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<p class="MsoNormal"><font size="3" color="#000099" face="Times New Roman"><span style="font-size:12.0pt"><a href="http://www.washingtonpost.com/opinions/nightmare-bacteria-are-real-and-the-us-needs-to-act-fast/2013/10/20/e457beec-3828-11e3-8a0e-4e2cf80831fc_story.html?wpisrc=nl_opinions">http://www.washingtonpost.com/opinions/nightmare-bacteria-are-real-and-the-us-needs-to-act-fast/2013/10/20/e457beec-3828-11e3-8a0e-4e2cf80831fc_story.html?wpisrc=nl_opinions</a></span><o:p></o:p></font></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><b><font size="4" color="black" face="Times New Roman"><span lang="EN" style="font-size:13.5pt;color:windowtext;font-weight:bold">Opinions<o:p></o:p></span></font></b></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><b><font size="6" color="black" face="Times New Roman"><span lang="EN" style="font-size:24.0pt;color:windowtext;font-weight:bold">‘Nightmare’ bacteria are real, and the U.S. needs
to act fast<o:p></o:p></span></font></b></p>
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<font size="3" color="black" face="Times New Roman"><span style="font-size:12.0pt;color:windowtext"><o:p> </o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><b><font size="4" color="black" face="Times New Roman"><span lang="EN" style="font-size:13.5pt;color:windowtext;font-weight:bold">By David E. Hoffman, Published: October 20<o:p></o:p></span></font></b></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><i><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext;font-style:italic">David E. Hoffman is a contributing editor to The
Post.</span></font></i><font color="black"><span lang="EN" style="color:windowtext">
<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">Last spring, Arjun Srinivasan, an associate director of the Centers
for Disease Control and Prevention, delivered a presentation to state health officials with some alarming information. Before the year 2000, he said, it was rare to find cases of bacteria resistant to carbapenems, a class of powerful, last-resort antibiotics.
But by February 2013 they had been seen in almost every state. Srinivasan also briefed Thomas Frieden, director of the CDC. On March 5, Frieden issued a public warning about “nightmare” bacteria,
<a href="http://www.nbcnews.com/health/more-bad-news-about-nightmare-bacteria-cdc-says-1C8701174">
<font color="blue"><span style="color:blue">a family of germs known as CREs</span></font></a>. They can kill up to half the patients who get bloodstream infections from them, resist most or all antibiotics and spread resistance to other strains.<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">Last month, Frieden released a
<a href="http://www.cdc.gov/drugresistance/threat-report-2013/"><font color="blue"><span style="color:blue">report</span></font></a> estimating that at least 2 million Americans get infections each year that are
<a href="http://www.cdc.gov/media/releases/2013/t0916_health-threats.html"><font color="blue"><span style="color:blue">resistant to antibiotics</span></font></a> and that at least 23,000 people die as a result. Margaret Chan, director general of the World Health
Organization, warned last year: “<a href="http://www.who.int/dg/speeches/2012/amr_20120314/en/"><font color="blue"><span style="color:blue">A post-antibiotic era means, in effect, an end to modern medicine as we know it.</span></font></a> Things as common
as strep throat or a child’s scratched knee could once again kill.” <o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">The words of Frieden and Chan ought to make our hair stand on end.
But my reporting for the documentary “<a href="http://ec2-107-21-207-21.compute-1.amazonaws.com/wgbh/pages/frontline/hunting-the-nightmare-bacteria/"><font color="blue"><span style="color:blue">Hunting the Nightmare Bacteria</span></font></a>,” which is to
air Tuesday on PBS’s “Frontline,” suggests that past warnings about antimicrobial resistance were largely discarded. This is not a threat that causes people to jump out of their chairs. It always seems to be someone else’s problem, some other time.
<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">We ought to snap out of our long complacency.<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">Alexander Fleming warned of resistance to penicillin in his
<a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.html">
<font color="blue"><span style="color:blue">1945 Nobel Prize lecture</span></font></a>. But after World War II, the “wonder drugs” seemed inexhaustible and their powers immensely potent, opening doors to new horizons in medicine. Infection no longer meant certain
death. What could go wrong?<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">The answer came in dozens of reports, books and scientific reports
warning that bacteria were developing resistance to antibiotics, in part because of careless overuse. In 1982, Marc Lappé published the book “<a href="http://www.amazon.com/dp/0385150938/ref=as_li_tf_til?tag=washpost-opinions-20&camp=0&creative=0&linkCode=as1&creativeASIN=0385150938&adid=1NPG60SC4DE2XD2BPV6R"><font color="blue"><span style="color:blue">Germs
That Won’t Die</span></font></a>.” A conference held in 1984 at the National Institutes of Health resulted in a study published three years later that noted “the consequence of microbial resistance is without boundaries and the spread of resistance genes has
been tracked among countries throughout the world.” <a href="http://www.tufts.edu/med/apua/about_us/staff.shtml">
<font color="blue"><span style="color:blue">Stuart B. Levy of Tufts University</span></font></a>, a pioneer in researching resistance who had overseen the NIH study, published a book in 1992, “T<a href="http://www.amazon.com/dp/0738204404/ref=as_li_tf_til?tag=washpost-opinions-20&camp=0&creative=0&linkCode=as1&creativeASIN=0738204404&adid=1MW8E7DXVEQSCY25MPD5"><font color="blue"><span style="color:blue">he
Antibiotic Paradox: How the Misuse of Antibioitcs Destroys Their Curative Powers</span></font></a>.” The Congressional Office of Technology Assessment weighed in with a
<a href="http://ota.fas.org/reports/9503.pdf" target="_blank"><font color="blue"><span style="color:blue">massive report</span></font></a> in 1995. Since then, there has been a stream of popular books and articles.
<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">If Frieden is right, a public health crisis demands more than a business-as-usual
approach in Washington. I found smart people at the CDC, NIH, the Food and Drug Administration and elsewhere all working on the resistance crisis, but it is almost impossible to find anyone at — or near — Cabinet-level who is leading the charge. I am told
the main coordinating effort is an <a href="http://www.cdc.gov/drugresistance/actionplan/aractionplan.pdf" target="_blank">
<font color="blue"><span style="color:blue">interagency task force created in 1999</span></font></a>. It meets once a year.
<o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">Our indifference can’t be chalked up to lack of evidence. Resistance
is real. <o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">But politically, there is no active constituency — no patient groups
marching in the streets. We take antibiotics for a short period and then forget about them. And hospitals, which can be cauldrons for resistant bacteria, often remain silent about infections and outbreaks out of concern for adverse publicity and patient privacy.
Yet another dimension of the crisis is that the economics of drug development have led major pharmaceutical firms to abandon research into new antibiotics while they pursue more lucrative therapies for chronic disease. The antibiotic pipeline is slowly drying
up. <o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">President Obama ought to shake us out of this lethargy and appoint
someone to tackle antimicrobial resistance across all fronts. The goals are clear: far more detailed, national data reporting; improved stewardship of existing antibiotics; and a major antibiotic drug discovery and development effort. We shouldn’t expect government
to do it all. This crisis will require truly broad collaboration, including scientists, clinicians, hospitals, regulators and the pharmaceutical industry. But government can light a spark and galvanize people toward a result that each could not achieve acting
alone in the face of a real threat. <o:p></o:p></span></font></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><font size="3" color="black" face="Times New Roman"><span lang="EN" style="font-size:12.0pt;color:windowtext">Antimicrobial resistance is driven by evolution, a relentless process.
But we shouldn’t throw up our hands. We do not have to return to the pre-antibiotic age. To sustain the wonder in wonder drugs, to find a way forward, a little leadership would go a long way.
<o:p></o:p></span></font></p>
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<p class="MsoNormal"><font size="2" color="navy" face="Times New Roman"><span style="font-size:10.0pt;color:navy">Deborah L. DeBiasi</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><b><font size="2" color="navy"><span style="font-size:10.0pt;color:navy;font-weight:bold">Email: Deborah.DeBiasi@deq.virginia.gov</span></font></b><b><i><font size="2" color="red"><span style="font-size:10.0pt;color:red;font-weight:bold;font-style:italic"><br>
</span></font></i></b><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">WEB site address:
<a href="http://www.deq.virginia.gov/">www.deq.virginia.gov</a></span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">Virginia Department of Environmental Quality</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">Office of Water Permits
</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">Industrial Pretreatment/Whole Effluent Toxicity (WET) Program</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">PPCPs, EDCs, and Microconstituents<o:p></o:p></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Times New Roman"><span style="font-size:11.0pt;color:navy"><a href="http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx">http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx</a></span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy"><o:p></o:p></span></font></p>
<p class="MsoNormal"><font size="2" color="navy" face="Times New Roman"><span style="font-size:10.0pt;color:navy">Mail: P.O. Box 1105, Richmond, VA 23218</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">Location: 629 E. Main Street, Richmond, VA 23219</span></font><font size="2" color="navy"><span style="font-size:11.0pt;color:navy"><br>
</span></font><font size="2" color="navy"><span style="font-size:10.0pt;color:navy">PH: 804-698-4028 FAX: 804-698-4032<o:p></o:p></span></font></p>
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