“Stay away from hospitals if you don’t want to be sick”

Charest 7The Honourable Jean Charest, the former Deputy Prime Minister of Canada and former Premier of Quebec, was recently introduced (below) as the newest member of Ondine Biomedical’s board of directors (along with former Mexican President Vicente Fox).

Addressing the Vancouver media, Mr. Charest commented on how this new role complements his life’s work: “There’s one ingredient of public life that you always seek forever after, and that’s … to do something meaningful [that] makes life better for other people and that is exactly what Ondine … is doing now…. I accepted to join the board at this point … because I felt that I could make a contribution to this effort and be part of it and I’m very, very proud.”

Then Mr. Charest shared a story about how he first came across the issue of hospital infections. As a young man, when he began dating his now-wife Michèle, he met her father, a general surgeon, in Sherbrooke, Quebec.

As Jean tells it: “I remember him saying something to me that quite surprised me: ‘Jean stay away from hospitals if you don’t want to be sick!’ Which is sort of counterintuitive but when you think of it, you learn about the tragedy of the infections in our world and in our healthcare system…. You know why he said that…. This is really one of the major sources of grief and of death in the world.”

Indeed, as part of the longest investigation in the then 40-year history of CBC’s The Fifth Estate, Dr. Dick Zoutman, Chief of Staff at Quinte Health Care in Belleville, Ontario, said that “Hospital infections could be the 4th leading cause of death [in Canada] … and between cancer, heart disease, and stroke, it’s coming up as number 4.”

Just how many such deaths are there? Dr. Zoutman puts it at 8,000 to 12,000 every year, that are “directly attributable” to hospital infection. Which are part and parcel of the 220,000 people who become infected while receiving hospital care – again, every year.

Brad Spellberg, MD, Chief Medical Officer of the Los Angeles County-University of Southern California Medical Center, explains why hospitals are such dangerous places:

I do think that people need to understand that the hospital is an inherently dangerous place and it’s not because hospitals are dirty or doctors are lazy or anything like that. Think about it this way. You’re taking the sickest people in society, crowding them into one building, tearing new holes in their bodies that they didn’t use to have by placing plastic catheters in their bloodstream, their bladder, putting tubes into their lungs that can breathe for them, and we’re using very large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic resistant bacteria.

As Premier of Quebec during a C. difficile-driven hospital infection crisis that “affected every single institution throughout the province of Quebec,” Mr. Charest told the Vancouver audience:

But what I remember from that episode … is all of this could have been avoided…. There are things that happen in life that you cannot avoid…. But there are things that we can do to avoid diseases, infections – if we put our mind to it. If we are conscious … of what the danger is. And if we just go out there and act upon it

For example, by joining a company whose mission statement is to do just that.

Mr. Charest’s remarks begin at the 9 minute mark:

Former Mexican President Vicente Fox Announces His Support for Ondine

In a video address (below) directed at Spanish speaking countries around the world, Vicente Fox, president of Mexico from 2000 to 2006, announced his participation with Ondine Biomedical to help fight the global burden of infectious disease.

Mr. Fox’s special concern for this area of the world is well-supported by the science. For example, a global study (12,539 patient records examined across 66 countries) published this month in The Lancet, compared the burden and effect of surgical site infections between low, middle, and high-income countries. It found:

  • Surgical site infections affect 12% of patients worldwide, but in developing countries that number skyrockets to 40% of the patients.
  • Worldwide, 22% of these infections were resistant to antibiotics; but again, the numbers escalate in developing countries where bugs were drug-resistant 33% of the time.
  • Staphlococcus aureus was not only the most ubiquitous pathogen, it dwarfed the presence of any other single organism by a factor of almost 10.

Crucially, the study says these higher rates of infection and resistance to drug therapy have real world consequences for the patients: Their rate of death was almost two and a half times as high; their hospital stay was three times longer; and they were more likely to require further medical procedures or to have another healthcare-associated infection.

Last October, the Chief Medical Officer of Britain, Sally Davies, MD, told us where this rising tide of drug-resistant infectious disease is taking us: “If antibiotics lose their effectiveness it will spell the end of modern medicine. Without the drugs used to fight infections, common medical interventions such as cesarean sections, cancer treatments and hip replacements will become incredibly risky and transplant medicine would be a thing of the past.”

There’s a saying that goes ‘The future is already here – it’s just not very evenly distributed.’ That’s exactly what the science is saying about the burden of drug-resistant infectious disease – that it’s the low and middle-income countries who are bearing the brunt of it.

Mr. Fox understands this. Hence his involvement in the struggle, in the words of Dr. Sally Davies, to help save modern medicine.

Simple Solutions to Complex Infections

MRSA 2

Our bodies are home to trillions of microbes – bacterial, fungal, and viral – and our surroundings are filled with billions of trillions more.  Our lives are dependent on these microbes, but also can be seriously harmed by them when they multiply out of control, invade areas of our bodies they are not meant to be in, or our immune systems are compromised.

In those instances, intervention is often necessary to help our bodies bring the “invaders” back under control. Those interventions typically include antibiotics, antivirals, and antifungals, though even more extreme measures such as amputation are sometimes necessary. For a number of decades this worked well and deaths from infections plummeted. Then, “the bugs started getting used to the drugs.” They developed resistance not just to one drug, but increasingly have become multi-drug resistant. According to the CDC, 40% of healthcare associated infections are now multi-drug resistant, making it increasingly more challenging to treat and prevent serious infections.

Multi-drug resistance is now considered one of the top 5 human health crises. The 2016 O’Neill report in the UK projects that by 2050, 10 million people (1 person every 3 seconds) will die of infections annually. That’s more than Cancer, Diabetes, and Cholera combined.

 At Ondine, that’s not a future we’re willing to accept.

The world needs a new approach and new solutions. For the past 17 years, the dedicated team at Ondine have been developing and perfecting exactly that: a revolutionary non-antibiotic technology that is capable of treating and preventing multi-drug resistant infections.

Imagine …

  • a technology that destroys bacteria, viruses, fungi and their virulence factors in minutes

  • immediate antimicrobial impact, no adverse side effects

  • no need to test for what is causing or may cause the infection, saving the critical time and cost for diagnosis

  • being able to use the technology without worrying about its use triggering resistance

Ondine’s patented photodisinfection platform technology is designed and has been proven to do exactly this. Ondine is developing applications with this breakthrough technology to prevent and treat a wide variety of acute and chronic conditions, such as:

  • Surgical site infections
  • Catheter and ventilator associated infections
  • Dental applications
  • Wounds and burns
  • Chronic sinusitis and otitis externa
  • Transmission of infections from mother to child during birth
  • Veterinary applications

Simple Solutions to Complex Infections

Antibiotic Blindspot: Don’t Forget About the Dentist

At the dentist

 

Clostridium difficile infection, the most common cause of hospital-acquired diarrhea, is serious business. There were nearly half a million C difficile infections in the US in 2011 – the last year numbers were available – and 29,000 patients died within a month of diagnosis. The two most important risk factors for developing C. diff infection are antibiotic exposure and age > 65 years old.

We tend to equate antibiotic exposure with the prescription from our doctor. But a new study reported in Medscape Medical News says that “Antibiotics prescribed by dentists could be contributing to cases of potentially deadly C. diff.”

Centers for Disease Control researchers looked at 1626 cases of C diff across Minnesota and found that 136 patients (15%) had been prescribed an antibiotic by a dentist in the prior 12 weeks. Moreover, just over a third (34%) of those prescribed antibiotics by a dentist had no mention of the dental antibiotics in their medical chart.

Lead researcher Stacy Holzbauer, DVM, MPH, an epidemiology field officer with the CDC, says we’re overlooking antibiotics that we get from the dentist, and identifies the factors contributing to this blindspot:

I think the biggest issue is that dentists have been left out of the conversation, because no one really recognized how large the dental prescribing was in the greater scheme of things, especially when it comes to outpatient prescribing ….

Physicians are not always asking about dental antibiotics specifically when they take a medical history, dentists are not necessarily focused on the possible harms of antibiotics and are not warning patients of the potential risks or reminding them to report the antibiotic use to their primary care physicians, and patients are not making sure all their providers know about antibiotics from different sources.

 

But the problem is especially acute for the elderly. Dr. Holzbauer explains:

People who were prescribed antibiotics for dental procedures tended to be older than those prescribed antibiotics for other indications (57 years old vs 45 years)….

From 1996 to 2013, physician prescribing declined by 18.2%. However, at the same time, dental prescribing increased by 62.2%…. The rate of prescribing increased most for dental patients aged 60 years or older….

[The elderly are] more likely to receive clindamycin, an antibiotic that causes diarrhea and has been more closely linked to C difficile infection, compared with other antibiotics (50% vs 10%)….

[S]ometimes patients come in to dentists saying their surgeon told them years ago when they got their hip replacement that they would need to take antibiotics before a dental cleaning.

 

Holzbauer notes that in 2015, the American Dental Association issued a practice guideline that said no antibiotic prophylaxis is needed for people with joint replacements. Yet she thinks “that change may not have reached all dentists.”

Observing that doctors have been warned about the inappropriate use of antibiotics “for at least 20 years, and they’re still struggling,” Holzbauer concludes: “I think dentists are at the place primary care physicians were 20 years ago.”

 

Watch: The Last Bugs Standing

Screenshot (12)

 

Calling antibiotics one of the “great disruptors of the modern area” that have the effect of “shock and awe weapons” on our bodies, science writer Ed Yong does something in this video (below) that no one else has: he shows us the effect these “weapons” are having on us. His demonstration is so extraordinary we’d be forgiven for overlooking its true import, hence this brief intro.

At about the 2:50 mark Yong introduces us to antibiotic resistance, the idea that our misuse of antibiotics is breeding a highly resistant population of superbugs, “the hardiest mutants of all.” Nothing new there. But get ready, as Yong shows us some novel work done at the Harvard Medical School. They developed what they call a MEGA-Plate (Microbial Evolution Growth Area-Plate) (above), which is basically a giant petri dish that resembles a football field. We watch E. coli bacteria move across the plate from both ends, converging towards the middle, as they develop ever-stronger resistance to the increasing concentrations of antibiotics. The “end zone,” in the middle of the plate, is an area that has 1,000 times the concentration of antibiotics necessary to kill them – but they don’t die, hence the term “superbug.” Okay, that’s pretty cool because we’re actually watching evolution happen.

But here’s the thing. The point isn’t that this is happening in some giant petri dish at Harvard Med. The point is that this is happening to us, in and on our bodies. It’s happening in hospitals, in our community, across the country; indeed, across the world. It’s also why, for example, infectious disease specialist Brad Spellberg, MD, named his book The Rising Plague; emphasis on “Rising.”

The screenshot, above, is the key point in the video. That’s Yong’s hand literally mapping this “rising plague” of pathogens that culminates with, in his words, “the last bugs standing”: the very ones that make us so sick because  we have so much trouble treating them. Again, the point is that he’s showing us what’s happening outside the lab, across the globe.

The remainder of the video weaves together various important strands of the resistance issue; for example, antibiotics in animal feed, antibacterial chemicals in soaps and gels, and the misuse of antibiotics to treat viral-based illness like the cold and the flu where, Yong says, “using an antibiotic on them would be like using a hammer to fix a leaky faucet.” All told, you’d be hard-pressed to find more important information delivered in such short a time, anywhere in the public sphere.

 

Mayo Clinic: Most Drugs are Safe & Effective Well After Their Expiration Dates

Expiration

 

In a study of 122 different medications that were about to expire, the FDA found that over 90% of them met the requirements for an extension – on average, for a period of over five years. In fact, in another study, that 90% rate held true for drugs that expired up to 40 years earlier.

These findings are published in the Mayo Clinic commentary Extending Shelf Life Just Makes Sense, which points out that expiration dates are misleading for one simple reason: FDA rules require drug manufacturers to test their products for safety & effectiveness for only two to three years after they’re made available – and so no further testing is ever done.

The result is colossal waste which is passed on to the consumer by way of high drug prices (so notice who benefits). Billions of dollars of prescription drugs are trashed every year that sit in federal & state government facilities, hospitals, and pharmacies. Tufts University Medical Center in Boston, for example, throws out some $200,000 worth of prescription medicines every year. There’s about 4,000 hospitals in the US so the total annual waste for them alone is around $800 million.

This practice also results in drug shortages. In the 122-medication study mentioned above, 15 of the drugs were designated by the FDA as “top performers.” And of those 15, 12 were in short supply since 2013. Where this will especially matter is if the short supply meds are needed for a national emergency such as a pandemic.

Accordingly, we should support the Mayo Clinic proposal of requiring drug companies to keep testing their products or have an independent agency do it and, in either case, immediately grant shelf-life extension to drugs that the FDA has monitored for years and have found to be stable.

In depth reporting can be found at ProPublica and NPR from which the following interview is taken:

 

The R-word: What happens when the clock winds down on new drug development?

Why are some top-notch scientists – “bioprospectors” – leaving the lab and scouring such places as the ocean floor, the Amazon rainforest and the caves of Western Canada? “I would like to look at bacteria that live in a very rare and extreme habitat and would like to see whether these types of bacteria could be our new drugs,” says the scientist in the video below.

She explains: “We now have a crisis, an antibiotic resistance crisis [on] our hands. Bacteria basically became resistant or became harder to kill.… If you don’t have new drugs people can just have these unnecessary death[s] from infection that used to be treatable before.”

Her remarks are timely. Last week the World Health Organization issued a report saying there are not enough new antibiotics in the pipeline and that most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and thus are only short-term solutions.

But there’s another problem. It takes decades of research and up to a billion dollars to create just one new antibiotic. Bioprospecting in such places as the caves of British Columbia is just the beginning of that process.

So what happens if we don’t beat the clock? We ration antibiotics – which has already begun in the UK – and that ain’t gonna be pretty.

 

Working out with millions of your little friends

exercise2

Those exercise mats at your gym everyone uses aren’t quite as innocent as they look. With people pouring sweat into them all day the combination of heat and moisture creates the perfect breeding ground for bad bacteria, viruses, and fungus that give rise to such things as MRSA infections, scaly circular rashes, boils and blisters, and nail fungus.

That’s because “We are walking microbial planets [who] shed huge amounts of skin cells every day from our bodies, as many as 500 million by some estimates,” says infectious disease specialist Brad Spellberg, MD, chief medical officer at the Los Angeles County-University of Southern California Medical Center. And so “If someone has a nasty bug and they shed it, you can acquire it when you touch the surface [of the mat].”

Because even a slight cut or abrasion on your skin can give these microbes a way into your body you want to protect yourself in the following ways:

  • Bring your own mat. Clean it with soap & water or an alcohol-based sanitizer after each use.
  • Shower immediately after exercise. Don’t share items that touch your bare skin.
  • Cover any irritated or open skin – cuts and scrapes – with a bandage. Lay a towel down when you sit on shared surfaces.
  • Wash your workout clothes after each use.

Community Service: Your vaccination protects more than just you

Your vaccination will prevent you from getting sick from the diseases you inoculate against. Less well known is that it will also prevent others from getting sick. An interesting report in the online medical journal STAT tells us that this protection of others happens through something called herd immunity and, separately, by indirectly decreasing the number of those nasty “superbugs” we create, thereby lessening the number of drug-resistant infections they cause.

Herd immunity, also called community immunity, is the idea that if you immunize enough people in a given population, then even those who aren’t vaccinated are less likely to get sick. That’s because they’re less likely to come into contact with someone who is infected – because they’ve been immunized. The following chart nicely illustrates this. Notice that the more people who are immunized the better it works.

 

Herd Imm.

 

Also, if we want to get rid of superbugs then we need to stop doing what creates them – overusing and misusing antibiotics: Nobody wants to die including bugs, so as we needlessly and relentlessly assault them with antibiotics they fight back by evolving mechanisms, “body armor” if you will, that renders these indispensable drugs obsolete.

Fortunately, immunization can help remedy this chronic overuse problem in 3 ways:

First, there are vaccines for bacterial diseases such as pneumococcal infections, bacterial meningitis, or pneumonia. Thus, through immunization that prevents these bacterial infections from arising in the first place, you eliminate the need to use antibiotics.

Second, by preventing influenza and other viral infections through immunization you eliminate the need for antibiotics to treat secondary bacterial infections that often follow virus-caused respiratory illnesses.

Finally, immunization “immunizes” us from our own folly. Antibiotics only work against bacteria, not viruses. Yet we insist on using antibiotics on viral-based flu-like conditions in about 80% of those cases – a harmful, huge, and needless waste of a precious resource. Thus, if we vaccinate against these viral diseases in the first place, there will be no viral infections to (mis)treat with an antibiotic.

 

A 9 ½ -year old girl under clinical guidance stopped her HIV therapy 8 ½ years ago and is doing just fine: Are we onto something or is this just a one-off?

HIV 2

 

 

Very few people can control HIV for more than a few weeks without antiretroviral (ARV) drugs. But a 9 ½ -year-old girl in South Africa has been doing it for over 8 ½ years now, according to a case presentation this week at the International AIDS Society Conference in Paris, as reported in the journal Science.

The girl (her name is being withheld) was born to an HIV-infected mother and was given ARVs starting at 8 weeks old. The treatment was stopped at 40 weeks as part of a clinical trial and today, remarkably, she’s doing just fine. Although there is a caveat – the virus remains in her system but the level is so low it’s invisible with standard tests, detectable only by an ultrasensitive DNA sequencing method.

Researchers believe the key to the girl’s sustained remission was starting her ARV treatment shortly after she become infected – 8 weeks later. The trick, they say, is to strike the right balance between using drugs early to keep the HIV load small, yet large enough for the immune system to see enough HIV to develop a robust memory response for when the virus comes back.

More good news: This same approach has been successful – so far – in an ongoing study at the Pasteur Institute in Paris. They’re following 23 patients who started ARV treatment shortly after becoming infected. The average treatment length was 3 years. And 7 years post-treatment (on average because people entered the study at different times) the virus remains undetected in all 23. One person in the group has gone without treatment for nearly 17 years.

But these are early days for this approach and as a recent Oxford University early-treatment study reminds us, getting it right isn’t easy: the virus remained undetectable in 14% of the people in one cohort (the longer treatment group), and just 4% in the other.

And as Sharon Lewin, director of the Peter Doherty Institute for Infection and Immunity in Melbourne, Australia, observes with respect to the girl in South Africa: “Single-case reports have limited value now. … We know it happens and we need to understand why.”

Nevertheless, Mark Cotton, PhD, one of the South African researchers says, “It’s exciting that we’ve identified the child, as it could provide answers for the future.” But he cautions, “There’s a long way to go.”

 

 

 

 

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