Map of life expectancy at birth from Global Education Project.

Thursday, April 07, 2011

I'm not going to talk about politics,

I'm not going to talk about politics, I'm not going to talk about politics. ...

Plenty of people are on the case, and anyway it's just gone beyond comment. Are we really talking seriously about repealing Medicare and Medicaid?

So, I'll bet you didn't know that today is World Health Day. Okay, that's kind of a made up thing, like National Pickle Week, but the WHO does it every year and this year, they've got an important theme, which is preserving the effectiveness of antibiotics.

You've probably heard about MRSA -- staphylococcus that is resistant to penicillin-like drugs. That problem concerns the so-called gram positive bacteria (named for a guy who invented a way of staining bacteria for viewing under a microscope). But there's another resistance problem affecting the gram-negative bacteria, called Klebsiella pneumoniae carbapenemases (KPC), which are enzymes produced by enterobacteria that confer resistance to all the beta lactam antibiotics, including penicillin-like drugs. This is a huge worry because gram negative bacteria exchange genes very readily, and because these organisms are often resistant to other antibiotics as well. Basically, we may soon be seeing a whole lot of untreatable infections.

WHO Director Margaret Chan isn't pulling any punches:

In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated. The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions, like cancer treatments, sophisticated surgical operations, and organ transplantations. With hospitals now the hotbeds for highly-resistant pathogens, such procedures become hazardous.

The actions we can, and must take are actually not all that hard, but they are urgent. Number one, most important, easiest to do in reality and apparently hardest to do politically, is top feeding antibiotics to livestock! Just outlaw it. Boom. Done. Of course this means that livestock will have to be raised more humanely, under less crowded and more hygienic conditions. It will take away our God-given right to fatten cattle and pigs while they wallow in their own feces, making the country a totalitarian dungeon. So be it.

Second, physicians must stop prescribing antibiotics inappropriately. This apparently will require some sort of intervention by payers, because they seem incapable of doing it on their own.

Third, everybody must get the message: don't ask for antibiotics, let your doctor decide if you really need them. If you do really need them, and you do start taking them, finish the entire course even though you already feel better. That is your duty to humanity.

Fourth, we need to improve infection control measures in hospitals and other health care settings. Equipment and facilities need to be designed so they are more readily cleanable. Microbes can obviously hide in every crack and crevice, so there mustn't be any. We have to get cleaner, make fewer holes in people, and enforce stricter policies on hospital visitation. Sorry.

Fifth, we can adopt better hygiene habits in our own lives. Keep washing those hands. But don't use those antibacterial cleaning products, the bugs just get resistant to them. Keep a clean house. Bleach and alcohol do disinfect and can't produce resistance, but they usually aren't really necessary.

Stay home if you're sick.

Do your part.


robin andrea said...

We have been spending quite a bit of time in hospitals and nursing homes lately, while Roger's mom recovers from pneumonia, which she picked up from one of her dining companions at the assisted living facility where we warehouse old people. The hospital is a surprisingly unclean place. We hated being there and used their creepy antiseptic sprays and wipes every chance we could get. I wanted to dip myself in bleach and alcohol when I got home, but settled for washing my hands with the hottest water I could stand, and drinking a glass of wine.

roger said...

humankind must take concerted, cooperative, rational steps to avoid disaster?

as tactfully as possible i say, hahahahahahahaha.

looked at from a different perspective, the germs might help us reduce our population.

Anonymous said...

WHO called for halting antibiotics > livestock in ..1977! (for the same reasons Chan is giving today.)

IN CH, hormones and antibiotics to stimulate growth are forbidden. Other antibiotic use is curtailed, reported, studied, etc. I’m not clear on the precise rules and a little googling shows me that officially it is much of a muddle (endless questions from ‘parliament’ with somewhat strange answers), this is a topic for a top expert in that field, which I am not.

One kilo (2.2 pounds) of prime beef costs 111 dollars.

Beef imports, about 20% of total consumption, only come from Uruguay, Ireland (prime sirloin) and France - all imports have to be certified as conforming to Swiss legislation and I suppose not many can be bothered with it all.

Some lamb is imported from Ireland, France, New Zealand and Australia. Lamb chops or rack of lamb go from 62 dollars a kilo to about 100 dollars depending on provenance, quality, etc.

For comparison purposes, I buy ‘farm chicken’ (whole) - no antibiotics at all, grain fed, free range, and delicious for 24 dollars a kilo.

Ordinary apples, carrots and cabbage are in the range of 1 to 6 dollars per kg. Supermarket has a bag to fill with ‘low price, ordinary vege and fruit’ for 10 dollars, in which the canny can cram 3 kgs. or more, provided you stick leek coming out of the top, which is allowed, the bag need not be closed.

Here we also eat ostrich, bison, goat, deer, elk, horse, and rabbit (mostly locally produced, though we get rabbit from Poland, goat from France, for ex.) and various game e.g. boar, pheasant. This diversity seems to me to be a good thing - small(er) producers can go for what suits their inclination, capacities, terrain, climate, etc.

I am not a big meat eater, I was just pointing out that producing veal- beef, pork and lamb with *some* (and only some, but it includes surveillance) limitations as to antibiotic use multiplies the price by 4 at least. And that is it is perfectly possible to do it, it leads to change in consumer habits, diversification, and the partial giving up of industrial agri.