Sunday, January 9, 2011

1 When will the media ask more of the right questions about antibiotics and vaccines?

I was originally going to title this post, "Why is the media drinking the Kool-Aid?", but then I thought better of it, and changed the title after recalling a well-written post on that phrase.

So, my original question stands: When will the media ask more of the right questions?

When I reflect on the media's approach to the issue of Chronic Lyme disease, it seems they almost completely side-step the issue of Lyme Disease and infectious diseases and their treatment in general.

Dear media, where is your sense of curiosity? Your ability to dig deeper into the issues? Your investigative reporting chops?

We begin with the old question by many Lyme patients of course, which is this:

"If Lyme Disease can be cured with 21-28 days of antibiotics, why are researchers working on a vaccine?"

A simple question. That would be a good start.

"If - as the official story claims - the Lymerix vaccine was pulled from the market because of low sales, why develop another vaccine?"

Okay. Not bad. Also a good question. Most readers will wonder this, too, once they realize Lyme Disease actually had a vaccine on the market around 1999, but it was pulled off the shelves.

But let's keep going, shall we? Indeed...

"If another spirochetal infection, Syphilis, is spread by sexual contact and is on the increase - why isn't more research going into developing a vaccine for Syphilis instead?"

If Lyme Disease is - as claimed by the IDSA and some medical professionals - so rare and hard to catch (even though, uh, the CDC says it is the fastest-growing vector-based disease) - then why isn't more money and research going into vaccines for common sexually-transmitted infections such as Syphilis?

Syphilis is seriously on the rise in the past several years, and it suffers from some similar treatment and diagnostic issues Lyme does - such as some people who are acutely infected do not get a visible chancre or sore signaling its presence (some people with acute Lyme never get a rash).

It's proven Syphilis is sexually-transmitted and congenitally-transmitted. With that in hand and no controversy over it, shouldn't there be a vaccine for it?

That's a better question, isn't it?

The short answer to why there is no Syphilis vaccine yet is that people are working on this problem, but they haven't come up with a solution. Why this is the case is a bit complicated (I will attempt to lay it out here some time in another post), but I am surprised the media hasn't jumped on this more.

Okay, let's try this one:

"If the IDSA is concerned about antibiotic resistance and not enough funding for R & D of new antibiotics, could this be pushing them down the route of more vaccine development in general and not just for Lyme Disease?"


Now we're talking. Very good question.

Now this starts sucking in the broader issues of politics and epidemiology and the soaring costs of healthcare.

According to the IDSA's 2010 testimony to the House Committee on Energy and Commerce Subcommittee on Health, more funding is needed for new antibiotics or everyone is in deep, deep trouble due to growing antibiotic resistance and lack of development of new antibiotics.

Entire fields of application of antibiotics will have to be more carefully scrutinized and medicine stringently doled out until new antibiotics are developed that evade resistance.

The use of antibiotics for acne treatment and indiscriminately for ear and sinus infections may be put to a standstill.  And yes, using antibiotics in factory farms has also been mentioned by the IDSA as something that needs reducing, too.

Tuberculosis? I think they'll draw the line there, but continue to also work on a Tuberculosis vaccine.

In their testimony, the IDSA states:
"The ESKAPE Pathogens: The so-called ESKAPE Pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and ESBL positive bacteria, such as E. coli and Enterobacter species) represent a grouping of antibiotic-resistant gram-positive and gram-negative bacteria  that cause the majority of U.S. HAIs (Health-care Associated Infections). The group is so-named because these bacteria effectively “escape” the effects of most approved antibacterial drugs."

Right now, MRSA and its even more evil sister, VRSA (so far, extremely rare with only 11 documented cases in the US, VRSA is the worst staph infection possible - because even vancomycin won't beat it), are the IDSA's top targets. Followed by that long list above - many hospital-acquired infections, but some community-acquired.

There's more:

"Clostridium difficile: Another resistant infection receiving increased scrutiny is Clostridium difficile (C. diff). C. diff. is an HAI that can lead to severe diarrhea, rupture of the colon, kidney failure, blood poisoning, and death. CDC estimates there are 500,000 cases of C. diff. infection annually in the U.S., contributing to between 15,000 and 30,000 deaths. States have reported increased rates of C. diff. nationwide over the past several years noting more severe disease and an associated increase in mortality. Elderly hospitalized patients are at especially high risk."

Well, none of us want that, either. Either as a public health crisis or as a personal one after I've taken months of antibiotics.

But it's useful to know that this is being mentioned before Congress and this is part of a bigger picture.

Does anyone here know about The STAAR Act, H.R. 2400? No? Doesn't sound familiar?

I did a quick search of Lymenet, Lymenet Europe (although it's not pertinent to them, they may want to watch what happens in the US), and googled it using the keywords, "STAAR Act H.R. 2400 Lyme Disease" in varying combinations. Neither of those two forums turned up a hit, and my last search on Google netted one result within seven pages of results for the blog of a Lyme patient from Utah.

This act should be more familiar to you all, because the STAAR Act stands for "Strategies to Reduce Antimicrobial Resistance".

Taken from the final 2010 report from the IDSA to the House Committee on Energy and Commerce Subcommittee on Health:

"The STAAR Act strengthens existing efforts by establishing an Antimicrobial Resistance Office (ARO) within the HHS Office of the Assistant Secretary of Health. The Director of ARO will serve as the director of the existing interagency task force. The Act also establishes a Public Health Antimicrobial Advisory Board (PHAAB) comprised of infectious diseases and public health experts who will provide much-needed advice to the ARO Director and task force about antimicrobial resistance and strategies to address it. The STAAR Act will strengthen existing surveillance, data collection, and research activities as a means to reduce the inappropriate use of antimicrobials, develop and test new interventions to limit the spread of resistant organisms, and create new tools to detect, prevent and treat drug-resistant “bad bugs.”"
And that's just part of it, really - you ought to read the entire report.

One of the IDSA's broader goals beyond this act is to institute a special fee called "the Antibiotic Innovation and Conservation Fee" on every course of antibiotics used by doctors and veterinarians in the future - both to acquire money for funding new antibiotic development - and to encourage restricted and judicial use of the antibiotics remaining in use. And then there is also the proposal for an "antibiotic stewardship program" which will be intended to track and reduce usage of antibiotics as well as lower medical cost.

Now, before you get all psyched out about all this, keep this bit in mind which is a double-edged sword:

The CDC and the IDSA have a major fiscal shortfall for Fiscal Year 2011. Cited from the IDSA's own website...
"Especially hard-hit in this year’s budget is CDC, which would have its budget cut by $135 million. Of particular concern to IDSA are:
  • the slashing of CDC’s Infectious Diseases program budget, which would be cut by almost $100 million, a 5 percent decline
  • a cut of more than 50 percent to the already strapped budget for the vital Antimicrobial Resistance program, which would force CDC to cut in half its support for state and local surveillance, prevention, and control efforts, and end all grants to states for the successful Get Smart in the Community program to combat improper antibiotic use
  • a 21 percent reduction in grants for the Section 317 immunization program compared to the current fiscal year, in light of the end of additional funding provided though the stimulus bill; these cuts will reduce access to immunizations, which save lives and millions of dollars in preventable medical spending
While infectious diseases research at the National Institutes of Health (NIH) would grow by $150 million in FY2011 under the proposed budget, this represents just over 3 percent above current funding levels. With biomedical research inflation increasing about 3.6 percent per year, this budget will actually result in fewer grants awarded and fewer new research projects, at a time when the need for this research is so critical."
As soon as there is any money, you can imagine where the IDSA wants at least some of it to go.

The double-edged sword is that even as antibiotic treatment may continue to be under less scrutiny, there isn't funding for new antibiotics to be developed.  This happens while the IDSA has proposed that 10 new antibiotics be developed by 2020.

This all brings up a few questions for me right now, having read all this:

Why is the NIH getting more money in 2011 and why is the CDC's budget getting cut?

When the IDSA's budget has been cut and it's facing increasing antibiotic resistance in society as a problem - are they going to advocate that those with acutely deadly infections get antibiotics first - while those with chronic infections that take longer to kill get antibiotics last?

When the IDSA's budget has been cut and more people are dying from MRSA and there's been few new antibiotics for years, when push comes to shove, does the IDSA start focusing more on vaccines alongside pushing for funding for new antibiotic research?

I have a feeling the reason the media doesn't ask more of the right questions is that they lead to even more questions - and answers that do not fit into a sound bite.

What's happening here? Anyone reading this know more about this stuff? 

Anybody have more recent information on this than me and google in a few minutes?

1 comment:

  1. The standards of the media are only becoming worse, I wouldn't hope that they'll become better.

    John S


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