I just read a really scary book.
It wasn’t written by Stephen King or James Patterson . It wasn’t even fiction. But the tales of necrotizing pneumonia and pus filled abscesses caused by a virulent strain of antibiotic resistant bacteria made my hair stand on end.
Maryn McKenna, an award-winning science and medical writer, has created a terrifying and vivid portrayal of drug-resistant staph in Superbug: The Fatal Menace of MRSA. The book has the style of a crisply written detective novel from its first paragraph, comprised of one line:
“Tony Love’s knee ached.”
This ordinary knee ache resulted from a collision on the volleyball court in the Chicago school gym where he scraped his elbow. From this small ordinary childhood injury, came a knee so swollen that this healthy teenager could not put weight on it. The first visit to the ER resulted in a prescription for Motrin and hot towels. A few days later, the teen was in so much pain that he could not walk, go to the bathroom, or even eat. The family made a second visit to the ER where they were referred to U of C’s children’s hospital. Within minutes of their arrival, Tony’s condition worsened and he crashed into septic shock. His body was wracked with infection – a voracious antibiotic resistant staph known as MRSA. Tony ultimately recovered after months of treatment and a few more months of rehab, but the story of how a little bit of bacteria felled an otherwise healthy kid is just the beginning of McKenna’s nightmarish portrayal of the infection that could hit any one of us at any time.
MRSA stands for methicillan-resistant Staphyloccus areus. As the historians among us will recall, the antibiotic era began during World War II. Sir Alexander Fleming discovered the mold that birthed penicillin on a culture dish of Staphyloccus (staph for short) in 1928. Twelve years later, a set of researchers proved the drug’s value to U.S. pharmaceutical companies who then manufactured the drug and sent it to Allied troops curing battlefield infections that previously were fatal. The public saw penicillin’s release in 1944. While it was heralded as a wonder drug, even its creator was beginning to fear the ability of the bacteria to circumvent the drug’s protection.
Given the wont of Americans to overdo, this fear was justified. Penicillin was added to face soaps and body creams and was prescribed to excess. The nimble bug evolved, getting stronger. Much of the book follows the bacteria and its aftermath. Appearing first mainly in hospitals where the patient’s resistance is weak, the bacteria then developed a community strain, infecting individuals with no connection to hospitals, either patients or workers, killing, in some instances, healthy children within hours.
The real story, however, is not the spread of this Superbug, but the system that we constructed to give it life. The over prescribing of antibiotics by busy doctors, overcrowded prisons, and poor hygiene are part of this perfect storm that we’ve created. While these are large contributors, we must not forget the livestock industry.
Between 70 and 80 % of the antibiotics used in this country are given to animals raised for food. While some of these drugs are given to sick animals, the majority is provided either preventatively (i.e. so that otherwise healthy animals will not get ill under the wretched confinement system that they are forced into) or as sub-therapeutic doses to help the animals gain weight so that they can reach slaughter sooner. Despite connections made between the antibiotics used in livestock production and resistant bacteria that infects individuals working with these animals, the livestock industry has claimed that this relationship is not proven with absolute certainty. (Whatever ever happened to the precautionary principle in science?). Their case is growing weaker by the day.
In the late 2000’s, a strain of MRSA know as ST398 emerged in the Netherlands. For years, the Netherlands instituted a stringent “search and destroy” policy to prevent the spread of MRSA. Anyone suspected of carrying MRSA (a patient previously admitted to a hospital in a foreign country or with a leaking wound) went immediately into isolation upon arrival to rid them of the offending bacteria. The system worked. According to McKenna, in 2000, only .03 % newly admitted patients in the Netherlands were carrying MRSA as compared to 2.6 percent in the U.S.
Then the young daughter of a pig farmer arrived at a hospital colonized with MRSA. A doctor from the Netherlands interviewed by McKenna stated that “I saw twenty patients colonized in a year, max, and in every case we knew the source. I had not seen a MRSA infection in fourteen years. Yet here was this little child, who had not been in a hospital abroad. It was amazing.” And, as McKenna adds, unnerving.
It turns out that the family were pig farmers, part of a network of small family farms being “subsumed by large American-style operations with thousands of animals.” The researchers surmised, correctly, that the pigs acquired MRSA and passed it onto the farmers and their families. As this superbug is apt to do, the strain spread from the Netherlands to Canada and then to Iowa. The fear is that this not only will this bacteria act like ordinary staph, colonizing on the skin and in the nose, but that it could potentially act as a contaminant causing foodborne illness. How scary is that?
Before reading Superbug, the question of confinement raised animals was an ethical one for me – whether the misery inflicted upon animals and, for that matter, the humans working in those facilities by the putrid conditions outweighed the need to eat cheap meat. Even the environmental degradation resulting from the inevitable careless management of CAFOs seemed a distant and intangible casualty. For me, Superbug has changed the argument from one of ethics to a moral imperative. In every hamburger of unknown origin, I see Tony Love’s face or even worse that of Carlos Don IV.
Carlos was another healthy kid who left on a school trip to the mountain and returned with a 104°F fever. The first doctor diagnosed Carlos with walking pneumonia so his mother kept him home bundled and hydrated until she realized that he was beginning to hallucinate. She rushed Carlos to the hospital and the doctor’s ultimately diagnosed his condition as MRSA. A long slow death march ensued during which Carlos’s lungs dissolved and clotting choked off the blood to his lower intestines, legs and arms. In two weeks, he was dead.
After reading Carlos’s story late in the evening, I woke my son from a dead sleep to scrub his hands clean. I hugged him as tightly as I could.
Here at the Beet, we like to have a local or personal angle. I just came back from Portland where I was speaking with a friend from Berkeley. She’s devoted to sustainable causes and eats well – I think she may even largely keep a vegetarian diet. Yet, she told me about the antibiotic staph infection she contracted after staying in the hospital for post-op. She eats well, she takes care of herself and yet, she has been impacted by this terrible scourge caused by the misuse of antibiotics. This isn’t about you or me or our personal choices, but how we protect society at large.
On the same trip, I had the pleasure to hear Ruth Reichl speak and she implored the audience to reject confinement raised animal. As she put it, if everyone stopped buying them and eating them, the practice would be history. Knowing what I now know, I think it’s a moral duty.
For more on this issue, read this recent New York Times Op-Ed piece by a former USDA head: Cows on Drugs. http://www.nytimes.com/2010/04/18/opinion/18kennedy.html
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