Always listen to the Mad Biologist. By way of Joe Windish at The Moderate Voice, we find out, just as I predicted, that the pork lobby would claim we don't know enough about the MRSA ST398 problem:
Livestock scientists call the opinion piece "highly speculative", and point to the Centers for Disease Control and Prevention (CDC) statements on MRSA that say most if not all cases of MRSA come from person to person contact, not person to animal. The column also does not define this strain as one that is found on any swine farm in the vicinity of Camden, Ind.
"They are making a huge leap attributing MRSA in these people to hogs," says Angela DeMirjyn, science communications manager for the National Pork Producers Council (NPPC). The pork organization has been researching MRSA for some time, says DeMirjyn, and supports the CDC's statement that most community acquired MRSA infections are caused by a different bacteria than is commonly associated with pigs or pig farms.
"We also know that MRSA is not just staph bacteria that can be found in pigs, it also can be found in horses, dogs and even marine animals. It is not a problem that is solely related to pigs," DeMirjyn says.
This is part of a larger strategy (that I'll describe below) that, on the one hand, says we need more research, while, on the other hand, attempts to deny funding to do the research they claim is needed.
I've actually had some limited dealing with pork lobbyists. Before I get to that, I want point out one tactic that the ag lobby has always used.
Whenever we start to see resistance to a particular drug in an agricultural setting, there's the response (or some variant thereof) that resistance to that drug is mostly clinical. What they neglect to add is the phrase "at the present time." Which is the whole fucking point. If we see a troubling rise in an MRSA clone in pigs (more like an epidemic sweep), then that should be cause for action. Of course, the ag lobby will argue that we should wait until resistance becomes relatively common--at which point, they will agree that it's a problem. Then they argue that changing antibiotic use is moot because resistance to the drug of interest is so common it won't make a difference. Nice denialist tautology you have there.
The reason that I'm worried about MRSA ST398 is not that entering the human population is predictable--that is, it's possible to devise a scenario where it could happen. It's not that entering the human population has been predicted--that is, someone is claiming it will occur. The reason ST398 is, as I noted in a previous post, a serious problem is that it has already jumped from pigs to the human clinical setting in the Netherlands (and keep in mind that the Netherlands has excellent MRSA hospital infection control policies, arguably the strictest in the world). You don't have to be smart or clever to realize what will happen--you just have to pay fucking attention.
Anyway, onto (some of) my experiences with pork lobbyists.
A couple of years ago, I testified at the Scientific Review of the National Antimicrobial Resistance Monitoring System (NARMS). This is a program that conducts research related to antibiotic resistance and agriculture; it also tracks the spread of resistance from the farm, through the food chain, and into the clinic. Several ag lobbyists were at the meeting, including one from the Pork Board (really, it's called that...). First of all, they had the nicest suits in the room (ok, the PHS people looked pretty snazzy, but they have uniforms and stuff). It must pay really well. Basically, the ag lobbyists spent the entire meeting trying to eviscerate the funding for NARMS.
First, they kept referring to 'statistically sound sampling' over and over again (clearly, this was a talking point). Of course, who could possibly be against statistically sound sampling? What are you, an Al-Queda sympathizer or sumthin'? What they meant is that NARMS should spend all of its time making the confidence intervals even smaller than they already are. Rather than spending its funding, I dunno, genetically tracking the spread of resistance, the pork lobby wants them to dither around testing thousands more bacteria for resistance.
Second, and I can't remember the exact phrase, they wanted equal contributions from the three agencies that support NARMS (CDC, FDA, and USDA). Basically, this was a way to reduce funding and personnel for NARMS: CDC, through the PHS, lends NARMS a lot of personnel, while FDA and USDA provide a lot of the funding. By calling for equal contributions (which is the dumbest governance 'principle' I've ever heard of), personnel staffing and funding would sink to the lowest agency level.
Of course, while they were doing this, they were also claiming that we need more research. We do need more research, but the ag lobby has consistently opposed meaningful research. I know NARMS personnel want to design rigorous surveillance schemes that would move from farms to the specific slaughterhouses, and then to the supermarkets and hospitals that receive food from those slaughterhouses (or that are near the farms and slaughterhouses). I know NARMS personnel want to use resistance to agricutlure-only antibiotics (e.g., florfenicol) as a genetic biomarker to track the srpead of resistance from the farm to the clinic. But they can barely keep their ongoing projects afloat due to the constant political assault from those opposing their work.
I told you this would happen
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Unfortunately, "Cassandra the Mad Biologist" doesn't have quite the same ring to it.
How many are already creating antibiotic resistance in their herds by giving them without cause? Ask large animal vets what they've seen in their practices.
I think MRSA ST398 is an emerging pathogen and it may well prove itself able to spread through the community as efficiently as USA300 strains. I think we all agree that we need to pay close attention to what strains are appearing in clinical MRSA isolates as well as those in community prevalence studies - especially in rural or agricultural areas.
Having said that, in the context of this NYT article, I think the NPCC has a point. It doesn't seem they are attacking the whole body of evidence that ST398 can spread from animals to humans (not in this very quote), but just this particular opinion piece. We just don't have any information on the patients in the article to assume with any confidence that they acquired ST398. Aside from lacking details about their isolates, we have no information on exposures (Were they farm workers? Children in daycare? Athletes? Nursing home residents? Recently hospitalized?) or demographic information...hell, we don't even know how many patients Dr. Anderson even saw with MRSA.
What we do have is an ecological piece of data, that there are hog farms in the area. This alone is not enough evidence for anyone to claim that any of these people acquired ST398, because this ecologic information says nothing about individual level exposures. For this reason, the article does not add to the growing body of epidemiologic evidence that ST398 is becoming a larger problem.
In conclusion, NPPC has every right to call the opinion piece "highly speculative", but peer-reviewed studies with isolate and exposure information cannot be effectively contested with these same claims.
The penicillins, including methicillin, all kill bacteria by blocking the formation of cell wall material during bacterial cell division. Thus they are bactericidal.
However, if exposed to a concentration of the penicillin just one tenth of the amount required to kill the cells, staphyllococci cells instead of being dissolved and dispersed, develop into l-forms - they appear like minute elongated worms, with cell walls only outside and no cells dividing their length.
The main two problems with the spread of methicillion resistant staphs are
1) the careless way in which medicla nsad nursing people in hospitals spread small amounts of the antibiotic about in the environment by squirting some out of the syringe to eliminsate air bubbles before injecting the antibiotic into the pstient.
2) the habit of bacteria of various sorts to swap genetic mstierial, such ss antibiotic resistance, between each other through small pseudopodia that make contct between them.
Both of these pheneomena described above have been knwon about since the late 1950's when I was engaged in the development of the semi-synthetic new (then) penicillins, and I took several microphotographs of both l-forms and the exchange of genetic msterial between different classes of bacteria.
Resistant strains are selected by the giving of too low doses of antibiotics, by too short courses of treatment, and by careless disposal of aerosolised antibiotic from syringes prior to injections being given.
Of course, if proper cleaning still took place in hospitals, the resistant strains would still be removed. In Swedish hospitals they have NO cases of infections from MRSAs, even in Belgium they have far less than in the UK. Since the advent of cost cutting subcontracted cleaning services matters have become far worse in the NHS.
Briar
If you think the pork lobby is bad, you need to come to Camden Indiana and read the local news and watch the local TV reporting. This little town, the subject of Kristof's March 12 article is hearing a lot of half truths and denials. Yes, we don't have any research showing that MRSA ST398 is in the hogs or in the workers. But we have no tests showing it is not. And no one is willing to have their animals or workers tested. It's "what you don't know won't hurt me" attitude around here.
This is great work you're doing! Keep it up. I just invited the Faculty of Agriculture to a public debate on intensive livestock operations (for which they train our students --and teach them all about the greatness of sow stalls).
The language the professors use is exactly what you describe: "at this time, the sows are fine; at this time, I can't make a recommendation; at this time; blhahahahhh"
Take care. Keep up the fight.
D