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The New Killer Diseases
by Elinor Levy and Mark Fischetti
Levy and Fischetti 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 find fixes. Flesh eating bacteria now kills 2,000 each year in the US, three times the number eight years ago. In just the past generation 20 old diseases evolved into nastier problems and humans discovered 30 new diseases such as AIDS and SARS the hard way. 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 far too short books. Much of it consists of scary anecdotal cases, leaving too little space for better arguments. The authors, for example, lead us on a detective hunt for the source of 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 interfere. 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 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.
The authors argue that lawsuits are a rotten method to deal with deadly food. Lawsuits come too late, and get thrown out because the companies did 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 ended. Many microbes resist 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. One atrocious abuse is antibiotics in animal feed, a practice done allegedly to make animals grow faster. One Danish study suggests eliminated the use of avoparcin in pig and chicken feed, reducing resistant strains of entercoccal from "73 percent to 5 percent."
Hospitals are easy 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 failure to catch hepatitis A causes allergies. Hepatitis A was once near universal among children.
Less fortunate are those catching 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 may kill more individuals than AIDS. Hepatitis C does not grow in lab cultures, hampering drug development. Hepatitis C also mutates so fast it develops resistance after infecting you.
Ninety percent of Americans suffer from some form of herpes, whether the cold sore variety or something worse. Herpes may seem minor, but its highly contagious nature 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 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 a cocktail of drugs, partly because some patients do not take the full course over six months. The use of "directly observed treatment" in Boston succeeded in making patients take the full course. TB moves in boom and bust cycles. After near victory, infrastructure weakens and the disease spreads. Fortunately, work is now beginning on a true TB vaccine.
AIDS is a king of mutations. In addition, recent prevention efforts lag. One 2002 study suggests 77 percent of HIV positive young gay men do not know it--at least according to what they told researchers.
Advances in genetic science create new problems. Killer viruses can be concocted 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 patients with specific infectious diseases.
Prions are 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 die. Any causal link between CJD and mad cow, however, remains 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 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 viruses have not been tried on humans out of fear of causing cancer.
The authors propose curtailing the overuse of antibiotics, especially a ban on antibiotics in animal feed. In addition, they recommend reducing the over-protection of children from low harm viruses and bacteria so children's immune systems develop properly. FDA and USDA standards and enforcement must improve. The use of directly observed treatment should increase. We need, they write, better incentives for vaccine production. Increased spending on health departments and more spending on research and development of researchers conclude their prescriptions. Highly recommended.
Book review article by JT Fournier, last updated June 29, 2009.