Tuesday, August 7, 2012

New 'superbug' strain of #gonorrhea resistant to all available antibiotics; researchers fear global outbreak



Government heath officials are warning that gonorrhea, one of the most common sexually transmitted diseases, is becoming increasingly resistant to the last type of antibiotics left to treat it.

Although no cases of resistant gonorrhea have been reported in the United States, the Centers for Disease Control and Prevention says its own laboratory studies are detecting growing signs of resistance to a class of antibiotic drugs called cephalosporins. 

In addition, resistant strains already have shown up in other countries. Recently, two cases in which gonorrhea treatment failed were reported in Norway among heterosexual men, and a new resistant strain of the bacteria was identified from a female sex worker in Japan, a finding reported this week at the International Society for Sexually Transmitted Disease Research conference in Quebec.

 The new strain may be “a true superbug that initiates a future era of untreatable gonorrhea,’’ wrote the team of Japanese and Swedish scientists in a recent report about the new strain. In its Morbidity and Mortality Weekly Report, the C.D.C. reported last weekon a decade-long analysis of 5,400 to 6,500 annual gonorrhea cases from men treated in 30 American cities. 

From 2000 to 2010, the percentage of gonorrhea cases that showed potential resistance to two cephalosporin drugs rose sharply. Surveillance data from 2010 showed that over all, 1.4 percent of samples showed increasing resistance to the oral drug cefixime, up from 0.2 percent in 2000.

 Resistance to the injectable drug ceftriaxone rose to 3 percent, up from 1 percent a decade ago. Some parts of the United States showed bigger increases than others. For instance, testing in Honolulu found 7.7 percent of 2010 samples with potential resistance to cefixime, compared with none in 2000. In California, 4.5 percent of samples showed signs of resistance in 2010, up from zero in 2000.

Health officials emphasized that while the signs of growing resistance are seen in laboratory studies, so far in the United States, there have been no cases of treatment-resistant gonorrhea in patients. The trends, however, are concerning, because cephalosporin drugs are the fourth type of antibiotic used to treat gonorrhea since the 1940s.

Resistance to penicillin and tetracycline occurred during the 1970s and became widespread during the early 1980s, the C.D.C. reported. More recently, the disease became resistant to a class of antibiotics called fluoroquinolones, and in 2007 the government stopped recommending those drugs for gonorrhea treatment. That left cephalosporin drugs as the last line of defense against gonorrhea. “The measurements we’re finding in the laboratory do show concerning trends of declining susceptibility to cephalosporin antibiotics,’’ said Dr. Robert D. Kirkcaldy, a medical epidemiologist in the C.D.C.’s division of sexually transmitted disease prevention and co-author of the agency’s report last week. “What we’ve been noticing is really since 2009 and 2010, it’s taking higher concentrations of antibiotic to kill the bacteria. This could mean resistance to the last antibiotic we have for gonorrhea could be on the horizon.’’ The problem of growing resistance appears limited to gonorrhea and is not occurring with other sexually transmitted bacterial diseases. “It’s a very complex bacteria which has a pretty amazing ability to mutate and for people to develop resistance to antibiotics,” said Dr. Kirkcaldy. “It has a pretty documented track record of developing resistance since the dawn of the antibiotic age.” More than 700,000 people in the United States get gonorrhea every year, although about only half those cases are reported to public health agencies. In women, untreated gonorrhea can lead to fertility problems, pelvic inflammatory disease or ectopic pregnancy, and pregnant women can pass the disease to their babies. In men, the disease can cause painful scarring of the urethra, urination problems and kidney failure. Long-term complications for both sexes include joint pain, heart valve infection and meningitis. The signs of emerging resistance to cephalosporin drugs are following roughly the same patterns that occurred when gonorrhea became resistant to fluoroquinolones a few years ago. In that case, resistance was documented first in Asia, then emerged in the United States, first in Hawaii followed by other Western states, according to the C.D.C. The hope is that new antibiotics eventually can be developed to treat gonorrhea. “The challenge is that there is not a well-studied second antibiotic we can turn to even when cephalosporin resistance does emerge,” said Dr. Kirkcaldy. “That’s why we’re so concerned, and one reason we wanted to sound the alarm about these findings. It’s incumbent on researchers in the pharmaceutical and other sectors to step up quickly and boldly to identify new drug combinations.” TARA PARKER-POPE: NY TIMES

Monday, August 6, 2012

Should there be a Fat Tax?

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Offering incentives for lifestyle choices likely to cut medical costs is an idea worth considering.

If an individual's body mass index isn't a purely personal matter, what is? We have the right to choose between healthy food or junk food, even if the latter is more likely to result in obesity and related health problems. But once our choices affect others, there's a natural conflict between individual freedom and social responsibility.

In a nation where rising healthcare costs and diminished access to medical care are issues of grave concern, personal decisions are no longer strictly private. The treatment of obesity- and smoking-related disease is tremendously expensive, which in turns drives up health insurance premiums for everyone, as well as raising the costs for Medicaid, Medicare and health coverage for public employees.

These legitimate concerns have resulted in a raft of nanny-state proposals to shape the public's dietary habits by taxing this food or that drink or by outlawing free toys that accompany unhealthy children's meals at some restaurants. Such proposals raise inevitable questions of fairness and effectiveness.

Does it make sense to tax a can of soda but not a fruit juice that contains more calories per cup and very little additional nutrition? Would a vitamin-fortified soda be exempt from the tax? And it's hard to figure out whether the bigger obesity culprit is a small order of fried chicken at a fast-foot outlet or a giant slab of prime rib at a pricey restaurant. Or, as many dietitians now think, maybe it's the carbs; has the time come for a public pasta tax?

In any case, there is much uncertainty about whether such tactics would have any effect on the country's collective bulging belly.

We prefer the approach most recently proposed in Arizona, where officials hope to levy a $50 annual fee on some Medicaid patients who don't take steps to improve their health. It is vague at this point how the proposal would work, who would be liable for the fee and under what circumstances; but some examples mentioned are obese patients who fail to follow their doctors' plans for losing weight, smokers who shun programs to help them quit the habit or certain diabetespatients who ignore medical advice on lifestyle changes that would improve their lab results.

News reports have cast the Arizona fees as a way to bring in more money for the state's Medicaid program, which might then be able to afford to reinstitute coverage for organ transplants for poor people. Even if that were the point — and it's not — there's no way the state would save money in the short term with what some are calling a "fat tax."

Administrative expenses alone would be higher than the $50 fee; the state would have to figure out which Medicaid recipients were affected, oversee progress and deal with appeals. In addition, the state would pay for at least some level of treatment, such as smoking-cessation programs or regular doctor visits for diet check-ins and advice. Instead, the program is expected to help Arizona's bottom line over time, by reducing healthcare costs for those patients.

Private companies already are trying similar strategies, with financial incentives for employees who make the kinds of smart decisions that are associated with better health. Safeway, for instance, offers significant discounts on health insurance premiums to employees who don't smoke and who maintain healthy weight, blood-pressure and cholesterol levels. The company reported that its per-person healthcare costs remained flat for four years during which such costs rose 38% for most companies.

For several years, Alabama has levied a health insurance surcharge on state employees who smoke or are obese and who fail to seek help for these conditions. Several other states have approved similar policies.

Of course, carrots — by which we mean incentives for healthier behavior, not the beta carotene-rich vegetables — are more popular with the public than sticks such as surcharges. But those terms lose some of their meaning when it comes to healthcare, with its rapidly rising costs. Whether it's a surcharge or an incentive makes no difference — people who lead healthier lifestyles pay less, while the higher costs associated with obesity, smoking and a life on the couch are assumed by those who generate them.

The bigger issue is whether far-reaching government policies can be implemented in ways that are fair and effective. About 10% of the obese population cannot reasonably lose weight through ordinary means because of special medical problems; they would need exemptions. And though Arizona's medical insurance for the poor proposes to cover visits to the doctor for weight loss, chances are it won't do much to make sure those patients have access to affordable, healthy food.

Low-income neighborhoods often lack farmers markets or even standard supermarkets; instead, they have an excess of cheap fast-food joints. Similarly, we can't expect children to get the exercise they need when they live in gang-infested neighborhoods too dangerous for outdoor play.

It's also unclear whether a $50 fee, even if it is imposed on the poorest residents, would change anyone's behavior. People who can afford a smoking habit are unlikely to be persuaded to quit by the prospect of saving less than the price of 10 packs.

There's the inevitable complaint that some smokers and overeaters live long and healthy lives and yet would have to pay the surcharge. That's true enough, but the statistics are against them, and that should be reflected in insurance costs. Smoking and obesity greatly increase the risk of chronic and life-threatening health problems that in many cases are preventable, including stroke, cancer, heart disease and diabetes.

 It makes sense to tie higher preventable risk to higher premiums. Not all rock climbers have serious accidents, either, but they still pay more for life insurance, when they can find it.

This approach is far more appealing than taxing soda and is more likely to improve America's health. It provides a direct link between unhealthy ways of living and the consequences. Americans need information, through labeling, nutrition education and medical advice, to make smart diet decisions. Then they should be free to eat what they want — as long as they bear the cost of their personal choices.

LA times - EDITORIAL


Most Americans Support Raising The Minimum Wage By $10


The majority of Americans say they support raising the minimum wage -- by a lot. More than two-thirds of Americans say lawmakers should raise the national minimum wage to $10 per hour from its current $7.25, a survey from the Public Religion Research Institute finds. While Democrats were more likely to support a minimum wage boost, more than half of Republican respondents said they would like to see the minimum wage go up, according to the survey. Support for a minimum wage boost has held at stable levels for more than a year.

An October 2010 by the National Employment Law Project found that at the time, two-thirds of Americans supported a hike in the minimum wage. If the current findings hold true come election day, some Republican candidates for president may have to change their tune. Herman Cain's campaign has floated the idea of scaling back minimum wage laws in impoverished areas and Michele Bachmann has said she would consider lowering it. Ron Paul has said that the minimum wage should be scrapped completely. The candidates' views of the minimum wage are not only at odds with those of many Americans, they contradict some economists' opinions as well.

A minimum wage boost would help to spur growth by pumping more money into the economy without cutting jobs, a July study from the left-leaning Center for American Progress found. Another study from researchers at the University of California-Berkley found that raising the minimum wage would also cut down on turnover in low-wage jobs. Still, some argue that a rise in the minimum wage would be harmful for job seekers. A study from conservative think tank, The Heritage Foundation, found that raising the minimum wage would put low-wage workers at risk because businesses would be hesitant to hire more of them.