, a disguise, a getaway car, and plans his escape route. The day of the robbery everything goes according to plan; the cops are called in and begin to work “backwards,” assembling the clues one by one, day by day, hoping they’ll lead to the guy whodunit before he gets away.

But what if, instead, the instant Big Louis hits town the cops know he’s there. They run his M.O. and learn everything within minutes: where he’s holed up, the crime he’s planning, his disguise, weapon, getaway plan, whether he has an accomplice, and so on, thus allowing them to scoop Big Louis at any point prior to the planned bank job.

 

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Where do the cops get all this information? This is the futuristic part: From having recorded not just every crime Big Louis has ever committed, but from having also recorded every crime he will commit over his lifetime. As if an experimenter had placed Big Louis in a time machine, pressed fast forward and recorded all of his future criminal behavior.

That, of course, is science fiction. But putting Staph aureus into a microgravity environment and accelerating its rate of growth and reproduction, recording each genetic change, plugging those changes into a data base, creating algorithms from that data that allow you to predict what Staph will do based on any given presenting genetic profile, and ultimately developing an antibiotic that targets that genetic profile, isn’t science fiction – as of this novel space experiment.

The project is led by Harvard’s Dr. Anita Goel, MD, PhD, whose one-of-a-kind resume is worth taking a look at. She admits that the space bug experiment is proof of concept. For example, they’re experimenting on 2 strains of Staph, yet there are hundreds, not to mention all the other different species of bad bugs that are out there. It’s as if, back to our crime analogy, they’re experimenting on Big Louis and his frequent accomplice, Little Ronnie Dinsdale, but leaving out the rest of the criminal underworld — Tony Soprano, Don Corleone, and so on — each with their own unique M.O.’s.

But here’s the thing. If the experiment works with either strain of Staph, then it means it will work with other disease microbes as well. And then … what about cancer cells?

Just 15 years ago we were introduced to the concept of “Pre-Crime” in the Tom Cruise film Minority Report. Pre-Crime was the name of the specialized police unit that arrested criminals based on foreknowledge of future crimes provided by psychics called “precogs.” Now replace psychics with scientists, have your foreknowledge based on microgravity enhanced “fast-forwarded” observations of the genomic changes in a superbug, and replace Pre-Crime with “Pre-Disease,” and we have Dr. Goel’s current work.

She chose to study Staph because MRSA kills more Americans every year than the combined total of emphysema, HIV/AIDS, Parkinson’s disease, and homicide. Worldwide, drug-resistant infections kill more than 500,000 people each year and by 2050 that number will exceed 10 million.

But if this notion of “Pre-Disease” intervention works we’ll have a different world. In fact, that’s what Dr. Goel said, with characteristic dry wit, in her 2010 TEDMED Talk: “Our aim with this is humble: We want to do nothing less than to revolutionize healthcare globally by enabling real time point of care diagnosis.”

Stay tuned.

 

 

 

 

 

 

Bugs on steroids: the antibiotic effect

Imagine prescribing steroids to people so we could build stronger antibiotic-resistant germs – “superbugs” – that grow and reproduce quicker than they otherwise would. Ridiculous, right?

Well, a study reported this week in the American Academy for the Advancement of Science tells us that’s exactly what we’re doing when we take antibiotics, i.e. they have a pronounced steroid-like effect, not on us, but on the bad bugs we harbor.

In the study, researchers exposed E. coli bacteria to 8 rounds of doxycycline treatment over four days and found that the bug – which can cause severe stomach pain, diarrhea and kidney failure in humans – had “increased antibiotic resistance with each treatment.” The E. coli also “reproduced faster than before encountering the drugs and formed populations that were three times larger [and] … [t]his was only seen in bacteria exposed to antibiotics.”

Therefore, say the researchers,”[b]acteria have a remarkable ability to rearrange their DNA and this can stop drugs working, sometimes in a matter of days” (my emphasis). And further: “It’s often said that Darwinian evolution is slow, but nothing could be further from the truth, particularly when bacteria are exposed to antibiotics.”

In fact, we can now literally watch this rapid evolution and spread of mutant superbugs thanks to a first-of-its-kind video produced by Harvard scientists that went viral on YouTube with some 25 million views. Here it is, with a nice voice-over explanation:

Here’s the takeaway. No one disputes that antibiotics are necessary and even lifesaving – but only when appropriately prescribed by a physician. The inconvenient truth, however, is that we horribly misuse and overuse them. For example, antibiotics cannot cure the common cold, are almost never needed for bronchitis, are not recommended to treat many ear infections, and are typically not needed to treat a sinus infection (sinusitis).

As Roy Kishony, one of the Harvard scientists involved in the video reminded us in an interview with STAT last December, “Every single antibiotic that has been introduced medically so far, bacteria found ways to evade it … every single one.”

So why help out the bugs even further by giving them “steroids”?

As Good as it Gets

WASHINGTON, D.C.: In the spring of 2015 President Obama convened a news conference where he addressed, in his words, “an issue of great importance to the public health of America and the world … [i.e.] antibiotics becoming less effective … one of the most serious public health issues we face today.”

Seated to his immediate left was DHSS Secretary Sylvia Burwell, a fellow graduate of Harvard, and also of Oxford, where she attended as a Rhodes Scholar. Together, they unfurled his National Action Plan for Combating Antibiotic-Resistant Bacteria, “a product of extraordinary work,” Obama continued, “from some of our top scientists … that covers the next five years starting right now.”

Presciently noting that “this is a problem that doesn’t always rise to the top of people’s day-to-day concerns until somebody in their family is impacted,” just last week the CDC presented us with an uncomfortable truth: An elderly woman (her name wasn’t released) in Nevada died of a bacterial infection that defeated every antibiotic in our arsenal – 26 of them in all.

Speaking about this woman’s death to Stat News, Lance Price, head of the Antibiotic Resistance Action Center at George Washington University, said “If we’re waiting for some sort of major signal that we need to attack this internationally, we need an aggressive program, both domestically and internationally to attack this problem, here’s one more signal that we need to do that.”

Here’s the thing: As of tomorrow, a new U.S. president will be sworn in. And it’s the right of every incoming administration to set their own policy and priorities. We know, for example, that they want to dismantle the Affordable Care Act. However, we don’t yet know their attitude towards the problem of antibiotic resistance in general and Obama’s National Action Plan to combat it, in particular. We do know that the incoming administration has yet to appoint just 3 cabinet members, and the presidential science advisor — head of the group that developed the National Action Plan — is one of them.

Obama’s science and technology teams were filled with our best and brightest, just one reason why that community saw him as “setting the modern standard” when it came to science. Under him it was as good as it gets. And so for that reason and because it’s President Barack Obama’s final day in office he gets the last word:

“We take antibiotics for granted for a lot of illnesses that can be deadly or debilitating and we’re extraordinarily fortunate to have been living in a period where our antibiotics worked … [Antibiotic resistance] is something we have to take seriously now and invest in now. If we do, then I’m confident we’re going to be able to deal w this effectively. If we don’t, if we put this off, there’s going to be a major public health problem and it’ll be a lot harder to solve.”

 

The Political Page: Will President-Elect Trump Appoint a Science Advisor?

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Last night, in President Obama’s moving farewell address, he said that “science and reason matter,” and using climate change as an example he outlined what happens when you operate without them: “… without bolder action, our children won’t have time to debate the existence of climate change. They’ll be busy dealing with its effects: more environmental disasters, more economic disruptions, waves of climate refugees seeking sanctuary.”

Climate change wasn’t the only science-related action that Obama took during his tenure. Less noticed was his unprecedented work on antibiotic resistance. Calling it “one of the most pressing public health issues facing the world today,” he developed a National Action Plan to Combat Antibiotic-Resistant Bacteria. To carry it out he proposed almost doubling the Department of Health and Human Services budget in FY 2016 to an unprecedented $1.2 billion.

Obama’s action on antibiotic resistance was driven by the President’s Council of Advisors on Science and Technology (PCAST), composed of, during Obama’s tenure, the nation’s best and brightest. For example, the co-chairs of PCAST are the president’s Science Advisor, John Holdren, PhD, who taught at Harvard prior to his appointment; and Eric Lander, PhD, of MIT and Harvard.

When Obama rolled out his National Action Plan on antibiotic resistance in 2015, Lander commented:

 

There is no permanent victory against microbes. If you use antibiotics, whether in human health care or in agriculture, you will over time see resistance. If we fail, if we fall behind in our stewardship, in our creation [of new antibiotics or equivalent therapies], or if we fail to surveil to understand what’s going on, it’s a very real risk to see a resurgence of what life looked like a century ago when we had bugs we could not treat. It’s a terrifying prospect. Now … it doesn’t help to do scare tactics around these things but it’s just plain scary.

 

But we have a problem: As of today, there are still three positions left unfilled in the incoming Administration and Science Advisor is one of them. And thus the question, where will we be without a Science Advisor and PCAST?

The online journal Science reports that more than two dozen U.S. scientific organizations have written the President-elect urging him to act quickly. They worry that a long delay on key appointments could mean science will take a back seat in policy deliberations by the new administration.

The reality is that superbugs are getting stronger, defeating our last resort antibiotics. More federal support is needed to develop new drugs and to carry out evidence-based programs that work in fighting antibiotic resistance — that’s the argument made in this informative year-end essay in Medscape News.

We either confront that reality — with a Science Advisor’s guiding hand — or the consequence will be, as the President warned the nation last night: “ … as my mother used to tell me, reality has a way of catching up with you.”

 

 

 

 

 

Butch Cassidy’s Question

Butch to Sundance: "Who are those guys?"

Butch to Sundance: “Who are those guys?”

In the 1969 Western classic Butch Cassidy and the Sundance Kid, our two outlaws and their Hole in the Wall Gang rob a Union Pacific train on both its eastward and westward runs, thinking that the second robbery would be unexpected and likely reap even more money than the first.

Problem was, the second robbery wasn’t so unexpected: Union Pacific, tired of being robbed, hired a six man Superposse to follow the train. It included renowned Indian tracker Lord Baltimore and relentless lawman Joe Lefors, who tore after Butch and Sundance in hot pursuit, night and day, without pause, “like a machine.” After using every trick in the book to elude the Superposse, and failing to do so, an exhausted Butch peers out from behind mountain rocks at the advancing trackers below and says to Sundance, “Who are those guys?”, a refrain repeated throughout the chase.

Misjudging an opponent is something the medical community is currently reckoning with when it comes to microbes and their increasing resistance to the antibiotics we use on them. Exactly, Who are those guys? — i.e. microbes — is a central question addressed by Brad Spellberg, MD, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, in his book Rising Plague: The global threat from deadly bacteria and our dwindling arsenal to fight them. Like Butch & Sundance’s Superposse, Spellberg and other leaders in the field of infectious disease have learned that bacteria and Superbacteria are not what we thought they were either. In essence, we underestimate them, too.

For example, Spellberg points out in his book that:

1. Microbes have existed for a thousand times longer than our species, outnumber us by a factor of 1022, outweigh us by a factor of 108, and represent 60 percent of the mass of life on the planet.

2. They reproduce “almost impossibly quickly.” E. coli bacterium, for instance, can create 69 billion progeny in just twelve hours of growth. “Now that’s an enemy for you,” says Spellberg. “Kill one and as many as 69 billion more can pop up within twelve hours.”

3. About 1.5 million of the 69 billion offspring can have mutations that enhance their ability to survive in hostile environments, such as the presence of antibiotics that would otherwise be lethal to the bacteria.

4. This “astounding replication and mutation rate,” i.e. the evolution in bacteria of resistance to antibiotics, is the method by which bacteria create new weapons and defense mechanisms within generations.

Here’s the neat part: the video below, developed at Harvard Medical School, allows us to watch the evolution of Superbacteria in action. It shows billions of bacteria breaking through ever stronger barriers of antibiotics inside a really big petri dish, or mega-plate. As the bacteria move towards the middle of the plate from both ends they are eating, growing, and multiplying. Along the way, they’re also mutating and evolving. As the bacteria move inwards, mutants evolve that are resistant to increasing doses of antibiotics that would otherwise — but for the mutations — kill the bugs.

Crucially, the evolution of bugs on the mega-plate mirrors real life, says Harvard’s Roy Kishony in an interview with STAT: “Every single antibiotic that we have introduced medically so far, the bacteria found ways to evade it … every single one.”

In other words, just like the Superposse chasing Butch & Sundance, nothing – no amount or kind of antibiotic – can stop the advance of the Superbacteria either.

Check it out:

In Praise of Vaccines: They also help fight the spread of antibiotic resistance

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We knew vaccines were good stuff. For example, according to a 2014 editorial in Science, “Vaccines are one of the safest and most cost-effective medical interventions in history. By immunizing infants, children, and teenagers, vaccines protect the entire community.”

And then just a few weeks ago we learned of yet another benefit. According to the World Health Organization vaccines can help fight the spread of antibiotic resistance, which the United Nations just called “the greatest and most urgent global risk.”

For example, as we enter the height of cold and flu season — December through March — the WHO says that vaccines not only protect us from those ills, they can also confer an added health benefit: “Vaccines against viruses, such as the flu, also have a role to play, because people often take antibiotics unnecessarily when they have symptoms such as fever that can be caused by a virus.”

The unnecessary use of antibiotics – i.e. overuse (e.g. in our food animals) and misuse (e.g. they don’t work on colds) – drives the resistance problem. Therefore, according to the WHO, “Vaccinating humans and animals is a very effective way to stop them from getting infected and thereby preventing the need for antibiotics.”

We tend to overlook the massive dosing of our food animals with antibiotics. One reason we give healthy animals antibiotics is to prevent them from getting sick — but you should no more give a healthy animal an antibiotic than you should a healthy person. As we noted this past April, the problem is vast:

“Over 8 tons of antibiotics are fed every year to the more than 8 billion food animals in the US alone, resulting in a ‘massive selection’ for resistant bacteria, writes Stuart Levy, MD, in his book The Antibiotic Paradox: How the misuse of antibiotics destroys their curative powers. With the upshot, Levy says, that resistant bacteria will develop in an animal within 2 – 3 days; from there it will spread to the other animals, then to the farm workers and their families, continuing outward to nearby communities, states, and even globally.”

Finally, the WHO also recommends expanding the use of existing vaccines in people. For example, they say that “if every child in the world received a vaccine to protect them from infection with Streptococcus pneumoniae bacteria (which can cause pneumonia, meningitis and middle ear infections), this would prevent an estimated 11 million days of antibiotic use each year.”

As we begin to tap in to this potential for vaccines — which includes the development of new ones — perhaps it will also help prevent one of the more dire scenarios that worries leading health authorities: that by the year 2050 antibiotic resistant disease will kill more people each  year than cancer.

Noam Chomsky Weighs in on Antibiotic Resistance: “We May Be Destroying Ourselves in That Way Too”

“Judged in terms of the power, range, novelty and influence of his thought, Noam Chomsky is arguably the most important intellectual alive today,” wrote the New York Times back in 1979. Since then, the polymath Professor Emeritus of Linguistics at MIT went on to prove the paper correct as he became the eighth most cited source in the history of the humanities: Marx was first, then Lenin, Shakespeare, Aristotle, the Bible, Plato, Freud, Chomsky, Hegel and Cicero. “What it means is that he is very widely read across disciplines and that his work is used by researchers across disciplines,” said the Humanities Librarian who checked the numbers.

 

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Many of us have been waiting for him to weigh in on antibiotic resistance because, for example, a heads-of-state meeting of the United Nations last month called it “the greatest and most urgent global risk.” And finally, just this month, from his office at MIT, he addressed it in an interview whose theme can be summed up in this question and answer:

Interviewer: If we don’t fix our problems, will the 21st Century be the last century of humanity?

Chomsky: Probably not of humanity but of organized human life on Earth.

In other words, says Chomsky, the question we face is: “Are we going to survive?” which he calls “The most serious problem that has ever arisen in human history.”

Two main drivers of our existential crisis are the ones we would suspect: “environmental catastrophe” and “the threat of nuclear war today [which] is greater than it was during the Cold War,” he says.

But after he made his case on those counts came the following surprise:

“I mentioned two [problems] which are enormous but there’s more than that. Another major problem is the threat of pandemics — diseases that can’t be controlled. That’s already happening, and it’s happening for important reasons. One reason that we haven’t mentioned … is industrial meat production. Industrial meat production is a huge contributor to global warming. It’s an enormous producer of carbon dioxide and methane.”

Then focusing on the resistance issue, he continued:

But it also has another feature. Corporations pour antibiotics into these systems. Animals are crowded together in horrible conditions and to prevent disease and to maintain growth there’s an extensive use of antibiotics. An enormous part of antibiotic production is for this. Use of antibiotics leads to mutations which make bacteria antibiotic resistant. We’re now … the rate of antibiotic resistance is growing faster than the techniques for dealing with them. So we may be destroying ourselves in that way too.

 

There’s something else about these issues that concerns Chomsky, as well: “If you watch something like the current electoral campaign … [you’ll] notice a very curious fact: None of this is being discussed.” “What strange form of intelligence,” he asks, “is it that enables great accomplishment to be achieved but is unable to ask the question, will we survive and how can we ensure our survival?

 

The leading causes of death are heart disease and cancer — Right?

As the headline news across the U.S. tracks the death toll of Hurricane Matthew — 108, as of this writing — the headline that you won’t see today concerns the growing body of evidence suggesting that the leading cause of death in the country is neither heart disease nor cancer: It’s death due to infection.

That’s the conclusion reached by a 2014 University of Michigan study, “Death Certificates Underestimate Infections as Proximal Causes of Death in the U.S.” Don’t be misled by the conservative title because the researchers contend something extraordinary: that if the count was performed by looking at patients’ Medicare billing records, which show what they were being treated for, rather than death certificates, which they say are unreliable, you would end up with the following tally (‘Malignancy’ means cancer):

 

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It’s the use of the different data set — Medicare insurance records — that gets you the significantly different result in column 3. Where infection not only comes out as the leading cause of death in the country, but does so by a full 11 percentage points over heart disease, which comes in second.

The Michigan study by no means stands alone in saying that death certificates are not a reliable indicator of what is actually killing us.

For example, U.S. Centers for Disease Control research published in 2010 found that in a survey of 521 New York City doctors: (1) 48.6% of them had knowingly reported an inaccurate cause of death on a death certificate, and (2) only 33% of them believed the current cause-of-death reporting system in New York City is accurate.

Recent eye-opening investigations by The Los Angeles Times and Reuters offer corroborating evidence.

The Reuters report, “The Uncounted: The deadly epidemic America is ignoring,” found that tens of thousands of “superbug” deaths in the U.S. are going uncounted because the death certificate omits any mention of the infection. Or because, even when it does, neither state health authorities nor the federal Centers for Disease Control bother to keep track of the numbers

The reasons for the huge undercount are indeed troubling. Reuters: “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.” And so hospitals will even hide the true numbers of infections.

Here’s an excellent summary of their work:

 

Just a few days ago, the Los Angeles Times published “No one knows how many patients are dying from superbug infections in California hospitals.” In a conclusion mirroring that of Reuters, the Times found that because “California does not track deaths from hospital-acquired infections [and because] California does not require hospitals to report when patients are sickened by [some] superbug[s],” that, “an epidemic of hospital-acquired infections is going unreported.”

“Science begins with counting,” writes physician-researcher Sid Mukherjee MD, in his 2011 Pulitzer prize-winning book, “The Emperor of all Maladies: A Biography of Cancer.” “To understand a phenomenon,” says Mukherjee, “a scientist must first describe it; to describe it objectively, he must first measure it. If cancer medicine was to be transformed into a rigorous science, then cancer would need to be counted somehow—measured in some reliable, reproducible way.”

To borrow from Dr. Mukherjee, then: “If infectious disease medicine is to be transformed into a rigorous science, then infectious disease would need to be counted somehow—measured in some reliable, reproducible way.” This matters, because as the emerging evidence suggests, infections may well be the leading cause of death in the U.S., and by extension, throughout the world.

Off the Record: Only “A Tiny Fraction of the Actual Toll” of Superbug Deaths are being Reported, says Reuters

Tens of thousands of “superbug” deaths in the U.S. are going uncounted because the death certificate omits any mention of the infection. Or because, even when it does, neither state health authorities nor the federal Centers for Disease Control bother to keep track of the numbers, concludes an eye-opening investigative report from Reuters, “The Uncounted: The deadly epidemic America is ignoring.”

On the state level, the discrepancy between the number of superbug deaths reported and the true numbers is staggering. For example, state health records for the period 2003 – 2014 reveal 3,300 deaths caused by superbugs. But the Reuters analysis — working with the CDC’s National Center for Health Statistics’ Division of Vital Statistics to search text descriptions on death certificates to identify relevant deaths — found 180,000 such deaths. (The state-by-state comparison can be seen in the “Through the cracks” graphic, below.)

 

Kelly and Ryan Breaux lost their 4-year old daughter Emma, to MRSA. The death certificate blamed the flu.

Kelly and Ryan Breaux lost their 4-year old daughter Emma, to MRSA. The death certificate blamed the flu.

 

On the federal level, the CDC estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and that an additional 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use. But even the CDC concede they don’t have the numbers right.

For example, Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, said the agency, pressured by Congress and the media to produce “the big number,” settled on “an impressionist painting rather than something that is much more technical.” Describing the estimates to Reuters, CDC officials used words like “jerry-rig,” “ballpark figure” and “a searchlight in the dark attempt.” Thus, say Reuters, you’re “introducing so much statistical uncertainty into the numbers as to render them useless for the purposes of fighting a persistent public health crisis.” And so “in the absence of a unified national surveillance system, the onus of monitoring drug-resistant infections and related deaths falls on the states” … where we have a documented discrepancy of 3,300 reported vs. 180,000 actual, deaths.

The reasons for the huge undercount aren’t pretty. For instance, according to Reuters, “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.” And so hospitals will even hide the true numbers of infections:

 

At a conference last year, hospital infection-control specialists told CDC officials that medical staff and internal review boards sometimes blocked them from reporting infections as required by state law or by the Centers for Medicare & Medicaid Services (CMS), which reduces payments to hospitals for preventable infections and high infection rates.

The specialists said medical staff sometimes were discouraged from testing patients with clear signs of infection – one of several tactics they said staff used to get around reporting rules.

 

Getting the numbers right matters because you need to know when, where, and how many deaths are occurring and who is most at risk. That determines where money and manpower — e.g., for basic research, drug development, and public health campaigns — are needed the most. The way to do it, say industry experts, is to copy the HIV/AIDS model.

Within three years of the first AIDS cases in 1981, most state health departments required hospitals and physicians to report and name each new diagnosis. Surveillance systems soon evolved to capture each AIDS-related death. Health officials used that information to direct resources to the hardest-hit areas and study how the disease was spreading. As a result, activism swelled, helping to attract millions of dollars for public education campaigns and drug development. The number of infections then peaked at about 78,000 in 1993 and rapidly fell thereafter. In 2013, the latest year for which numbers are available, about 13,000 people died with AIDS. So far, drug-resistant infections haven’t prompted anything like that sort of broad mobilization.

Until we adopt such a model we know that we will continue to have avoidable tragedy’s like that of 4-year old Emma Grace Breau. Reuters reports:

 

She contracted an infection shortly after her birth at the Lafayette General Medical Center in Lafayette, Louisiana, in 2005. Emma had a MRSA infection. She survived, but with permanent damage to her heart, lungs and one leg. Three and a half years later, Emma was in Florida to have her leg repaired when she came down with swine flu. It was too much for her heart and lungs. After a six-week battle, she died at Miami Children’s Hospital just shy of her fourth birthday. Her death certificate blamed flu-related pneumonia. Including MRSA as a cause of death ‘was not considered,’ said Dr Sharon Skaletzky, who was at Miami Children’s at the time and signed the death certificate … Her medical expenses alone eventually exceeded $4 million for repeated hospitalizations due to complications from her MRSA infection. The family sold their home, truck and other possessions to stay afloat while she underwent multiple operations.

 

 

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Taylor’s Story

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On Tuesday, the US Centers for Disease Control declared sepsis to be a “medical emergency.” Also called septic shock, it occurs when the body creates an overwhelming response to an infection, and chemicals released into the bloodstream (because that’s where the infecting bug is) cause inflammation, tissue damage, organ failure, and oftentimes, death.

The CDC is drawing attention to this issue because 1 – 3 million Americans are diagnosed with sepsis each year, about 25% of whom die, and because — and this is the key — 80% of the cases occur outside of a hospital. And for that very reason people are dying needlessly because the symptoms of sepsis are usually misinterpreted as something familiar and benign: at bedtime we may be thinking the flu but by morning we have runaway sepsis — and no time to lose.

Taylor Church’s story illustrates the problem. Taylor was then a healthy twenty-one year old, the mother of an 18 month old boy, Aiden, and excited about starting nursing school the following week. She had been feeling a bit run down — it was probably just the flu — so she had stayed home for a few days. Suddenly, though, things went downhill. She went to the hospital and then, surprisingly, was whisked into surgery. She had no idea what she was facing. The following video is Taylor, soon after her surgery, telling you what happened (please watch):

 

 

When Taylor went into surgery she didn’t know she was facing amputation: “I didn’t know that they were taking my hands and feet. I woke up like this.”

Like most sepsis patients, Taylor was at home when it began and chalked it up to the flu. And by the time she sought medical care it was too late.

Taylor’s story is also unique. Anyone can contract sepsis but almost ¾ of sepsis patients are vulnerable to begin with. For example, they are over 65, and are living with some chronic conditions like diabetes and, especially, pneumonia, which is reported in 35% of sepsis cases.

The CDC tells us that the bugs usually associated with the initial infection are Staphylococcus, Escherichia coli (E. coli), and some types of Streptococcus. Interestingly, in 1/3 of patients no pathogen is ever identified. This suggests that the burden of disease cause caused by these pathogens is much greater than is being reported.

The CDC issued the medical emergency so we will “think sepsis” when we see one of the following six key signs of it:

Shivering, fever, or feeling very cold

Extreme pain or discomfort

Clammy or sweaty skin

Confusion or disorientation

Shortness of breath

A high heart rate

These are the warning signs, say the CDC, that you’re in the midst of a medical emergency, and therefore need to “act fast.”

Four years ago when these signs were little known, Taylor Church, understandably, thought she had the flu. And so now, post-amputation, Taylor says, “I’ll make the best of this. I will make the best of this.”

Taylor Church puts her story out there for one reason: she hopes that someday you won’t find yourself having to find the strength and courage to utter those very same words.

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