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Book Reviews
The New Killer Diseases
by Elinor Levy and Mark Fischetti
The authors argue that humans face a bio war with microbes that only grows more intense. New diseases keep appearing and old diseases mutate faster than we can find fixes. Flesh eating bacteria now kills 2,000 each year in the US, three times what it killed eight years ago. In just the past generation 20 old diseases have evolved into nastier problems and 30 new diseases such as AIDS and SARS have been found. Fortunately, none of the new diseases or mutating old diseases has become giga-killers. AIDS and malaria, however, kill millions worldwide.
Unfortunately, The New Killer Diseases is among the few books that is far too short. Much of it consists of scary anecdotal cases, leaving too little space for their arguments.
The authors lead us on a detective hunt for the source of an outbreak resulting from a deadly strain of E. Coli. One fascinating, potential method of dealing with the strain is to engineer a benign strain that absorbs the toxins released by the killer strain.
Regulation of the meat industry is pathetic. Even when the USDA tries to stop bad meat, judges and politicians get in the way. Forty-seven percent of samples at one meat producer contained salmonella, but an Appeals Court ruled that killing salmonella is the consumer's problem. Deadly food products are rarely recalled. The authors contend that the USDA should get out of the food industry promotion business or, better, it and all the other food agencies with partial jurisdictions should be replaced by an agency with enforcement teeth.
They argue that lawsuits are a poor method to deal with deadly food. They are too late, and they get thrown out of court because the companies have done nothing illegal. (They have done nothing illegal because their lobbying makes the corrupt regulations.)
The Safe Tables Our Priority website at www.stop-usa.org lists ways to prevent food born disease.
The golden age of anti-biotics is over. Increasing numbers of microbes are resistant to multiple antibiotics. Microbes evolve both by adopting resistant genes from other creatures and by novel self-mutations.
Over prescription of antibiotics, one-third of antibiotic prescriptions, is among the leading causes of drug resistance. Among the worst abuses, is antibiotics in animal feed, a practice done primarily to make animals grow faster. A Danish study suggests banning the use of avoparcin in pig and chicken feed reduced resistant strains of entercoccal from "73 percent to 5 percent."
Hospitals are among the easiest places to get diseases. Five percent of patients get infections, resulting in 20,000 annual US fatalities. Hospital staffs wash their hands about half as often as they should. Failure to wash hands is the leading preventable cause of hospital infections.
Antibacterial soaps and their ilk are worse than useless. They kill weak, harmless bacteria, leaving room for harmful bacterial to flourish. In addition, killing harmless microorganisms prevents the immune systems of children from developing properly, causing asthma or allergies or both. (Recent research reported elsewhere suggests that failure to catch hepatitis A is the biggest cause of allergies. Hepatitis A was once near universal among children. Now vaccines prevent children from catching it.)
Less fortunate are those who catch hepatitis C, the most lethal form of hepatitis. About three million people become infected each year worldwide. Within the next handful of years hepatitis C will begin killing more people than AIDS. Development of hepatitis C drugs and vaccines is hampered by the fact that it does not grow in lab cultures. Hepatitis C also mutates so fast that it develops resistance after infecting you.
Ninety percent of Americans have some form of herpes, whether the cold sore variety or something worse, which may seem like a minor problem. Herpes’ highly contagious nature, however, poses a great danger if it were to share its ability to spread with slow spreading diseases such as HIV or hepatitis C.
Tuberculosis is among the worst new-old diseases. About 10 million individuals catch the disease each year worldwide. In 90 percent of those infected the disease remains latent until they die of other causes or until age or some other disease weakens their immune systems. It then strikes hard. The remaining ten percent develop full-fledged tuberculosis immediately. TB is proving increasingly resistant to the cocktail of drugs that combats it, partly because some patients do not take the full course over six months. The use of "directly observed treatment" in Boston has been successful in making sure patients take the full course. TB moves in boom and bust cycles. After near victory is achieved, infrastructure is weakened and the disease spreads. Fortunately, work is now slowly beginning on a true TB vaccine.
AIDS is a king at mutations. In addition, recent prevention efforts lag. One 2002 study suggests that 77 percent of young gay men who are HIV positive do not know they are HIV positive--at least according to what they told researchers.
Advances in genetic science create new problems. Killer viruses can be created from scratch and from old viruses. Even viruses engineered to serve beneficial purposes can backfire. An Australian virus designed to cause infertility in rabbits inadvertently killed over 100 million rabbits.
A stunning chapter details the inadequacies of our alert system. Many doctors do not even know that laws require they report when they have patients with certain infectious diseases.
Prions are even more deadly than they are bizarre. Not only do prion diseases such as mad cow and CJD have no cure, but the most reliable diagnostic test works only after animals are dead. Any causal link between CJD and mad cow, however, is being hotly debated.
Increasingly lethal and frequent battles with bioterrorists are probable. Tularemia, Pneumonic plague, and other diseases are easily spread in aerosol form. Numerous cold war era bioweapons still exist in questionable stewardship. The Soviet Union once had 50,000 individuals employed in the bioweapons industry. Many of those individuals are now free agents.
On the plus side, one promising class of vaccines is made of only virus DNA, which is injected into the body, producing immunity. But these have not been tried on humans out of fear of causing cancer.
The authors recommend: · Curtailing the overuse of antibiotics, especially a ban on antibiotics in animal feed. · Reducing the overprotection of children from low harm viruses and bacteria so that their immune systems can develop properly. · Improving FDA and USDA standards and enforcement. · Increasing the use of directly observed treatment. · Improving incentives for vaccine production. · Spending more on research and the development of researchers. · Increasing spending on health departments. Highly recommended.
Book review article by Joseph Thomas Fournier.