Hello. I work for public health. My job is to support the computer systems that allow epidemiologists to track 'superbugs' (and regular ones).
Deathcerts is an interesting dataset. It's not the only one.
Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked.
There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent just HOW resistant a particular bug is to a standard battery of antibiotics, broken down per antibiotic.
That data is transmitted from the labs that performed the test to the state health department where it is analyzed.
Fascinating article, but there's NO WAY that Reuters had that much contact with state public health folks without being aware that they track lab results. Misleading!
Edit: elaborated about the susceptibilities results.
Fascinating article, but there's NO WAY that Reuters had that much contact with state public health folks without being aware that they track lab results. Misleading!
This shouldn't be surprising. Imagine if Reuters wrote an article that said:
- Everyone acknowledges that superbugs are an issue
- Hospitals are doing their best with their limited resources, but overall are capturing a good deal of data
- The data systems are old, but the CDC can get the data and with some manual work process it, but it takes time
- Everyone agrees that more could be done, but they also agree it's complex and nothing is perfect.
From the subhead: "government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem"
I ask as someone who is quite a novice when it comes to knowledge of what is the expected reporting requirement: That subhead is a blanket assertion, but when applied to the death-by-MRSA issue, do the public have access to accurate, up-to-date information? If not, isn't that assertion partially correct?
OK, so somebody's tracking it in secret, doing the 'antibiotic susceptibilities' tests and logging the results, and the state health dept receives the data, but the info is being kept from the patients' relatives and from the public in general?
This creates two obvious results. 1) suppression of legitimate claims from relatives, and 2) suppression of valid concern and pressure for govt action such as increased research funding.
I'm not saying it is good. I'm just saying that there is more than one thing going on here.
I don't think hospitals have any motivation to hide antibiotic-resistant infections ("superbugs") specifically. HOWEVER, the motive to hide hospital-acquired infections[0] is clear!
Here's some mud in the water: what's the difference between a HAI with some bug that is easily killed by antibiotics vs. an antibiotic resistant bug?
As for "tracking it in secret", that's one way to put it, but it will cloud your thinking. :) Your own medical records--specifically blood test lab results--have your name, address, and phone number on them. Consider replacing the word 'secret' with 'private' and re-working the whole thought.
You start out by saying that the article is "misleading", and that MRSA is tracked. The article is pretty convincing that it's not accurately reported.
Then you agree with the article that "the motive to hide hospital-acquired infections is clear".
I stand by my assertion that nobody is trying to "hide" the "superbug" problem.
The human tendency to not self-report failures is a thing. But it's not some kind of biohazard conspiracy.
And one more thing about the death certificates...
> In a statement emailed to Reuters, Frieden said:
> "While death certificates provide helpful
> information, the unfortunate reality is that they
> don't provide in-depth clinical information."
I'm guessing that Frieden, the boss of the whole CDC, went on to say something like: "But it makes sense, because death certificates are primarily legal records. The clinical information lives in medical records." OR, OR, something more accurate. That's why he gets the big bucks. :)
Well, you know more about this space than I do. So maybe it's not so bad...
But the article sure makes it sound like hospitals are hiding MRSA-related deaths, since MRSA infections are often "hospital acquired". And we all agree that hospitals would have an incentive to hide these numbers.
And the apparent under-reporting seems to indicate that this is in fact what's going on. This sounds like a problem! Thanks a lot, dishonest hospitals!
> There’s also a powerful incentive not to mention a hospital-acquired infection: Counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage.
Or (perhaps more likely) Medicare/Medicaid and/or private insurers might start penalizing the ones that are screwing it up (by renegotiating contracts and reimbursements). I know of one center where executive laziness led to a $2 million fine (completely unjustified) for a line infection in an immunosuppressed patient. Which was cleared up in hours, probably didn't come from the line to begin with, and got said executive fired (because if there's one thing hospital "leadership" understands, it's money).
Actually I have all sorts of examples of the above, but the point is that oftentimes the data is "corrupted" on the way to the collection point(s). Anyways, the executive (VP of some bullshit) got his walking papers and funnily enough, no more reportable line infections that didn't come from lines.
So at least sometimes there are happy endings, sort of...
Sorry, I am a little confused. Why was it a happy ending? Because the VP was just a titular post? Also, looking at your comment, it reads like the problem went away not because the hospital improved, but because the data stopped being reported. This does not look like a happy ending either. And if the line infection was cleared up in hours, how did it also "probably didn't come from the line to begin with"?
The VP was a douche and the "line infection" was almost certainly not from a line in the first place. The patient was on IST, so calling any random opportunistic infection a central line infection is (at best) irresponsible.
CLIs are only supposed to be reported when the central line can reasonably be implicated as the vector and the blood is the primary infection site. Neither was established.
As far as cleaning up procedures, there will always be room for further improvement, but that's no reason to accept a $2 million fine (which still had to be paid) as a cost of doing business when the "root cause" was incorrect reporting.
Daveloyall is correct. I'll add that pretty much every local hospital system has their own database of antibiotic susceptibilities that is updated regularly so that doctors can prescribe the best antibiotic for the microbe populations specific to their region. Pretty nifty.
Strange, so that basically refutes the a pretty core point of the article (that it isn't being tracked).
The reason they said doctors don't put it on death records is because they dont always want to wait the 2-3 days it takes to get results back from the labs. So it makes way more sense that the labs record the bugs. Instead of doctors in the field.
Those are the people who are trained to detect the bugs... so they should be responsible for tracking them. I presume they could get indications from the doctors on whether the patients died as well.
Couldn't the doctors update death records after-the-fact? If they found out afterwards what the actual cause of death was, they should really being recording that.
Update... I asked around the office and learned more about this. TL;DR: I'm less right than I thought.
Specifically regarding tracking cause of death:
Not every disease or condition is "reportable". Each state maintains a list of reportable diseases. When a hospital/lab (hereafter: facility) encounters a disease on the list, then they are required to report it.
State health departments will open investigations in various circumstances. You've seen events like e. coli outbreaks in the news--those always precipitate an investigation. There are also investigations associated with individual infections, i.e. every case of tuberculosis.
If a patient involved in an investigation dies, public health will find out.
But, if a patient dies from (because of) an infection that wasn't on the reportable list, then public health won't know the cause of death unless it is on the death certificate. Just like the article says!
Regarding tracking the susceptibility of bacteria to antibiotics (superbugs):
Any sample that is tested for antibiotic susceptibility is reportable. The results of that testing generally include the specimen source, but don't include why the test was ordered (i.e. because some person has sepsis and might die) and certainly there's no (deliberate) relation between this data and cause of death.
Really fascinating to me how some of the problem originates from the lack of proper coding standards:
> As examples in this article show, superbug infections are often omitted from death certificates. But even when they are recorded, NCHS can’t feed that information into vital statistics: The World Health Organization (WHO) classification system the agency uses lacks mortality codes for most drug-resistant infections, though it has codes for more than 8,000 other possible causes of death.
> The CDC added codes for use in the United States for terrorism-related deaths a year after the Sept. 11, 2001, attacks. It could do the same for deaths from drug-resistant infections. Officials told Reuters the CDC is instead working to incorporate the codes into the WHO’s next revision of the international classification system. The revised system is expected to be completed in 2018 but not fully in use until the 2020s.
Part of the issue is assigning "cause" (singular) of death. I'm still kind of shocked that there isn't mandatory reporting of bacterial vectors (when identified) the way there is for (eg) tumors. Sepsis is common enough that positive identification of the primary strain(s) involved could be a huge unfunded mandate, though, and judging by the way Zika is going, unfunded is being optimistic.
Fastest growing source of CMS billings over the past 10 years and one of the top 20 causes of death overall. In the US, it seems that nosocomial cases are rising faster than expected (larger proportion of the total) which is especially worrying.
As far as the "old" crowd -- who gets sick most often?! It certainly isn't strapping young men and women, not in any hospital I've ever been in outside of a war zone.
From the wikipedia page, it seems more common than you would think. In the US it is the 10th most common cause of death, and globally kills 200k a year.
This is why antibiotics use in livestock should be a top question in international trade. Not only should every country stop using antibiotics in healthy livestock, all imports of meat and animals from such countries should be banned, and to take it one step further - stop importing umbrellas and calculators from those countries too, in order to apply economic pressure.
> Not only should every country stop using antibiotics in healthy livestock
Antibiotics are not used for healthy livestock in many countries. The US is a very notable exception.
It comes down to cutting costs. In the US, it's not typical to clean the facilities between batches of animals like chicken. This mean that the new batch would contract any bacteria left behind the previous animals. It's not even that big of a cost, I'd call it borderline negligence.
I agree with you, this practice should end. Giving antibiotics to livestock at all is harmful and it should never be done as a precautionary measure.
On smaller farms, isolating or just killing the sick animals would be fine but that will not work in industrial scale.
This is not the reason antibiotics are given to livestock. A wide class of antibiotics, when delivered in subtherapeutic doses, increase feed conversion efficiency and result in larger animals for the same feed inputs.
So yes, it's about costs, but not for the reasons you cite.
But that's irrelevant, it's a cost cutting measure with harmful consequences to the society as a whole. The regulations and producer prices should be adjusted to make small to medium scale farming profitable and stop the antibiotics madness.
My mother in law, a healthy 50 year old, recently died of an unspecified infection. They still don't know what it was or why antibiotics weren't helping. Ultimately, her lungs gave out after more than a week on life support.
Was it a superbug? Dunno, and nothing in her medical record leaves any indication that it might have been, the world just moved on.
Condolences, it's rough when someone close is taken suddenly. Can't brace yourself for something you can't see coming.
Part of the problem is the sheer volume of such cases -- where did the infection come from? Why did it get worse so fast? Was it bacterial, viral, fungal? The diversity of microbial life on earth is so vast, and the rate of evolution so quick, that any one center is going to be hard pressed to keep up just cataloging new strains, let alone figuring out what sequence of drugs to try.
This is why it is a national tragedy (at least in the US) that we don't put more emphasis on funding the CDC. Other countries do better or worse, and particularly some states like Minnesota do a lot more. But I can reasonably guarantee that the possibility of humanity being devastated by an easily transmitted bacterial or viral vector is greater than anything a YF-22A is likely to ward off. A centralized repository and clearinghouse can do so much more than any one center, even the richest hospitals, because it can (in principle) see everything at every center. Just needs enough funding and oversight to get the job done.
I recognize that nothing can bring your MIL back, but perhaps if the CDC were given a bit more respect (instead of being a political football to defund abortion and legalize Confederate flags, as at the present), you might have some answers and the next person in that situation might pull through. No guarantees in life, but it seems like a higher expected return on investment than many government priorities. JMHO.
Sorry for your loss, and the open questions around it.
There was an article a few years ago about the fall of the medical autopsy rate. Because it's unclear how we fund it, and most people aren't in a position of knowledge to request it (or in a financial position to pay for it), the rates of autopsy to find a considered cause of death have been dropping precipitously.
Atul Gawande talks about this a lot in "Complications" [1]. A great book about medical procedure, and specifically about the process of learning, trial and error and the whole feedback loop of working with disease.
When my grandfather died with cancer and fibrosis, one of the main complications involved in getting compensation from EEOICPA was the fact that his county doesn't have a coroner. They have a "medical examiner" who is based 70 miles away and never visits, plus some nurses he employs. As a result, death certificates in that county are only signed in extraordinary circumstances. The federal bureaucracy doesn't accept unsigned certificates for the purpose of establishing a cause of death. The county medical examiner is paid a flat yearly fee, so guess how many autopsies he performs?
We shelled out for a private company for an autopsy, but post-mortem, lots of things happen to the body that make identifying a source of an infection really hard – basically, it didn't tell us anything new :(
Bear in mind that in the US, our lovely republican party literally made it illegal to research where the superbugs are being bred.
In the US, the problem is mostly pig and cattle feedlots that rely on antibiotics to keep the animals from being sickened but he crowding. Naturally, there is no proof that superbugs are coming out of the feedlots, because the feedlot owners do not allow any sort of sample collection by scientists.
Now comes the GOP with the "ag-gag" laws, which don't just ban sneaking into these feedlots with cameras. They also ban the smuggling of manure samples from the feedlots.
This is the GOP's war on science: they literally criminalize it.
> Naturally, there is no proof that superbugs are coming out of the feedlots, because the feedlot owners do not allow any sort of sample collection by scientists.
"In the bed of a truck that they parked on county roads adjacent to ten Lubbock-area feed yards, they set up small, generator-powered vacuums. On a number of windy days, they collected upwind and downwind air samples. The results confirmed their suspicions: downwind, they found antibiotics—specifically tetracycline—present at significantly higher levels than in the upwind samples. Yet as they dug deeper, they discovered something even more worrisome. Along with the antibiotics, they found another hitchhiker: remnants of bacteria that had acquired a gene that made them resistant to tetracycline." (1)
The article also describes the pushback from the CFA (Cattle Feeders Association)
What states are you referring to? Most of these laws that were introduced in the 1990's have all been deemed unconstitutional in the states where they were passed. Not to mention, any other states that have attempted to pass these laws have failed.
I'm sure you enjoy demonizing the GOP, but I don't see much merit in your argument if there are no states where these laws are currently in effect and nobody has been successfully convicted of violating these laws.
According to that link, the laws are mostly recent, passed in the 2010s rather than 1990s, e.g. 2014 for Idaho's and 2012 for Missouri's. And I don't see anywhere there that they've all been struck down. Only one is mentioned as having been struck down, Idaho's, and from what I can find that's still being litigated, currently being heard by an appeals court [1].
Farmers massively administer antibiotics so they can keep animals in crowded/unsanitary conditions. If antibiotics were administered properly that would severely affect their revenue.
- Constantly feeding livestock antibiotics makes them grow bigger. The mechanism for why this happens is not understood (but who cares because bigger livestock means more money).
- It is costly to deal with an animal after it gets an infection rather than just being preventative.
- Farmers are scared about diseases sweeping through their herds and causing issues where they are forced to kill the whole herd (e.g. mad cow disease -- though antibiotics don't prevent prion diseases).
I would much rather pay 1% more for my food than 10% more for may healthcare. For many there will be no amount that can be paid to keep up with antibiotic resistant bacteria, it will kill people.
I am sure that farmer's would rather risk their livestock than risk their children or grandchildren.
I think the only way this practice can exist is when people do not understand or are coerced into doing it. Many of the largest farms just have people following rote instructions and not actually understanding what is happening.
Let's compare to an easier to understand industry, think about fast food. The people in the kitchen at a McDonald's don't need to know how to cook, they follow the instructions and put uncooked meat in a machine and food comes out of the machine. If that process killed kittens somehow the McDonalds worker would never know.
I suspect the near minimum wage workers manning livestock farms and farmers that might not have the benefit of a full education, simply don't or don't accept that antibiotic abuse creates a breeding ground for something will kill some of their children.
>I am sure that farmer's would rather risk their livestock than risk their children or grandchildren.
you're kidding right? sure economical impact today vs. theoretical risk to grand/children tomorrow - Nov 8 will show how many people and of what demographics what choice would make, and I'm somehow sure what choice the farmers would make :)
I am not kidding. I am in one of those red states at the moment and most people doing the farming literally do not believe or accept anthropogenic global warming.
When the discussion is calm enough, they do largely agree that they wouldn't do anything harmful to their children or their farm's legacy. The just don't think global warming is real so their low mpg cars don't contribute to harming their farm.
Combine this with the fact that people defending a stance often become emotionally entrenched and likely they will continue to believe global warming is not real until they can no longer plant corn. Then once that emotionally devastates them, or some similarly life shattering cognitive dissonance destroying event occurs, they can take a look with fresh eyes.
EDIT - I know this is mostly about glbobal warming and the original discussion related to antibiotic resistance, but largely the resistance is from uneducated super-conservative people with a fundamental religion and a fundamental distrust of science. I really see these two problems as two sides of the same coin.
that is dialectical smile - for example, ignoring climate change by voting red the farmers from the mid-states are thus letting the climate change to proceed to the point where open-air farming in those states becomes impossible, and thus they are basically selecting themselves out...
If I had to speculate I would say that they grow bigger since the animal requires to spend less energy in its immune system, resulting in a surplus of energy that is spent in growth.
"The thoughtless person playing with penicillin treatment is morally responsible for the death of a man who succumbs to infection with a penicillin-resistant organism."
It should be noted that Fleming discovered Pencillin and the statement is especially prescient coming from him. He spoke countless times around the world trying to raise awareness that antibiotic resistance would be inevitable when used improperly.
The nightmare scenario is medical science gets rolled back by a century as non-trivial infections return to being a death sentence.
OK and how do you locate and invoice all of these morally responsible individuals who have led to this resistance? It's hundreds of thousands of doctors. I doubt their malpractice insurance will cover this. And then aside from the unnecessary prescriptions, because the ignorant patient-consumer demanded it, is the ignorant patient-consumer who doesn't take the entire prescribed dosage which is itself the far bigger problem that lead to resistance. How are they punished and insured for their immorality?
I think you've mistaken moral for legal. We don't punish immorality except through social and cultural pressure, or to make it a legal issue, and then we aren't punishing morality so much as legality (even if rooted in morality).
>Farmers are few, people who get diseases are many. Shouldn't be too hard.
"Concentrated benefits, dispersed costs." Farmers are highly organized and vigilant in defense of their subsidies and regulations, whereas sick people are not similarly organized and the policy connection to their condition isn't obvious. Concentrated benefits are what create special interests, which by their nature put their own interest ahead of the national interest.
>I know it's not, we reap the benefits in lower food prices, but does beef really need to be cheap enough we can eat it 7 days a week?
No it is. The total cost to society has to include healthcare costs as well. Saying, 'This lowers our cost at the dinner table' is only looking at part of the equation.
Never mind that people don't eat dinner together which is a by product of having super cheap convenient packaged calories available. Eating as a family increases child development significantly, it's like the cheapest thing you can do to give kids a good start.
Never mind that we don't really need nearly as much corn as we produce. When the farm bill came out and started picking agricultural winners, we turned garbage farm land into prime producers of a crop that we don't need. Then we added tariffs to sugar imports, then we put corn into everything, providing a cheap source of calories and diabetes, heart disease, perhaps cancer (most of the links here are still from correlation and haven't been proven as causation). Corn moved from a side dish to being in everything you eat unless you are cooking all (most) of your own food.
We have the (possible) super bug issue from our meat sources.
It takes like 50 gallons of water to grow an avocado but we do that anyways because irrigation water is subsidized in many states even as we start to drain our reservoirs.
It takes 2 calories of fossil fuel to make one calorie of food. We do this because it's still cost effective because of subsidies.
The whole picture makes it look not quite as cheap, we've just pushed the cost into other categories to hide it.
> It takes 2 calories of fossil fuel to make one calorie of food. We do this because it's still cost effective because of subsidies.
I think "we do this because we can't eat fossil fuels no matter how many calories they provide, so trading total energy content for ability to serve as food is valuable, independent of subsidy" would be more accurate.
Partly, but we can grow food in a more efficient way. It's currently cost prohibitive because we use feed lots, and subsidies water and fuel for farming.
I think you have an unrealistic view of what mother nature is like. Wild animals (i.e. not in feed lots) succumb to disease, including bacteria infections all the time. Even with free-range animals, you'd have a ton of livestock dying (and suffering needlessly) if you never allowed antibiotics to be used.
I think the idea is to ban their use for purely profit reasons (though that leaves a loophole where medical care is claimed when the intent is just to increase growth of the animals for profit).
And Democrats are powerless to prevent the GOP from "criminalizing science"?
How about having the mainstream media news talk about it, and then some kind of general vote on whether "ag-gag" laws should be repealed immediately?
You think the public might support the idea?
Of course. It would be simple to get it repealed with massive public support and outrage. So why don't they do it?
Might it be that shafting the general population is a bi-partisan effort after all, just like with SOPA / PIPA / CISPA / NDAA / TPP / TTIP and so on ad infinitum?
> And Democrats are powerless to prevent the GOP from "criminalizing science"?
Basically, yes.
> How about having the mainstream media news talk about it
The "mainstream media news" doesn't work for the Democratic Party (in fact, it mostly is owned by corporations that preferentially support the Republican Party, though people tend to get confused by studies showing that workers in much of the media lean Democratic, as if firms were directed by workers rather than owners.)
Should someone be allowed to sneak into a company's building, or pretend to be an honest employee, just to investigate potential wrongdoing? That's the government's job, not private activists'.
If someone wants to walk into your private property and research your operations, you should have the right to tell them to beat feet. If there is a legitimate public interest then the government should create an inspection scheme; there probably should be one but that's a separate debate. But allowing guerilla espionage by activist groups is not an acceptable alternative.
I sort of agree with you, but the laws overstep what I consider acceptable.
I'm fine with an operation banning employees from filming, for example, and employees getting fired for doing so, or for arresting people for trespassing.
The laws referenced by the OP go further, though, to criminalize recordings that were taken by individuals who were allowed on the property by the owner, and who were documenting what happened. In my opinion, owners have the right to fire employees who violate their policies, and to sue former and current employees for libel, but not to sue former and current employees for distributing recordings of things that actually occurred, when there's no reasonable expectation of privacy (which almost by definition is impossible in a workplace, except for maybe things like medical settings).
I agree with you, though, that if there's a public health interest, the government should create laws regarding that, or at least give authority to DPHs to do that.
This is my thinking as well. It means your hothead animal rights person can't assault your staff, tresspass, visit with fake credentials, etc for a political agenda. Property rights do matter, regardless of the exceptions the left keeps trying to give itself against the non-left.
If this is really a public rights issue and lets assume the entirely of the GOP has been paid off, from POTUS to dog catcher, then where is the Democratic response? Oh right, it doesn't exist, because this is a non-issue outside of extremist views. Its trivial for any political group to start a case and get it to SCOTUS if they believe any of this is unconstitutional. Its trivial for law enforcement to get warrants against these farms if they're violating the law.
I do understand the controversy here, but I think in the end, whistleblowing will always come with some risk. Its a little naive to think it doesn't. I think most people are okay with that because casual whistlblowing becomes office politics, meaningless outrage politics, and endless bikeshedding. There should be a high threshold for exemption to the laws that guarantee our freedom and rights.
There is legitimate public interest as these sites are key components of the food production system. The point that the OP was intentionally making is that the government (via GOP leadership, apparently) has specifically excused itself from creating such an inspection scheme and done so in a way that seems comprehensive enough to understand the alternative paths "guerilla ... activist" scientists could even potentially report on such a matter.
That the government is failing to investigate something cannot be a license to trespassing or lying your way to a private investigation. If you want government action on something, then you have to win in the political process. Taking matters into your own hands and assuming the powers reserved for the government is not acceptable.
===================
Replying to swashek below since I'm rate-limited: what are you talking about "thought crime"? None of the laws here concern thought or the freedom to publish your thoughts. They ban conducting suriptitious investigations on farms, which necessarily involves either trespassing or deceit in gaining access (e.g. an activist getting himself hired as an employee)
Where do you see ANYthing about trespassing, and how do you interpret ANYthing that either I or the OP stated as condoning it? It was simply stated that trespassing is clearly defined as illegal. Lobbyists have cornered winning in the political process so all we have is our voice, which it sounds like you're trying to take away.
Even as a country of laws (which I support), you still have to be able to admit that said laws are absurd when they are, in fact, absurd. This goes beyond absurd and endangers the populace. You seem more interested in ensuring that we definitively prosecute thought crimes rather than work to change the system which, at face value, appears to place the government as accessories to the wrongful deaths of many of its citizens (keeping focus on this particular topic). As such, doesn't OP have the right to criticize and suspect the government, especially when the government is ostensibly blockading one of those "inalienable rights" of "life ..."
This comment was fine-ish up until that last line. Please edit it away.
I don't think that the person you're replying to is suggesting that the law should remain as-is. Rather, he's suggesting that the law should be modified via the established political processes for doing so. I'm not sure where you're getting the "thought crime" thing -- even if he supported the ag-gag laws, it wouldn't be thought crime to say so, and he wouldn't be accusing others of thought crime by saying so. This is simply called a "disagreement". It doesn't need to be dramatized.
Of course OP has a right to criticize and suspect the government. Who said he didn't? That doesn't mean OP has the right to disregard property boundaries or to enter a private premises under false pretenses, even if the stated intent is to "prove antibiotics in farm animals are causing human superbugs".
If one believes that the local trespassing laws should be modified to accommodate persons acting in this particular public interest, he should contact his local representatives, or, alternately, run against them and lead the charge himself.
It is probably much easier to convince someone in one of the several government bureaucracies to open an investigation than to get a special exception to trespassing laws codified.
> If there is a legitimate public interest then the government should create an inspection scheme
The problem is that the public doesn't always know any better or know what is going on without the undercover folks investigating and making a big deal about it. It would be different if we could trust policy makers to investigate some of the stuff or listen to the science, but at this point (at least in the US), that's not happening.
>That's the government's job, not private activists Sure, maybe it is the government's job technically. Unfortunately, that doesn't always work. In addition to the above, many governement oversight programs are underfunded or have had their power legistlated away. On top of all that, companies aren't always upfront with letting an inspector see the normal daily operations.
Ancedotes I worked as a CNA in a nursing home. They were commonly understaffed. This is fairly common with nursing homes in the state I was in. There was a state agency that checked such things, but it seemed the nursing homes always had a notice when they were going to visit. Suddenly, they had a lot of manditory and voluntary overtime available and stuck to the rules. If the visits were sporadic, more often, and they checked things like logs and historic staffing levels, I'm guessing this would change. I think the only way to get this improved would be for enough private activists to gather evidence from many different places and get state laws changed after making a public outcry.
Ancedote 2 I worked in a food factory for a day or two. Now, they were horrible employers for various reasons, but the facility was clean and there was a lot of focus on meeting food prep safety guidelines. In fact, there were USDA employees assigned to that factory, and they could not run without it. Actual oversight. But food factories might not have been like this had it not been for private activists, and it still isn't perfect. One still hears horror stories in small towns with a meat processing plant, for example, but I have no clue if they are true or not.
>Should someone be allowed to sneak into a company's building, or pretend to be an honest employee, just to investigate potential wrongdoing? That's the government's job, not private activists'.
It was legal for the entire history of the Republic, albeit it was also grounds for civil litigation.
"That's the government's job, not private activists'."
Taking a broad view, I disagree. Everything the government is permitted to do is (or at least should be) ultimately by consent of the governed. Anything that is the government's job is only their job because the governed delegated it to them; it is the job of the governed first, delegated to the government. It is private activists' job; the government has simply been tasked with it.
I believe the governed have a moral duty to take back any such job when the government proves unable to properly execute their duties.
The line of "unable to properly execute" is, unfortunately, enormously open to interpretation. Morality isn't easy.
> If someone wants to walk into your private property and research your operations, you should have the right to tell them to beat feet.
To the extent that there is a valid right here, how is regular, generally-applicable civil and criminal trespassing law an insufficient vindication of the valid rights at issue so as to require special additional "ag-gag" laws providing additional privileges to a particular industry?
> Should someone be allowed to sneak into a company's building, or pretend to be an honest employee, just to investigate potential wrongdoing? That's the government's job, not private activists'.
So Upton Sinclair was wrong to go undercover to gather material for his book The Jungle?
In case you're not aware, until the 80's, American law practically encouraged a level of industrial espionage, because it discouraged reliance on trade secrecy and therefore encouraged the dissemination of knowledge. And yes, because it enabled undercover investigations of wrong doing, both the illegal and what ought-to-be illegal.
It's the flipside of the factory farm and overprescriptio fiascos. Yes, those are bad, but we haven't discovered new types of antibiotics for decades... and many diseases get far less attention, because of patents and silos. Even researchers working as a result of public funding are snapped up by big pharma once they make a discovery which then acts as a parasite on the public money.
Science progresses when anyone, anywhere, can contribute. Same with open source. It is the reason Wikipedia is larger than and just as accurate as Brittanica or any other encyclopedia. It is the reason Android runs on so many phones, and Linux runs on toasters. It has given us everything from WebKit to Wordpress and created a massive amount of solutions for the LONG TAIL instead of just boutique drugs.
It took 30 years to discover a new antbiotic type:
The question that comes to my mind is, are the European countries doing any better in tracking MRSA, etc. infections? They certainly exist. One might hope a more centralized health-care system, not balkanized like the USA one[1], would keep better records. Do they?
I think 'balkanized' is good word to describe some health-care systems in Europe.
However I think there is a basic difference in approach. Hospitals in europe are usually uber clean, everything is desinfected and there is a small army of cleaners. My impression from US is that McDonnald was cleaner than hospital.
Second difference is post-operation treatment. People in weakened state are left in hospital for a few days for monitoring. With broken immune system (after chemotherapy) you get into strict hermetic isolation. In US leukemia patients go to hotel after treatments.
> My impression from US is that McDonnald was cleaner than hospital.
I'm really interested in this. Where were you? Because my impression of the US is that they are very thorough on the small stuff … because they can pass the bill on to someone for taking precautions, whereas they can be sued for not taking them.
By design. The dramatic recounting of terrible but rare diseases as if they happen as often as sneezing keeps you reading. Eyeballs on ads == $$$ for the publisher.
MRSA is Staph Aureus, a gram-positive organism, and colistin is only (to my knowledge) used in treating gram negative infections (such as e coli, which can carry mcr-1).
MRSA can be treated with a number of different antibiotics, including vancomycin, daptomycin, linezolid, Bactrim, and clindamycin to name a few. Teixobactin is not yet on the market or approved for use in humans.
Or only go to the top hospitals in the country. Comparing how the staff at a place like MD Anderson manages sanitary conditions compared to county or state hospitals is mind boggling.
Even with in the same state and county it is pretty mind boggling the differences from hospital to hospital. For example in Massachusetts where we are known for having some of the best hospital there are still certain hospitals in the greater Boston area to seriously avoid...
Non-native speaker here, I would probably express my condolence in the same way ("I'm sorry for your loss"). What is so wrong with these words that they deserve WTF?
I skimmed the article, I only saw mention of MRSA. Is that the "super bug" they talk about? This is for the most part why I won't step foot in a hospital unless I am literally on my death bed. The last research I read about MRSA (years ago) was it was hard to study because lab rats could not be easily infected with it unless it was directly injected into their blood stream. This shows just how nasty hospitals are. Nobody gets MRSA unless they are in the hospital.
> To estimate the proportion of community-acquired MRSA, we analyzed previous hospitalizations for all MRSA-positive persons in Finland from1997 to 1999 by using data from the National Hospital Discharge Register. Of 526 MRSA-positive persons, 21% had community-acquired MRSA.
My brother got exactly this, presumably from swimming in the ocean during a vacation in the Philippines. I speculate that there was sewage being released into the sea somewhere not far from where he was staying. He lived, but the infection site was pretty nasty to behold.
> No one gets MRSA unless they are in the hospital.
Completely untrue. I personally know of 2 incidences: My cousins child carries MRSA. He doesn't get symptoms, but the rest of the family has to be extra diligent about picking it up from him.
The second was a lady I worked with. She got what she thought was a spider bite on her upper leg, somewhat near the groin region. When it wasn't healing and looking worse, she went to the doctor. Turns out, it was MRSA. She had the same misconceptions as you, so she asked the doctor how she could have possibly gotten it. Turns out, in a miriad of ways, but judging by the location she probably had contact with it on her hands, and then touched her leg when she used the restroom. He suspected it got in through a small cut from shaving, actually. I know for a long while, she washed her hands both before and after using the toilet in public, and was on different antibiotics for some time.
Deathcerts is an interesting dataset. It's not the only one.
Even if death-by-MSRA isn't tracked, I assure you that MSRA itself is tracked.
There's a specific class of lab test called "antibiotic susceptibilities". The results report includes a bunch of numbers that represent just HOW resistant a particular bug is to a standard battery of antibiotics, broken down per antibiotic.
That data is transmitted from the labs that performed the test to the state health department where it is analyzed.
Fascinating article, but there's NO WAY that Reuters had that much contact with state public health folks without being aware that they track lab results. Misleading!
Edit: elaborated about the susceptibilities results.