Bacteria that are Resistant to Antibiotics

I was rather impressed by an article in the November 2005 issue of Discover magazine, entitled Are Antibiotics Killing Us? because it was finally being made plain to the public that the overuse of antibiotics by the medical profession was causing bacteria to mutate, some to the point where they can’t be killed off by any of the known medicines. This is a good article and I was about to recommend everyone go buy this magazine, if for nothing else, just to read that article and stop requesting antibiotics from your doctor before trying other means.

But something was nagging at the back of my mind. I rummaged through my file of old Scientific American magazines and it jumped right out and bit me! The March 1998 issue had a great article entitled The Challenge of Antibiotic Resistance. It was written in response to the fact that, in three geographically separate patients, an often deadly bacterium, Staphylococcus aureus, responded poorly to a once reliable antidote – the antibiotic Vancomycin. This event, which happened in 1997, was the first known appearance of a version of S. aureus that was not readily cleared by Vancomycin, and that clearly foreshadowed trouble for the medical people. Of course that article, like the one in this month’s Discover, went on to chide doctors for overuse of antibiotics, and to remind the public of the dangers this overuse will cause by creating mutating bacteria.

My big question here is simple: these articles are seven years apart and say almost the same thing. Surely the 1997 event made news to all the medical professionals. Or did it? It clearly did not impress some sense of reserve regarding the overuse of antibiotics because they continue to be used for things that they cannot possibly fix (an antibiotic is useless against a viral problem, like the common cold), yet each and every time they are given to a patient, that patient’s system becomes a breeding ground for mutational forms that will one day bring humanity to its collective knees. Why are we not learning?

Not only are the doctors not learning, but apparently this craziness has spread thoroughly through the sanitation industry. Look in the household goods section of any supermarket or Wally World store and you will find hundreds of antibacterial agents – compounds that kill or inhibit bacteria but are too toxic to be taken internally. These products have been proliferating at insane rates for the past decade. These compounds are called “disinfectants” and “antiseptics” and even “antibacterials.” These substances, including triclocarbon, triclosan, and such quaternary ammonium compounds as benzalkonium chloride, have been mixed into soaps, lotions and dishwashing detergents. They are being impregnated into babies’ toys, high chairs, mattress pads, and your kitchen cutting board. (If you touch it, do you not get it on your skin? If it is on your skin, can it not get into your system? And what about babies who chew on those toys?)

The sad part, beyond the cheap marketing scare tactics, is that the scientific evidence is very clear that the addition of antibacterials to such household products does absolutely nothing to ward off infections. What has become clear, however, is that the proliferation of products containing them raises significant public health concerns.

Like antibiotics, antibacterials can alter the mix of bacteria: they simultaneously kill susceptible bacteria and promote the growth of resistant strains. These resistant microbes might include bacteria that were already present but also include those that were unable to gain a foothold previously and are now able to thrive thanks to the destruction of their competing microbes. If we continue to attempt to live in a totally sterile environment, the only thing we will achieve is a forced situation where we have no choice but to cohabit with bacteria that are so resistant to antibacterials and antibiotics that when you really do need to have them killed off, there will be no weapon of any kind at your disposal. Simply, they will win.

On second thought, do go buy the magazine. Maybe you need to read the specifics.

Historical Oath and Law of Hippocrates

Hippocrates, the celebrated Greek physician, was a contemporary of the historian Herodotus. He was born on the island of Cos circa 470-460 BCE, and belonged to the family that claimed descent from the mythical Æsculapius, son of Apollo. There was already a long medical tradition in Greece before Hippocrates’ day, and this he is supposed to have inherited chiefly through his predecessor, Herodicus. He enlarged his education by extensive travel. He is said, though the evidence is unsatisfactory, to have taken part in the efforts to check the great plague that devastated Athens at the beginning of the Peloponnesian war. He died at Larissa between 380 and 360 BCE.

The works attributed to Hippocrates are the earliest extant Greek medical writings, but very many of them are certainly not his. Some five or six, however, are generally granted to be genuine, and among these is the famous “Oath.” This interesting document shows that, even in his time, physicians were already organized into a corporation or guild, with regulations for the training of disciples, and with an esprit de corps and a professional ideal that, with slight exceptions, can hardly yet be regarded as out of date.

One saying occurring in the words of Hippocrates has achieved worldwide use, though few who quote it today are aware that it originally referred to the art of the physician. It is the first of his “Aphorisms”: “Life is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.”

Please note that the commentary presented here is not intended to blast today’s doctors as individuals. Most of them have never even seen this oath.

Hippocratic Oath – Classical Version

I swear by Apollo Physician and Æsculapius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will abstain from whatever is deleterious and mischievous.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman a pessary to produce abortion. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

Note that a great deal of this oath is the intent to teach family or dedicated students, but to not share their knowledge with anyone else. Remind you of the AMA? He also says doctors should not involve themselves in mischief, don’t poison anyone, or use any mechanical vaginal device intended to terminate a pregnancy. I suppose the intent was that doctors will do no harm. Gee, that’s a far cry from today’s statistics of doctors being the third leading cause of death (or number one, whichever study you choose to believe).

He will apply dietetic measures (i.e., let food be your medicine), which doctors deny today, some with great vehemence (I have personally heard these words, “In no way is your diet the cause of, nor can it possibly be the cure, of this disease.”). One must bear in mind, however, that 2,500 years ago, the only medicines available were those made from plants. Today we have the invincible might of the pharmaceutical industry, to whom all doctors pay homage (is that different than swearing by Apollo?), which pill gods hath bade man deny the efficacy of anything which Nature hath grown in favor of that which the laboratory doth groweth.

He will not cut persons… hmmm, does this mean that there was already a separation between the fields of the family physician and the surgeons even 2,500 years ago? Their version of the AMA must have dictated that “thou shalt not infringe upon my specialty.” J

It is nice that Hippocrates decided to hold his patients and their families’ affairs to be a private matter (no gossip about who’s doing what), which would be nice if all of today’s doctors would keep their mouths shut. Most do. Some don’t. And look! He made house calls! Gee, do you think you can actually find a doctor willing to do that today?

Nice that he also decided that while he was in their homes, he wouldn’t have heterosexual or homosexual liaisons with the family or their servants. I am not sure that this is not against human nature (Who hasn’t been infatuated with their teacher or doctor or some other figure in a “uniform”?). I know (knew) a few doctors who routinely used their patients in that manner, but like Catholic priests, they seldom get in trouble, much less get arrested. Oh well. Let’s look at the laws he wrote to uphold this oath.

The Law of Hippocrates

1. Medicine is of all the arts the most noble; but, owing to the ignorance of those who practice it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.

At least he admits that some doctors were just plain ignorant. And even way back then, the doctors who screwed up got no punishment for their wrongdoing. I figure that a profession that kills over 100,000 people a year in this country ought to be held accountable for those murders.

2. Whoever is to acquire a competent knowledge of medicine, ought to be possessed of the following advantages: a natural disposition; instruction; a favorable position for the study; early tuition; love of labor; leisure. First of all, a natural talent is required; for, when Nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming an early pupil in a place well adapted for instruction. He must also bring to the task a love of labor and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.

Start learning the skills early, have a predisposition to help people, take lots of time to do your job, and love what you are doing. This would imply that he wasn’t in it for the money. Then why was it so necessary to keep it such a secret? Could it be merely the protection of an egotistical “power of profession”?

3. Instruction in medicine is like the culture of the productions of the earth. For our natural disposition, is, as it were, the soil; the tenets of our teacher are, as it were, the seed; instruction in youth is like the planting of the seed in the ground at the proper season; the place where the instruction is communicated is like the food imparted to vegetables by the atmosphere; diligent study is like the cultivation of the fields; and it is time which imparts strength to all things and brings them to maturity.

This one reminds me of the Zen statement: “If you’re going to eat, eat. If you’re going to talk, talk. To do both at once is to do neither well.” At least Hippocrates knew that important things should not be discussed or studied in unimportant places or at unimportant times.

4. Having brought all these requisites to the study of medicine, and having acquired a true knowledge of it, we shall thus, in traveling through the cities, be esteemed physicians not only in name but in reality. But inexperience is a bad treasure, and a bad fund to those who possess it, whether in opinion or reality, being devoid of self-reliance and contentedness, and the nurse both of timidity and audacity. For timidity betrays a want of powers, and audacity a lack of skill. They are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.

If you don’t know the answer, admit it. Do not presume to authority when you haven’t a clue what’s going on or you’ll be an obvious egocentric idiot. Nice. Note that the word “nurse” here is not implying the profession, but means “that which feeds.”

5. Those things which are sacred are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated into the mysteries of the science.

Let us not forget, if we don’t keep what we know a secret, the masses will not need us and we’ll be out of business. Personally, I would think that anyone who truly loves helping and healing others would want to have no patients left who need him. But that’s just me…

Hippocratic Oath -- Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of over-treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Sadly, I know of no doctor (at least who I have met) who remembers this oath, and many who say they have never even read it, much less sworn to uphold it. And you notice that the statement about using plants was removed entirely in favor of all measures which are required, which leaves this totally open to the doctor’s discretion, or that of those who dictate his practice.

Hippocratic Oath – The “as approved by the AMA” Version

You do solemnly swear, each by whatever he or she holds most sacred: That you will be loyal to the Profession of Medicine and just and generous to its members. That you will lead your lives and practice your art in uprightness and honor.

That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice.

That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it.

That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret.

These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.

Sounds like the benediction of a graduation ceremony, and note that no student was required to “swear” to this oath, but merely to bow his or her head in acknowledgement that such was read to them. Still, most doctors do not even remember that they did this (and maybe they didn’t).

I do not blame them for such lapse of memory. Back in 1989, while I was playing at being a police officer, I interviewed 10 other officers (city, county, and state) and only one could recite to me the oath he swore to get his badge. So sad. Sigh…

Thanks to Doug Kaufmann and his excited hand-waving on TV for the inspiration for this cartoon.

Fungal Contamination of Bedding

Researchers at The University of Manchester funded by the Fungal Research Trust have discovered millions of fungal spores right under our noses - in our pillows.

Aspergillus fumigatus, the species most commonly found in pillows, is most likely to cause disease; and the resulting condition, Aspergillosis, has become the leading infectious cause of death in leukemia and bone marrow transplant patients. Fungi also exacerbate asthma in adults.

The researchers dissected both feather and synthetic samples and identified several thousand spores of fungus per gram of used pillow - more than a million spores per pillow.

Fungal contamination of bedding was first studied in 1936, but there have been no reports in the last seventy years. For this new study, which was published online today in the scientific journal Allergy, the team studied samples from ten pillows with between 1.5 and 20 years of regular use.

Each pillow was found to contain a substantial fungal load, with four to 16 different species being identified per sample and even higher numbers found in synthetic pillows. The microscopic fungus Aspergillus fumigatus was particularly evident in synthetic pillows, and fungi as diverse as bread and vine moulds and those usually found on damp walls and in showers were also found.

Professor Ashley Woodcock who led the research said: “We know that pillows are inhabited by the house dust mite which eats fungi, and one theory is that the fungi are in turn using the house dust mites’ feces as a major source of nitrogen and nutrition (along with human skin scales). There could therefore be a ‘miniature ecosystem’ at work inside our pillows.”

Aspergillus is a very common fungus, carried in the air as well as being found in cellars, household plant pots, compost, computers, ground pepper and spices. Invasive Aspergillosis occurs mainly in the lungs and sinuses, although it can spread to other organs such as the brain, and is becoming increasingly common across other patient groups. It is very difficult to treat, and as many as 1 in 25 patients who die in modern European teaching hospitals have the disease.

Immuno-compromised patients such as transplantation, AIDS and steroid treatment patients are also frequently affected with life-threatening Aspergillus pneumonia and sinusitis. Fortunately, hospital pillows have plastic covers and so are unlikely to cause problems, but patients being discharged home - where pillows may be old and fungus-infected - could be at risk of infection.

Aspergillus can also worsen asthma, particularly in adults who have had asthma for many years, and cause allergic sinusitis in patients with allergic tendencies. Constant exposure to fungus in bed could be problematic. It can also get into the lung cavities created by tuberculosis, which affects one third of the world’s population, causing general ill-health and bleeding in the lung, as well as causing a range of plant and animal diseases.

Dr Geoffrey Scott, Chairman of the Fungal Research Trust, which funded the study, said: “These new findings are potentially of major significance to people with allergic diseases of the lungs and damaged immune systems - especially those being sent home from hospital.”

Professor Ashley Woodcock added: “Since patients spend a third of their life sleeping and breathing close to a potentially large and varied source of fungi, these findings certainly have important implications for patients with respiratory disease - especially asthma and sinusitis.”

http://www.manchester.ac.uk/