Stuff that isnt from

openevidence

Disease Stuff - Brought to you

by totalnoob
Sorry a lot of this isnt highlighted

General No Impact
Diseases wont cause extinction burnout or variation
York, 6/4/2014 (Ian, head of the Influenza Molecular Virology and Vaccines team in the Immunology and
Pathogenesis Branch, Influenza Division at the CDC, former assistant professor in immunology/virology/molecular
biology (MSU), former RA Professor in antiviral and antitumor immunity (UMass Medical School), Research Fellow
(Harvard), Ph.D., Virology (McMaster), M.Sc., Immunology (Guelph), Why Don't Diseases Completely Wipe Out
Species? 6/4, http://www.quora.com/Why-dont-diseases-completely-wipe-out-species#THUR)

mostly diseases don't drive species extinct. There are several reasons for that. For one, the
most dangerous diseases are those that spread from one individual to another. If
the disease is highly lethal, then the population drops, and it becomes less likely
But

that individuals will contact each other during the infectious phase. Highly

contagious diseases tend to burn themselves out that way. Probably the
main reason is variation. Within the host and the pathogen population there will be a wide
range of variants. Some hosts may be naturally resistant. Some pathogens will be less
virulent. And either alone or in combination,

you end up with infected

individuals who survive. We see this in HIV, for example. There is a small
fraction of humans who are naturally resistant or altogether immune to HIV, either because of their CCR5
allele or their MHC Class I type. And there are a handful of people who were infected with defective
versions of HIV that didn't progress to disease. We can see indications of this sort of thing happening
in the past, because our genomes contain many instances of pathogen resistance
genes that have spread through the whole population . Those all started off as rare mutations that
conferred a strong selection advantage to the carriers, meaning that the specific infectious diseases were serious threats to the
species.

And, international actors check

Wayne, 2014 (Alex, syndicated columnist on US health policy, Global Effort Signed to Halt
Spread of Infectious Disease, Bloomber, 2/13, http://www.bloomberg.com/news/2014-02-13/globaleffort-signed-to-halt-spread-of-infectious-disease.html#THUR)

U.S. won commitments from 25 countries and the World Health Organization to work
together on systems to better detect and combat outbreaks of infectious
diseases such as H7N9 avian flu and Ebola virus. The Obama administration plans to spend $40
million in 10 countries this year to upgrade laboratories and communications
networks so outbreaks can be controlled more quickly, Thomas Frieden, director of the Centers for Disease
Control and Prevention, said today in an interview. President Barack Obama will seek another $45 million next year
The

to expand the program. Infectious diseases account for about 1 in 4 deaths worldwide, according to the U.S. National Institutes of Health. While diseases
such as Ebola and Severe Acute Respiratory Syndrome havent posed a threat to the U.S., lapses in other countries may allow an outbreak to spread

Were all only as safe as the

weakest link out there. This is an effort to essentially make the U.S. safer and make
the world safer, to improve countries capacity to better find, stop and prevent
health threats. Frieden and Kathleen Sebelius, the U.S. health secretary, held a videoconference today with the partners in the effort.
While no other country made a specific financial commitment today, Frieden said, all the nations at the conference
including China, Russia, France and the U.K. agreed to accelerate progress and
address not just the health sector but include security in health in new ways. First
Consensus For the first time, really, we have a consensus on not only what are the
threats, but what do we have to do to address them, he said. As an example, Frieden said
Turkeys government agreed to host a WHO office to respond to outbreaks in its region. The
rapidly, Frieden said. No country can protect itself solely within its borders, Frieden said.

agreement will also target emerging infections such as Middle East Respiratory Syndrome. The 10
countries in line for the U.S. investment, which will be funded by the CDC and the Department of Defense, werent identified. The CDC plans
to build on test projects last year in Uganda and Vietnam, where the agency helped the two nations
health officials improve systems to detect and combat outbreaks of dangerous pathogens that
include drug-resistant tuberculosis, Ebola virus and exotic flu strains. In Uganda, CDC officials helped the
countrys Ministry of Health upgrade laboratories where tissue samples would be tested in the event of an
outbreak, and developed a system for local doctors to report cases of illness by text message,
according to an article published in the CDCs journal Morbidity and Mortality Weekly Report. Uganda now is able to quickly
transport tissue samples from rural outbreaks to a high-security lab in the capital, Kampala, by
motorcycle courier and overnight mail, Frieden said. A mobile phone network-connected printer then texts lab results back to rural hospitals, he said.

Ultimately every country in the world should have this kind of system, Frieden

said. The $40 million, he said, is

certainly enough to make a good

start.
SARS changed everything created effective mechanisms and
political will for multilateral cooperation to survey, contain and
treat disease
Roos, 2013 (Robert, medical editor, master's degree in science journalism (Minnesota), fellow at the Center
for Infectious Disease Research and Policy, Experts: SARS Sparked Global Cooperation to Fight Disease, Minnesota
Center for Infectious Disease Research and Policy, 4/15, http://www.cidrap.umn.edu/newsperspective/2013/04/experts-sars-sparked-global-cooperation-fight-disease#THUR)

new set of journal articles related to the 10th anniversary of the SARS epidemic in 2003 says the episode
did much to boost recognition of the need for coordinated international and national
responses to emerging infectious diseases. The articles and commentaries in Emerging Infectious Diseases
A

reflect on the effects of SARS (severe acute respiratory syndrome), which arose in China in late 2002 and spread to more than 30
countries in early 2003, sickening about 8,000 people and killing around 800. The outbreak was first publicized by the World Health
Organization (WHO) on Mar 12, 2003. Among the reports is one describing two new SARS-like coronavirusesclose relatives of the
SARS coronavirusfound in bats in China. The new viruses are more distant relatives of the novel human coronavirus that has

Publication
of the articles comes as the world is contending with still another emerging pathogen, the
novel H7N9 influenza virus in China, which has infected at least 64 people and killed 14 in recent weeks. Surveillance and
response In a "synopsis" piece, a team led by Christopher R. Braden, MD, of the US Centers for Disease Control and Prevention
(CDC) reports on progress in global surveillance and response capacity in the 10 years since
SARS emerged. They review the milestones of the epidemic, from its silent emergence in southern China in
November 2002 to its spread to Hong Kong and, boosted by a "superspreader," from there to many other countries. They say
the SARS epidemic powerfully stimulated international cooperation to fight
emerging diseases. "Perhaps the most important legacy of SARS is the recognition of
the critical need for a multilateral response, led by WHO , in the event of a rapidly moving but
ultimately containable global epidemic," they write. "The central role of WHO in coordinating the
laboratory network that identified the etiologic agent and shared reagents, the epidemiology network that
characterized the spread and identified the most effective control measures, and the policy and communications network
that incorporated rapidly changing knowledge into measured travel advisories was critical for the control of
the epidemic and a credit to WHO." The SARS epidemic dramatically reduced global travel and
business, showing how disruptive a new pathogen could be, Braden and colleagues observe. Those effects stimulated
pandemic flu planning and surveillance, a greater focus on global health security,
and improved laboratory and surveillance networks. Further, the episode spurred
efforts to update the International Health Regulations, which had not been revised
since 1969, the article says. The regulations took effect in 2007. However, fewer than 20% of the 194 WHO countries that
caused illnesses in 17 people, with 11 deaths, in the past year. All of the cases had connections to the Middle East.

accepted the regulations had complied with their core requirements by the June 2012 deadline, according to Braden and colleagues.

Another effect of SARS was to spur the establishment of new national public health
agencies in Canada (the Public Health Agency of Canada, or PHAC) and the United Kingdom (the Health
Protection Agency), the authors say. In a related perspective article, a team led by Jeffrey P. Koplan, MD, MPH, of Emory
University, a former CDC director, says the value of national public health institutes was one of
the major lessons of SARS. Koplan is joined by authors from the PHAC and its counterparts in Hong Kong and China.
They note that more than 80 national public health institutes are now linked through the
International Association of National Public Health Institutes , which promotes the establishment of
new institutes and helps strengthen existing ones.

No Pandemic Extinction --- Our evidence assumes mutations

and unlikely worst case scenarios
Brooks 12 (Michael Brooks, Consultant for New Scientist, Deep future: Why we'll still be here, New
Scientist, Volume 213, Issue 2854, March, p. 3637, Science Direct)//NR

We are also unlikely to be extinguished by a killer virus pandemic. The

worst pandemics occur when a new strain of flu virus spreads across the
globe. In this scenario people have no immunity, leaving large populations
exposed. Four such events have occurred in the last 100 years the worst,
the 1918 flu pandemic, killed less than 6 per cent of the world's population .
More will come, but disease-led extinctions of an entire species only occur
when the population is confined to a small area, such as an island. A severe
outbreak will kill many millions but there is no compelling reason to think any
future virus mutations will trigger our total demise .

Disease cant cause extinction epidemiology proves

Lenihan et al 13 (Professor of Applied UC Santa Barbra, Tal Ben-Horin, Post Doctoral Researcher, Kevin
Lafferty Research ecologist USGS, Variable intertidal temperature explains why disease endangers black abalone
in Ecology, http://hsrl.rutgers.edu/abstracts.articles/Ben-Horin.et.al.2013.ecology.pdf \\ME)

Epidemiological theory holds that host-specific infectious diseases will rarely drive
hosts to extinction because transmission eventually breaks down due to a decline
in susceptible hosts (Anderson and May 1992, de Castro and Bolker 2005). This phenomenon, known as epizootic fade out,
implies that a disease will die out when the host population falls below a threshold
density (Lloyd-Smith et al. 2005). Accordingly, infectious diseases have played only a minor role in
global species loss, and have rarely provided the sole cause of threat for species
listed under either the U.S. Endangered Species Act or IUCN Red List of Threatened Species (Smith et al. 2006). Yet there are cases of infectious diseases threatening species with
extinction on local scales (McCallum et al. 2009). In these cases, pathogens maintain high incidence and the ability to spread efficiently even as the susceptible host population
declines, either through frequency-dependent transmission or the presence of a reservoir host species (de Castro and Bolker 2005). Here, we consider a less appreciated pathway to
host extinction, a disease that spreads rapidly through a tolerant host population followed by host mortality linked to an environmental stressor.

Extinction genetically impossible and empirically disproven

Posner 2005 (Richard A., Judge U.S. Court of Appeals 7th Circuit, Professor
Chicago School of Law, January 1, 2005, Skeptic, Altadena, CA, Catastrophe: Risk
and Response, http://goliath.ecnext.com/coms2/gi_0199-4150331/Catastrophe-thedozen-most-significant.html#abstract)
sapiens has managed to survive every disease to assail it in the
200,000 years or so of its existence is a source of genuine comfort, at least if the
focus is on extinction events. There have been enormously destructive plagues,
such as the Black Death, smallpox, and now AIDS, but none has come close to destroying the
Yet the fact that Homo

Natural selection favors germs of limited lethality;

they are fitter in an evolutionary sense because their genes are more likely to be
spread if the germs do not kill their hosts too quickly. The AIDS virus is an example of a lethal virus,
entire human race. There is a biological reason.

wholly natural, that by lying dormant yet infectious in its host for years maximizes its spread. Yet there is no danger that AIDS will

The likelihood of a natural pandemic that would cause the

extinction of the human race is probably even less today than in the past (except in
destroy the entire human race.

prehistoric times, when people lived in small, scattered bands, which would have limited the spread of disease), despite wider
human contacts that make it more difficult to localize an infectious disease. The reason is improvements in medical science. But the
comfort is a small one. Pandemics can still impose enormous losses and resist prevention and cure: the lesson of the AIDS
pandemic. And there is always a lust time. That the human race has not yet been destroyed by germs created or made more lethal
by modern science, as distinct from completely natural disease agents such as the flu and AIDS viruses, is even less reassuring. We
haven't had these products long enough to be able to infer survivability from our experience with them. A recent study suggests
that as immunity to smallpox declines because people am no longer being vaccinated against it, monkeypox may evolve into "a
successful human pathogen," (9) yet one that vaccination against smallpox would provide at least some protection against; and
even before the discovery of the smallpox vaccine, smallpox did not wipe out the human race. What is new is the possibility that
science, bypassing evolution, will enable monkeypox to be "juiced up" through gene splicing into a far more lethal pathogen than
smallpox ever was.

Lethal diseases burn out fastEbola proves

Morse, 4 (Stephen Morse, director of the Center for Public Helth Preparedness, at the
Mailman School of Public Health of Columbia University, 04 ActionBioscience.org, Emerging
and Reemerging Infectious Diseases: A Global Problem", 2004,
http://www.actionbioscience.org/newfrontiers/morse.html, [Zheng])
ActionBioscience.org: How do infectious diseases become pandemic? Morse: A pandemic is a very big epidemic. It

many infections that get introduced from time to time

in the human population and, like Ebola, burn themselves out because they kill too
quickly or they dont have a way to get from person to person . They are a terrible
tragedy, but also, in a sense, it is a lucky thing that they dont have an efficient
means of transmission. In some cases, we may inadvertently create pathways to allow transmission of
requires a number of things. There are

infections that may be poorly transmissible, for example, spreading HIV through needle sharing, the blood supply,
and, of course, initially through the commercial sex trade. The disease is not easily transmitted, but we provided,
without realizing it, means for it to spread. It is now pandemic in spite of its relatively inefficient transmission. We
also get complacent and do not take steps to prevent its spread.

Diseases wont cause extinction humans will outgrow disease

National Geographic, 2004 (Our Friend, The Plague: Can Germs Keep Us Healthy?
September 8, http://www.promedpersonnel.com/whatsnew.asp?intCategoryID=73&intArticleID=443)

Disease organisms

become less virulent over time. When it was first recognized in

The quick progression of the disease
from infection to death limited the ability of syphilis to spread. So a new form
evolved, one that gave carriers years to infect others. For the same reason, the common cold
can, in fact,

Europe around 1495, syphilis killed its human hosts within months .

has become less dangerous. Milder strains of the virus spread by people out and about, touching things, and
shaking hands have an evolutionary advantage over more debilitating strains. You cant spread a cold very easily
if youre incapable of rolling out of bed.

This process has already weakened all but one virulent

strain of malaria: Plasmodium falciparum succeeds in part because bedridden victims of the disease are more
vulnerable to mosquitoes that carry and transmit the parasite. To mitigate malaria, the secret is to improve housing
conditions. If people put screens on doors and windows, and use bed nets, it creates an evolutionary incentive for
Plasmodium falciparum to become milder and self-limiting. Immobilized people protected by nets and screens cant
easily spread the parasite, so evolution would favor forms that let infected people walk around and get bitten by
mosquitoes. There are also a few high-tech tricks for nudging microbes in the right evolutionary direction. One
company, called MedImmune, has created a flu vaccine using a modified influenza virus that thrives at 77 degrees
Fahrenheit instead of 98.6 degrees Fahrenheit, the normal human body temperature. The vaccine can be sprayed in
a persons nose, where the virus survives in the cool nasal passages but not in the hot lungs or elsewhere in the
body. The immune system produces antibodies that make the person better prepared for most normal, nasty
influenza bugs.

Maybe someday well barely notice when we get colonized by disease

organisms. Well have co-opted them. Theyll be

like in-laws, a little annoying but

a friend sees us sniffling, well just say, Oh, its nothing just a touch of the plague.

tolerable. If

Virus burnout solves the impact

The Guardian, 2003 (Second Sight, September 25,
http://technology.guardian.co.uk/online/story/0,3605,1048929,00.html)

Take the case of everyone's favourite evil virus, Ebola. This

is so virulent that it kills up to 90% of infected hosts within one to two weeks . There is
no known cure. So how come the entire population hasn't dropped dead from
haemorrhaging, shock or renal failure? The "organism" is just too deadly: it kills too
quickly and has too short an incubation period, so the pool of infected people
doesn't grow.
The parallel with the natural world is illustrative.

Squo solves whatnot

Status quo solves marine biotechnology to develop antibiotics,
but terrestrial resources are more important

Bruckner 13coral reef ecologist in the National Marine Fisheries Services

Office of Protected Resources

(Andrew W., Silver Spring, Maryland, Life-Saving Products from Coral

Reefs, Issues in Science and Technology, November 27, 2013, http://issues.org/18-3/p_bruckner/)

marine
biotechnology has been applied to the areas of public health and human disease,
seafood safety, development of new materials and processes, and marine
ecosystem restoration and remediation. Dozens of promising products from marine
organisms are being advanced, including a cancer therapy made from algae and a
painkiller taken from the venom in cone snail s. The antiviral drugs Ara-A and AZT and the anticancer agent Ara-C, developed from
Coral reefs are storehouses of genetic resources with vast medicinal potential, but they must be properly managed. During the past decade,

extracts of sponges found on a Caribbean reef, were among the earliest modern medicines obtained from coral reefs. Other products, such as Dolostatin 10, isolated from a sea hare
found in the Indian Ocean, are under clinical trials for use in the treatment of breast and liver cancers, tumors, and leukemia. Indeed, coral reefs represent an important and as yet
largely untapped source of natural products with enormous potential as pharmaceuticals, nutritional supplements, enzymes, pesticides, cosmetics, and other novel commercial products.
The potential importance of coral reefs as a source of life-saving and life-enhancing products, however, is still not well understood by the public or policymakers. But it is a powerful
reason for bolstering efforts to protect reefs from degradation and overexploitation and for managing them in sustainable ways. Between 40 and 50 percent of all drugs currently in use,

Most of these were

derived from terrestrial plants, animals, and microorganisms, but marine
biotechnology is rapidly expanding. After all, 80 percent of all life forms on Earth are present only in the oceans. Unique medicinal properties
including many of the anti-tumor and anti-infective agents introduced during the 1980s and 1990s, have their origins in natural products.

of coral reef organisms were recognized by Eastern cultures as early as the 14th century, and some species continue to be in high demand for traditional medicines. In China, Japan, and
Taiwan, tonics and medicines derived from seahorse extracts are used to treat a wide range of ailments, including sexual disorders, respiratory and circulatory problems, kidney and liver

scientists using new methods and techniques have

intensified the search for valuable chemical compounds and genetic material found
in wild marine organisms for the development of new commercial products. Until
recently, however, the technology needed to reach remote and deepwater reefs and to commercially develop marine biotechnology products from organisms
occurring in these environments was largely inadequate. The prospect of finding a new drug in the sea, especially among coral reef species, may be 300 to
diseases, throat infections, skin ailments, and pain. In recent decades,

400 times more likely than isolating one from a terrestrial ecosystem. Although terrestrial organisms exhibit great species diversity, marine organisms have greater phylogenetic
diversity, including several phyla and thousands of species found nowhere else. Coral reefs are home to sessile plants and fungi similar to those found on land, but coral reefs also
contain a diverse assemblage of invertebrates such as corals, tunicates, molluscs, bryozoans, sponges, and echinoderms that are absent from terrestrial ecosystems. These animals
spend most of their time firmly attached to the reef and cannot escape environmental perturbations, predators, or other stressors. Many engage in a form of chemical warfare, using
bioactive compounds to deter predation, fight disease, and prevent overgrowth by fouling and competing organisms. In some animals, toxins are also used to catch their prey. These
compounds may be synthesized by the organism or by the endosymbiotic microorganisms that inhabit its tissues, or they are sequestered from food that they eat. Because of their
unique structures or properties, these compounds may yield life-saving medicines or other important industrial and agricultural products.

The US is exploring the ocean now for cures of diseases

NOAA no date (NOAA, no date, Medicines From the Sea,
http://www.noaa.gov/features/economic_0309/medicines.html, 7/1/14, AG)
researchers are
exploring the ocean's depths for new medications to treat cancer, bacterial
infections, viruses, heart disease, pain, and other ailments . The seas contain an uncounted number of
species of plants and animals. These creatures provide a vast storehouse of chemical compounds unknown on land. An ocean
commission report lists chemicals and biological materials from marine organisms
now in use or development, including 10 anti-cancer drugs, drugs to fight
inflammation, fungus, tuberculosis, HIV, malaria and dengue.
Ocean exploration often leads to new ideas, new theories and discoveries, including new medicines. From slime to sponges,

Bioprospecting sux
Bioprospecting iz bad
Satel 5
(Sally, MD and lecturer at Yale School of Medicine, Diminishing Biodiverse Returns,"
Feb 16 2005, http://www.aei.org/article/health/diminishing-biodiverse-returns/
bioprospecting actually constitutes a small and shrinking percentage of the
portfolio of major drug companies. Eli Lilly, for example, has not engaged in the activity for several years. It is high risk and
very low yield. Instead, companies screen millions of synthetic molecules for
promising medicinal leads. Natural molecules, it turns out, are often maddeningly
intricate and thus it is hard to replicate the molecular structure reliably and to
reproduce the substance on a large scale for manufacturing. Japanese
pharmaceutical companies, for example, have had virtually no success in isolating
key elements from traditional herbal medicines and commercializing drugs from
them.
But, in truth,

AT Antibiotic Resistance
Current treatment effectively curtails resistant bacteria growth
Morran 13 1/15/2013-PHD, NIH postdoctoral fellow at Indiana University, research recently featured on BBC
(Levi, Averting the Approaching Apocalypse, Nothing In Biology.org,
http://nothinginbiology.org/2013/01/15/averting-the-approaching-apocalypse/)

A paper by Quan-Guo Zhang and Angus Buckling (2012) takes an experimental

evolution approach to begin addressing this issue empirically. In search of a different strategy for curbing the
evolution of antibiotic resistance in their experimental populations of the bacterial species Pseudomons flourences, Zhang and Buckling treated
their bacterial populations with either antibiotics, a bacteriophage or phage (a
virus that attacks bacteria), or a combination of the antibiotic and phage. Zhang and Buckling predicted that the combination treatment might be more
effective than either antibiotics or phage alone because the combination treatments should better reduce bacterial population sizes and limit their response to selection (Alisky et al.

bacterial mutations that confer resistance to antibiotics

generally do not also confer resistance to phage, so evolution of resistance to the
combination treatments would likely require at least two mutations , and thus require more time to evolve
1998, Chanishvili 2001, Comeau 2007). Additionally,

resistance than the other treatments (Chanishvili 2001, Kutateladze 2010). Zhang and Buckling evolved their bacterial populations under the 3 different treatments (in addition to a
control in which they allowed the bacterial populations to grow under normal conditions) for 24 days. A total of 24 replicate populations were exposed to each treatment. After 24 days of

In contrast, 12 of the replicate

populations exposed to only the antibiotic were extinct while 23 of the populations
exposed to combination treatment went extinct (Figure 1). Therefore, the combination treatment was the most effective
bacterial evolution none of the replicate populations exposed to control conditions or phage went extinct (Figure 1).

treatment for killing the bacteria. However, that single population that survived the combination treatment could mean trouble. Intense natural selection, like that imposed by the
combination treatment, could have produced a super-strain of the bacteria. Creation of a super-strain, in this case a strain resistant to both the antibiotic and phage with little cost of
maintaining such resistance, would be troubling because the antibiotic-phage combination treatment strategy would have only accelerated the arms race rather than curbing it.

in many cases the evolution of resistance comes with fitness costs, like
significantly reduced growth rates in absence of the antibiotic or phage. These
fitness costs are thought to stop the spread of some antibiotic resistant strains
simply because the strains cannot successful compete with strains in nature when
the antibiotic is not present. Zhang and Buckling tested the fitness of their surviving
populations in competition with the ancestral bacterial population that represents
the starting point for evolution in this experiment. They found that in a short term
loans scenario, only the control bacteria increased in fitness relative to the ancestor
when competed under control conditions (Figure 2). More importantly, they observed that the fitness of the single surviving population
from the combination treatment was less than half of the ancestors fitness in the absence of antibiotic and phage (Figure 2). Therefore, the antibiotic plus
phage treatment resulted in the extinction of 23 out of 24 bacterial replicate
populations, while the lone surviving population was far from being a super-strain. The
However,

ability of the surviving bacterial populations to grow under normal conditions was assessed relative to their ancestral bacterial population. Here, any deviation from 0 is indicative of

Control populations increased in fitness under

normal growth conditions, while populations exposed to either phage or
antibiotic exhibited reduced fitness. Most importantly, the population that
survived the combined treatment of antibiotic and phage evolved greatly reduced
fitness under normal conditions (Zhang and Buckling 2012).
evolutionary change (a change from the ancestor population).

No major impacts from anti-biotic resistance

Urrutia 2014 -a PhD candidate in Health Policy, Ethics Concentration, at Harvard
University, holds a BA in Philosophy, Politics, and Economics from the University of
Pennsylvania (Julin, The bright side of antibiotic resistance, Harvard Law,
http://blogs.law.harvard.edu/billofhealth/2014/02/07/the-bright-side-of-antibioticresistance/)
I dont believe were going to be able to
keep discovering new classes of antibiotics ad infinitum
But if
But bacteria dont care. Theyre (still) here, theyre (always) evolving, get used to it. I say that because

although I certainly hope Im wrong.

Im not, it means that were only ever going to have so many treatment options,
and that the bugs are eventually going to become resistant to all of them (although
probably not in our lifetime).

What then? And what do we do until then? Lets start with the first one, since post-apocalyptic scenarios are always fun: Medicine will certainly have to

change. Hospitals will become very, very dangerous places (much more than they already are!) Theres going to be much stronger and urgent pressure to reduce hospital stays and readmissions to the absolute minimum, and most
patient care will have to be shifted to community and home settings. Health systems will have to go through major structural transformations to improve prevention. GPs, primary-care specialists, and allied healthcare

Funny
apart from the first part about hospitals becoming (more) dangerous, none of these
sound all that terrible. In fact, theyre all changes I would very much like to see in
my lifetime, bacterial apocalypse or not. It sounds like we would save a lot of lives,
avoid a lot of suffering, and spend a lot less money doing it. It certainly makes me
wonder why we arent doing a lot of those post-apocalyptic things now
professionals will become much more important and esteemed members of the healthcare professions. The notion that individual health is highly interdependent will become a part of popular culture.

(i.e. way before the apocalypse.) We

should probably also be trying harder to prevent resistance, even if it does happen to be true that its battle we will eventually lose. For example, we should make a bigger effort to identify germ sheds and bacterial breeding
grounds, and we should be making an even bigger effort to eliminate them. (One would think that the imperative to eliminate them is an obvious corollary of the imperative to identify them, but weve known for a long time that
overcrowded prisons are a major source of super-bugs, and yet we still seem quite pleased to have overcrowded prisons proliferating I guess corollaries just arent very popular nowadays.) However, the idea that we will not be able
to keep our drugs effective forever suggests that there are certain things we should not be doing in the name of stewardship. For example, we should not withhold antibiotics from patients for whom they are currently a life-saving
or suffering-ending option simply because doing so might save/help other patients tomorrow. (Again, to me this seems like a line out of Deep Thoughts by Captain Obvious, but millions are currently dying from lack of access to
antibiotics that are still effective for their conditions, and I suspect that stewardship could become a way of justifying that.) To summarize:

thing

Antibiotic resistance is a scary

. Last summer I would probably have lost a loved one due to a ruptured appendix (i.e. due to a failure of early detection, which is part of primary care). Peritonitis is a serious condition even now, but it would most likely

But at least it serves to remind us

that there are better approaches to healthcare that could be realized within our
lifetime, and at least it does not give us any reason to deny each other proper care
and consideration if we happen to get sick today.
have been fatal if the bugs that hit her had been resistant to the antibiotics we have available. I dont like antibiotic resistance one bit.

AT Tuberculosis

New Drugs Solve

New vaccines solve
Vaccine Weekly 9 (1/21, "Tuberculosis; Sequella lead drug compund SQ109
selected for phase 1B clinical trial program", 1-21, p.85, ProQuest,
a clinical-stage
biopharmaceutical company focused on diseases of epidemic potential, announced that SQ109, its
lead drug candidate for the treatment of tuberculosis (TB), was the first drug approved
for evaluation in a newly awarded clinical program contra ct to Dynport Vaccine Company LLC
and Quintiles Transnational. The contract, awarded by the National Institute of Allergy and
Infectious Diseases (NIAID), National Institutes of Health (NIH), is part of NIAID's clinical resource
infrastructure to accelerate Phase 1 studies of promising clinical stage drugs or vaccines that
2009 JAN 21 - (<http://www.newsrx.com> NewsRx.com) -- Sequella, Inc.,

address emerging and re- emerging infectious tropical diseases and bioweapon pathogens. The Phase 1B clinical
study of SQ109 should be initiated in Q1 2009 (see also <http:// www.newsrx.com/library/topics/Tuberculosis.html>
Tuberculosis). SQ-109 is a new diamine antibiotic intended to replace one or more of the current first-line anti-TB

SQ109 was granted U.S. FDA Fast Track designation and

SQ109 shows activity against drug sensitive and
multi-drug resistant (MDR and XDR) Mycobacterium tuberculosis, the causative agent of TB. The Phase
drugs and simplify patient therapy.

FDA/EMEA Orphan Drug Designation in 2007.

1B study will assess safety and pharmacokinetics of multiple doses of SQ109 in healthy subjects. "This is absolutely
the best of both worlds for Sequella," commented Dr. Carol Nacy, Sequella CEO. "We again successfully competed
for support from our most valued funding partner, NIAID, while retaining the capacity to work with the same
industry-leading contract research organization, Quintiles Transnational, that conducted our first-in-human Phase 1A
trial for SQ109.

And, new drugs overcome the factors that cause resistance.

AIDS Weekly 9 ("HIV/AIDS Co-Infection; Beating the Number-One Killer in AIDS:
Tuberculosis", p.72, 1-1, ProQuest)
Researchers from PolyMedix and the University of Pennsylvania reported their findings in
a poster, "Antimicrobial Molecules for Treatment of Multi-drug Resistant (MDR) and Extensively Drug Resistant (XDR)

at the HIV DART conference on antiretroviral therapies ,

Investigators screened a library of PolyMedix's HDP
mimics in collaboration with the Tuberculosis Antimicrobial Acquisition Facility, a
branch of the National Institute of Allergy and Infectious Diseases. Three of the antimicrobial
compounds exhibited high antimicrobial activity (IC90 < 5 g/ml) against H37Rv, a common
laboratory strain of M. tuberculosis, with selectivity greater than 30-120 fold for TB versus mammalian cells.
Because they have a biophysical mechanism of action, and do not operate through
known biological pathways or specific molecular targets , PolyMedix's HDP mimics are
unlikely to cause antimicrobial resistance -- the mechanism by which antibiotic
drugs lose their effectiveness over time. PolyMedix has confirmed the lack of experimental
Strains of Mycobacterium Tuberculosis,"

held in Puerto Rico December 9-12, 2008.

resistance to these and other of its HDP mimic antibiotic compounds against a wide range of infectious agents
through "serial passaging" studies. These tests involve re-culturing the infective organism, grown in the presence of
the drug, for many generations. No increase in minimum inhibitory concentration has been noted for any bacterium
paired with a PolyMedix HDP mimic compound.

Status quo vaccinations solve

Landry and Heilman 5 (Sarah Landry and Carole Heilman, the associate director of policy and
program operations, National Vaccine Program Office, U.S. Department of Health and Human Services, and director
of the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Disease,
Future Directions In Vaccines: The Payoffs Of Basic Research, May 2005, http://web.lexisnexis.com.fetch.mhsl.uab.edu/universe/document?

_m=51cf6e9a7f9bd548830ee047df23ba89&_docnum=4&wchp=dGLzVlzzSkVb&_md5=d4451074a68f45367fedda32084e521c)
Promise of new technologies. The payoffs from these standard approaches are now beginning to plateau. In fact, most of the "easy" vaccines have been developed, and many challenges

New technologies may provide stronger, broader, and more

durable immune responses than those induced by some earlier vaccines. New
vaccines are also likely to exploit genomics and high-throughput screening
approaches that are based on computational methods. These methods will allow for
development of rationally based approaches that select potential antigens more
effectively and precisely. In addition, future vaccines will use these new tools to get around
the challenges of the remaining infectious diseases. [n2] These challenges include the
inherent ability of many viruses to change (antigenic variation), as is seen with HIV and
influenza; the need to develop vaccines that rely on cell-based immunity for
protection for infections such as tuberculosis; and tools for addressing a pathogen's
ability to outsmart the immune system--immune evasion strategies, such as seen with hepatitis C. [n3] Impact of new immune concepts.
Research on the immune system has helped identify new ways of fighting infections
and is helping define the mechanisms needed for successful immunizatio n. Most currently
lie ahead for new and improved vaccines.

licensed vaccines protect by producing neutralizing antibodies, made by the B cells of the immune system. One of the advantages of stimulating this arm of the immune system is that it

Researchers believe that vaccines against many of the infections that

are of highest priority (HIV, TB, and malaria) will need to have the other arm of the immune
system--the cellular component, or T cells--pulled into action. [n4] For the first time in sixty years,
new TB vaccines are in clinical trials. [n5]
can be easily measured.

No Resistant Strains
No such thing as incurable strainsPeru study proves.
News Rx 8 (8/18, "Harvard Medical School; Comprehensive treatment of
extensively drug-resistant TB works, study finds", p.2467, 8-18, ProQuest)
The death sentence that too often accompanies a diagnosis of extensively drugresistant tuberculosis (XDR-TB) can be commuted if an individualized outpatient
therapy program is followed -- even in countries with limited resources and a heavy
burden of TB. A study conducted in Peru between 1999 and 2002 shows that more
than 60 percent of XDR-TB patients not co-infected with HIV were cured after
receiving the bulk of their personalized treatment at home or in community-based
settings. The paper appears in the August 7, 2008 issue of The New England Journal
of Medicine. "It's essential that the world know that XDR-TB is not a death
sentence," says lead author Carole Mitnick, instructor in the Department of Global Health and Social Medicine at Harvard Medical School (HMS).
"As or even more importantly, our study shows that effective treatment does not require hospitalization or indefinite confinement of patients." In some
parts of the world, however, patients with XDR-TB and other drug- resistant forms of the disease are confined against their will in TB hospitals that
resemble prisons, Mitnick adds. Researchers from HMS, Brigham and Women's Hospital, Partners In Health, Harvard School of Public Health, and the
Massachusetts State Laboratory Institute, along with Lima, Peru-based organizations Socios en Salud, the Peruvian Ministry of Health, and Hospital

aggressive, outpatient treatment could cure multidrug resistant tuberculosis (MDR-TB), which is resistant to two first-line anti-TB
drugs. That pilot program has been adopted as a national endeavor by the Peruvian
government. A similar protocol was used for the recent study of XDR-TB, which is
caused by TB bacteria that are resistant not only to the same first-line anti-TB drugs,
but also to the two most important second-line drug classes.
Nacional Sergio E. Bernales, had already demonstrated that

No Impact
No risk of spreading
Collins and Fidel 7 (Lois M. Collins and Steve Fidel Deseret Morning News June
3, 2007 Sunday) http://web.lexis-nexis.com/universe/document?
_m=f074682274f46d461ed74eb44d822c9a&_docnum=17&wchp=dGLbVzbzSkVA&_md5=3d7b5016a80a5dee75c1b63bd175e216
The frenzy over tuberculosis spawned by a single "extensively drug-resistant" case
is capturing headlines. But most people exposed to the airborne bacteria will never
develop active disease. The Atlanta attorney's case has health officials concerned because his TB falls into
a class of infections that resists two first-line TB drugs and some second-line drugs -- one of only 49 other
extensively drug-resistant cases reported in the United States between 1993 and 2006. There's also a class called
multidrug-resistant TB, which is easier to treat than cases like this one but more difficult than typical TB. Although

it's no easier to spread than any other tubercolosis, according to Carrie

Taylor, an infection control practice nurse at LDS Hospital. "You have to breathe in
air that's coughed." Doctors treat an average of 38 active TB cases each year in Utah, according to the Utah
it's harder to kill,

Department of Health. The disease usually settles in the lungs, although it can affect the kidneys, spine, brain and
other organs. The disease is caused by Mycobacterium tuberculosis, which spreads person-to-person but only
through close contact. Taylor and her colleague Vickie Anderson, also an infectn-control practice nurse at LDS
Hospital, describe it as passing from one person's lungs directly into another's. It's not like a cold that is easily
spread and fairly hardy. In fact, sunlight kills it. Unless the individual has a drug-resistant TB strain -- "not common
in Utah," said Taylor -- it's very treatable, although it takes a long time and several medications. Left untreated, it
can kill. At least initially, patients are isolated to avoid spread of the disease. Both chicken pox and measles are
more contagious, said infectious disease specialist Dr. John Kriesel of University Hospital. As an example, when a
Provo High School student was recently diagnosed with tuberculosis and health officials asked 250 of the student's

People in
casual contact are extremely unlikely to get the disease. Just being exposed doesn't
mean you could pass it on, Taylor said. Without symptoms, you can't spread it, even if you have a positive
school contacts to be tested for it, Kriesel predicted "not one of them will test positive for TB."

skin test. People who live with a patient are at higher risk, but most won't get it, either.

Alt Causes
No global solvency, TB is in 90 countries
Shah et al 7 (N. Sarita Shaw, CDC and WHO, Abigail Wright, Gill-Han Bai, Lucia
Barrera, Fadila Boulahlbal, 15 other epidemiology experts, Emerging Infectious
Diseases, 13:3, March, "Worldwide emergence of extensively drug-resistant
tuberculosis", http://origin.cdc.gov/eid/content/13/3/pdfs/380.pdf)
Multidrug-resistant tuberculosis (MDR TB) has been documented in nearly 90 countries and regions
worldwide (1); 424,203 cases of MDR TB were estimated to have occurred in 2004 , which is
4.3% of all new and previously treated TB cases (2). Treatment for MDR TB patients requires use of second-line drugs for
>24 months. These drugs are more costly, toxic, and less effective than first-line drugs used for routine
treatment of TB (36). As with other diseases, resistance to TB drugs results primarily from nonadherence by patients, incorrect drug prescribing by providers, poor quality drugs, or
erratic supply of drugs (7).

Russia outweighs
Zuger 2k (Abigail, New York Times, "Russia has few weapons as infectious
diseases surge", 12-5, L/N)
this is Russia, where TB, once nearly under control, has become epidemic since
the collapse of the Soviet Un-ion. Doctors often use air injections to fight TB strains
that resist the most commonly used drugs.
in most of Russia's overcrowded prisons,
tuberculosis has been spiraling out of control
But

The technique com-presses infected lungs, giving them time to rest and heal. Ms. Kostina, 24, was healthy until

two years ago, working as a nurse at the local prison, just a mile down the road from this hospital. There, as

. When she fell ill with fever and a cough, doctors quickly ascertained that she had caught tuberculosis from

one of her inmate patients. Despite months of treatment, her disease got worse. All four of the antituberculosis drugs she tried were powerless against it. Moreover, during the year she spent traveling from work to home, then into

Russia's political turmoil, its

economic crisis and its new freedoms have been accompanied by a wave of old diseases. Tuberculosis is flooding the country, producing what some authorities are
calling the world's largest outbreak of the drug-resistant variety, one of medicine's
most ominous problems. Rates of other infections including
AIDS, are
skyrocketing
Health experts describe Russia's prison system as an "epidemiologic pump,"
continuously seeding the country with pockets of tuberculosis that can spread on
their own. Increasingly, TB cases of Russian origin are turning up in the Bal-tic
countries and even farther afield
Specialists worry that if the rising
rates of infectious diseases in Russia continue unabated, the country itself may turn
into an epidemiologic pump, sending infectious diseases into the rest of the world.
the hospital, then to a convales-cent home, then back to the hospital, she had undoubtedly exposed dozens of others to her drug-resistant germs.

hepatitis, syphilis and

. An epidemic of diphtheria swept through in the mid-1990's. Reports of smaller, regional outbreaks of encephalitis, typhoid fever, malaria, polio, pneu-monia and influenza pepper the nightly news.

-- for instance, Germany and Israel.

"It's

not surprising to see a case here," said Barry N. Kreiswirth, a tuberculosis expert at the Public Health Research Institute in New York City, "but it's a good reminder that it doesn't take much for one person to be a vector and start an
epidemic."

Poverty root causenot vice versa

Cohen 1 former director of the United Nations Development Programmes HIV
and Development program and Senior Advisor to the UNPD on HIV and
Development-2001 ( Desmond Cohen, "Poverty and HIV/AIDS in Sub-Saharan
Africa," Issue NO.27,
http://www.undp.org/hiv/publications/issues/english/issue27e.html)
Poor nutrition leads to poor health
Poor and damp housing is a major factor in
causing illnesses such as TB which is itself exacerbated by HIV
There are also the direct effects of what has happened to the children which are material and damaging to their futures.

which is an

important cause of low labour productivity and thus the persistence of low incomes for the poor.

the

epidemic (where there is now a dual epidemic

These children will continue to experience poor health status over their
lifetimes
underway in Africa).

with all kinds of social and economic consequences for them and their families.

Alt cause, HIV

IPS 9 (Inter Press Service, AllAfrica, "Zimbabwe; doctors fear high risk of drugresistant TB", 3-3,L/N)
Someone in the world is newly infected with tuberculosis (TB) bacilli every second; overall, onethird of the world's population is currently infected with the TB bacillus. TB is spread through the air
when infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. Left
untreated, each person with active TB disease will infect on average between 10
and 15 people every year. But people infected with TB bacilli will not necessarily
become sick with the disease. The immune system "walls off" the TB bacilli which ,
protected by a thick waxy coat, can lie dormant for years. HIV and TB form a lethal combination, each
speeding the other's progress. HIV weakens the immune system; someone who is
HIV-positive and infected with TB bacilli is many times more likely to become sick
with TB. TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in incidence of TB since
1990.

Russian TB outweighs US TB
Feschbach and Keshavjee 7 - *instructor at Bringham and Women's
Hospital at the Harvard Medical School, **Senior Scholar at the Woodrow Wilson
Center ("Drug-Resistant TB in Russia", Woodrow Wilson International Center for
Scholars, 7-24, http://www.wilsoncenter.org/index.cfm?
topic_id=116811&fuseaction=topics.event_summary&event_id=239772,)
62 percent of all new multidrug-resistant
cases will be concentrated
in Russia, China, and India, warned
the Brigham and Woman's Hospital
and Harvard Medical School
although people have known for a number of years that
TB) is prone to
resistance when treated ineffectively overall, the number of
resistant strains
continues to rise
perfect storm of HIV, very high TB rates, and a
programmatic infrastructure that lacks the ability to adequately address complex
health interventions is brewing in the former Soviet republics,
until quite recently, political will and funding
were not available in substantial levels to address the health crisis
Russian officials have been extremely slow to address TB
The substantial success in controlling
TB during the Soviet years has been lost, and TB deaths have skyrocketed in Russia
over the past 18 years
Much of this increase is due to overcrowding in
urban centers, and prison populations
It is expected that

tuberculosis (MDR-TB)

Dr. Salmaan Keshavjee, instructor at

. Speaking at a July 24, 2007 discussion co-sponsored by the Global Health Initiative and the Kennan Institute, Dr. Keshavjee said that
mycobacterium tuberculosis (

antibiotic-

of TB

. Some experts worry that a

he continued. Murray Feshbach, senior scholar at the

Woodrow Wilson Center, highlighted the lethargy in addressing TB in Russia by mentioning that,

facing the Russian population. Based on his

research and first-hand experience,

at the national level, and are just now

beginning to acknowledge the existence of extensively drug-resistant tuberculosis (XDR-TB) within the Russian population.

, particularly among working-age men.

in

especially, explained Dr. Keshavjee. Globally, TB strainsincluding MDR- and XDR-TB strainskill approximately 1.8 million

people per year, he said, disproportionally affecting the poor and immunocompromised.

Uncoordinated testing makes resistant TB inevitable.

The Lancet 9 (Crunch time for tuberculosis control", 373:9670, p. 1145, 4-4,
ProQuest)
In 2007, there were 9.3 million incident reports of tuber culosis
Overall,
1.3 million people were co-infected with HIV.
AIDS was responsible for almost a quarter of the 1.7 million deaths in
; half in Asia and a third in Africa.

456 000 co-infected individuals died, making tuberculosis the commonest cause of death in people with HIV/

AIDS. Conversely, HIV/

people with tuberculosis

. 500 000 people were thought to have MDR-TB and perhaps another 40 000 to have XDR-TB. India and China have the world's largest burdens of incident

The tragedyis that established

procedures for HIV co-infection and MDR-TB have not been implemented widely. I
Testing
accelerates diagnosis, improves treatment, and protects
However, testing and treatment
occur at separate sites
tuberculosis, 2.0 million and 1.3 million people, respectively, and both have over 100 000 people with MDR-TB.

some might say folly-

/AIDS

2004, WHO urged more collaboration between HIV and tuberculosis programmes, with routine testing for HIV in people with tuberculosis and for tuber culosis in people with HIV/AIDS.

immunocompromised with HIV from tuber culosis.

for the two infections often

. In 2007, the Global Plan targets for intensified case

finding were missed worldwide. In Africa, the aim was to test 900 000 people with tuberculosis for HIV and 13 million people with HIV for tuberculosis. Only 500 000 and 300 000, respectively, were screened-and few of those

MDR-TB is encouraged by poor case-detection, treatment with

inappropriate drug regimens, and lack of clinical supervision. Almost half of
treatment relapses in eastern Europe are from drug-resistant strains. Accurate
diagnosis
requires drug sensitivity testing in a qualified laboratory
diagnosed with co-infection received appropriate treatment.

of MDR/ XDR-TB

. Only 2% of the estimated 500 000

people infected with drug-resistant strains were tested in 2007. And even when diagnosed with this more lethal form of tuberculosis, fewer than 3% received treatment recommended by international guidelines.

Mechanisms to ensure best practice have failed

because of lack of
discipline, infrastructure, and resources. Clearly the changing nature of tuberculosis
epidemiology demands a reassessment and scaling-up of control measures.
at many levels in several countries

To redefine and

redirect the actions necessary to combat tuberculosis, resolu tions from the Stop TB Partners Forum will be presented in Beijing on April 1-3, when health ministers from the countries most affected by MDR/ XDR-TB will discuss
strategies for tackling drug- resistant infection. To succeed they will need to build consensus, establish political will, and secure sustainable funding.

Drug use makes it inevitable

National Institute of Drug Abuse 6 (National Institute of Drug Abuse,
NIDA InforFacts: Drug Abuse and the Link to HIV/AIDS and Other Infectious Diseases,
"HIV/AIDS," December 2006, http://www.nida.nih.gov/Infofacts/drugabuse.html)
Besides increasing their risk of HIV infection, individuals who take drugs or engage in high-risk behaviors associated with drug
use also put themselves and others at risk for contracting or transmitting hepatitis C (HCV), hepatitis B (HBV), tuberculosis (T B), as well as
a number of other sexually transmitted diseases, including syphilis, chlamydia, trichomoniasis, gonorrhea, and genital herpes. Injecting drug users ( IDUs) are also
commonly susceptible to skin infections at the site of injection and to bacterial and
viral infections, such as bacterial pneumonia and endocarditis, which, if left untreated, can lead to serious health problems.

Migration makes TB inevitable.

Chest Medicine 7 ("The changing face of tuberculosis: a new challenge to the
developing world." http://www.priory.com/cmol/tbanga.htm, accessed July 24 2007)
In England 60% of
cases are in ethnic minority groups, which comprise only 5% of the population . Of these
Immigration: the developed world's problem Within the developed world immigration is the greatest factor contributing to the increase in cases.

individuals from the Indian Subcontinent form the majority. For the last two years I have had no less than two Indian doctors on treatment for TB at any time. In should however, be
remembered that tuberculosis was a disease which killed one in four people in Western Europe 200 years ago and was effectively exported to what is now the developing world through

There is occurring a reimportation of disease with migration for

economic or political reasons. Within the developing world migration is also playing
a part for example refugees from Somalia in Kenya or from Afghanistan in Pakistan .
trade and Empire building.

7.

AT Zoonotic

SQ Solves
Zoonotics have been contained if not eliminated due to the
restrictions placed on animal trade, vaccines, and quarantines.
Torres 99 (Alfonso, D.V.M., M.S., Ph.D., Deputy Administrator, USDA, Animal Plant
and Health Inspection Service, Veterinary Services, International Economic
Considerations Concerning Agricultural Diseases and Human Health Costs of
Zoonotic Diseases, Annals of the New York Academy of Sciences 894:80-82)
Animal diseases can negatively affect the number and availability of animals, their productivity, or their
appearance. 1 A few centuries ago, animal diseases affected mostly individual owners or herdsmen, but did not
have serious consequences on the larger community. A similar event today will not only have a negative impact on
the animal owners, but more importantly, will significantly affect the general economy of the region, the entire

animal diseases as an element affecting

international trade of animals and animal products has reached its full impact level with
the recent designation by the World Trade Organization (WTO) of the International Office of Epizootics
(OIE) as the international agency in charge of establishing animal health standards
upon which international commerce can institute restrictions to prevent the spread
of animal diseases from one nation to another. It is important to point out that while the spread of
human diseases around the world is due to the unrestricted movement of people
across political boundaries, animal diseases are , for the most part, restricted to defined
geographic areas of the world due to the implementation of animal importation
requirements, quarantines, animal movement regulations, and by disease control
measures that include mass vaccination campaigns and animal depopulation
practices. A number of animal diseases have been eradicated from countries or even from
continents around the world by aggressive, well-coordinated, long-term animal health campaigns. This is
in contrast to the relatively few human diseases successfully eradicated from large
areas of the world.
nation, even a group of nations. The importance of

No Solvency
Impacts inevitablepeople are morally opposed to killing
animals to stem the spread of the disease.
Blancou et al 5 (Jean, former General Director of OEI, Bruno and Albino,
Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance
and control, Vet. Res., pg 507-522)
The main obstacles that are encountered in the control of bacterial zoonoses are the same as those opposed to
the control of any infectious disease, that is most often finan- cial and human obstacles rather than tech- nical
limitations.

The financial resources needed to effi- ciently fight against zoonotic

agents are not available for all countries. Only the inter- national communitys
financial support, could, notably, allow developing countries to organize a proper
control of zoonotic dis- eases, but it is rare that this is materialized as a financial
gift and mobilization of spe- cific funds , even by well-known interna- tional organizations (such as
WHO, FAO, OIE), is limited for such diseases. Due to all these difficulties, many sanitary authorities of these
countries have given up the estab- lishment of such prevention programs. Oth- ers manage, with a lot of
perseverance, to elaborate complicated multilateral financial arrangements. This allows punctual projects to be
realized, but rarely to establish the long-term prophylaxis plans that they really need. When financial and
material problems are supposedly solved,

human-related dif- ficulties should not be

underestimated. These

difficulties can originate within the services in charge of applying the national
prophy- laxis plans, when these services are not themselves convinced of the good use of these plans, or when

The obstacles sometimes result from a lack of

cooperation between specific professional categories, amongst which figure breeders, as
well as livestock brokers or even veterinarians bothered by the application of
certain pro- grams of control or the limited incentive given by the health
authorities for perform- ing prophylaxis tasks. Finally, the obstacle to such plans may
be caused by the active opposition of the public opinion to certain methods of
control. This is notably the case for the hostility of some groups to the mass
slaughtering of animals during epizootics, or to the use of vaccines issued from
genetic engineering. By lack of an appropriate con- sensus, the control of some zoonotic dis- eases may
they do not seem to get specific benefits from it.

simply be impossible in some countries.

AT Superbugs

Threat is Exaggerated
Superbugs are a delusion based on a perverse love of panic
the threat is exaggerated CRE is not as big an issue as posed
Sepkowitz, 13. Kent Sepkowitz is an infectious-disease specialist in New York
City. He writes for The New York Times, Slate, and O magazine. He also writes
academic medical articles. Why Im Not Worried About Dying From a Superbug,
and You Shouldnt be Either. March 8, 2013
http://www.thedailybeast.com/articles/2013/03/08/why-i-m-not-worried-about-dyingfrom-a-superbug-and-you-shouldn-t-be-either.html
Pity the poor public-health official: in the midst of an epidemic, he must adopt a soothing avuncular tone of near-boredom, a weve seen this, not to
worry sort of yawn to calm people who otherwise seem ready to run screaming into the streets. But on the other hand, in this day of sequestered publichealth funding, he has to raise a major ruckus about some other problem that might happen, swearing that the earth may end soon if we dont wake up

The cavalcade of past get-ready-for-the-big-one hits includes drugresistant TB, avian flu, swine flu, and drug-resistant gonorrhea among others, each
introduced with shrill press releases and snapshots of grim faces peering through
microscopes. It is no surprise, therefore, to see the CDC roll out the heavy artillery
this week by proclaiming the dangers of the latest superbug. This one is ugly for sure, a resistant-tonow and face the music.

almost-everything bacteria that preys on the hospitalized patient. Called carbapenem-resistant Enterobacteriaceae, or CRE, to denote the class of
antibiotics (carbapenems) to which it is resistant, and the group of bacterial organismsEnterobacteriaceae, bacteria that reside in the gutto which it
belongs, CRE is being seen increasingly in hospitals across the U.S. Unheard of before 2001, CRE now is in 181 (4.6 percent) U.S. acute-care hospitals,
affecting hundreds of patients. In August 2012, the NIH Clinical Center had a widely reported outbreak from a CRE that killed six of 18 patients, the

The CDC and other public-health officials are particularly alarmed

by this latest wrinkle because the carbapenem class was the last thoroughly
modern group of antibiotics with predictable activity against gut bacteria. With the
carbapenem hegemony now wobbling, the next (and last) antibiotic is an oldie from
the 1960s, pulled from the market then because of concerns about toxicity, but now
being used in many hospitals and ICUs to treat CRE infection. If and when CRE
becomes resistant to this old-timer, the cupboard is truly bare. This sort of progressive resistance to
mortality rate seen in most series.

antibiotics is standard operating procedure for bacteria exposed to high doses of potent antibiotics over time; resistance can and must occur according to
the most basic principle of evolution: survival of the fittest. If a billion bacteria are exposed to an antibiotic and just one bacterium, because of a chance
mutation, is resistant to the antibiotic while the other near-billion are not, that single organism will survive while the others will die off. The resistant
organism will then have the run of the place with enough nutrition to support the billion now-absented brethren, allowing the resistant clone to take root

. We have been here before of course: methicillin-resistant

Staphylococcus aureus (MRSA) played through the hospitals and the headlines (and
even the National Football League) last decade, alarming the public and spurring
new regulations to contain it as well as the application of money, sort of, to develop
new weapons. Perhaps because of all the hubbub, MRSA now seems almost quaint
and surely not a headline-screaming scourge: mostly contained, a nuisance, a
problem, but being dealt with at the right place by the right people. In other words,
it has assumed its proper proportion in the world of threats and dangers . The same likely will
and get in position to spread

happen with CRE. More cases will occur, hospitals will make the necessary adjustments suggested by the CDC, specialists will learn their way around the
diseases, and eventually the threat and the excitement around it will flatten out. And then the next red-hot development on some other front will emerge

The problem though is this: the mix of steady CDC concern about
a real issue that requires attention, a world with infinite capacity for both news and
news, and a perverse public enjoyment of being frightened has succeeded in little
other than scaring the crap out of people who might need medical care. Indeed,
hospitals seem to occupy the same imagined place as the Overlook Hotel, the
cavernous inn Jack Nicholson prowled in The Shiningthe last place on earth a sane
person would go. Health care in general and hospitals specifically are viewed these
days by just about everyone as a veritable killing field, the place where the two
inevitabilitiesdeath and taxesmeet daily as people are fleeced then killed. Such
rendering the acronym to oblivion.

is not the case. Honest. Yes, I know I am tainted goods because of my conflict of interest: I work in a hospital and I believe in medical
care. But please remember that people in ICUs, where CRE and so many other deadly infections lurk, are not denizens of executive suites. They are
already quite ill, usually with multiorgan failure from the heart attack or stroke or high-speed automobile crash that brought them to emergency medical
care. They then are exposed to the high-tech ballet of life-sustaining futuristic machines, venous and urinary catheters, potent and often toxic
medications, and all the rest. They also are exposed to the bacteria in their own intestines, mouth, and skin, as well those in the environment, much less
the imperfectly cleaned hands of hospital staff. Horrible, heartbreaking, and fully preventable things happen in ICUs, but so too are many lives saved.

The demonization of health care has occurred simultaneously with our deepening
fascination of the promise of tomorrow, an almost religious belief that medicine is
just inches away from conquering just about everything. These two fantastic
extremes pervert reality with equal force and fully obscure the truth about medical
care in 2013: we are neither in a hell of ineptitude and willful neglect nor just inches
from the next great golden age of health. And though hospitals are complicated,
difficult places to spend time, the view that, to preserve health, it is safer to avoid
care than to seek it is a dangerous and troubling delusion.

Superbugs arent as serious as the population assumes.

Sermonis 7 (Nathan Sermonis is a writer for the Cornell Daily Sun. Gannett:No
Need for Outcry Over Super Bug http://cornellsun.com/node/25491)
A recent series of deadly methicillin-resistant staphylococcus aureus infections
the super bug have driven the nation into a panic, but some health officials are
saying this widespread fear is a severe overreaction. Its not a threat to the
average person. It can cause minor to serious cases only under specific
circumstances, said Claire Pospisil, spokesperson for the New York State
Department of Health. This specific staph-infection causing bacteria strain, identified over 40 years ago, typically occurs in healthcare settings, but recent
media coverage has emphasized dangers posed to the general population from community-associated MRSA which is spread by poor hygiene and close personal contact. Stories of high
school and college students becoming severely ill, in some cases even dying, from MRSA have forced many people to think seriously about the potential dangers posed by the bacteria

However, according to Sharon Dittman, associate director of

community relations at Gannett, many of the concerns erupting from this coverage
and drastic prevention measures being taken closing schools, canceling sports
events, disinfecting entire facilities top to bottom are out of proportion with the
real problem. This has really scared people into making decisions that may or may
not be called for, she said. While she encouraged people to take precautions
against the bacteria, like washing hands and not sharing personal items such as
razors andtowels, Dittman said the potential risk for developing a serious MRSA
infection is quite low, even for collegestudents living in close-quarters conditions.
and take precautions against it.

Usually present as a mild skin condition, MRSA infections appear as reddened skin rashes that may develop into boils or pimples, causing fevers and pain. Pospisil said that at this stage,
the infection is not serious as long as it is taken care of. She said, I think for community-associated MRSA cases, the important thing for people to know is if they have a skin infection,
they should have a doctor look at it. The sooner they identify it, the better. Although the MRSA strain is resistant to methicillin, an antibiotic in the same family as penicillin, infection is
treatable. According to Christine Pearson, spokesperson for the Centers for Disease Control and Prevention, these cases can easily be taken care of and are no cause for alarm. Most

Blaming a misinterpretation of a recent CDC report

that found 19,000 people died in 2005 from the antibiotic-resistant bacteria,
Pearson said the nation has become overly concerned with MRSA. The study
indicated that invasive MRSA cases are a serious problem in hospitals and
healthcare clinics, but did not indicate heightened risks for most of the general
population. There are two different things here, she said. According to the CDC,
invasive MRSA cases often cause serious complications by infecting bloodstreams
and spreading throughout the body, but the more common MRSA skin infections
usually do not become this serious. Different people are susceptible to different stages of MRSA infection. Healthy individuals with infections
MRSA skin infections are mild and dont cause death, she said.

can typically isolate the problem and easily treat it. On the other hand, people with weak immune systems run a higher risk of developing a case of the potentially deadly invasive MRSA.

While health officials across the country are making attempts to calm down frantic
parents and students, many welcome the opportunity to educate people on how to
avoid MRSA infections, issuing guidelines and fact sheets about the bacteria.

Pearson said, It never hurts to remind people about how to stay safe. Finding a
positive side to the recent nationwide media attention, Dittman said that at least
those who do run the risk of developing a life-threatening infection from MRSA will
now be aware of the condition. Crediting the CDC report, she said she thinks people
will be more likely to understand just how deadly MRSA can be under certain
conditions and take the necessary precaution s.

Antimicrobiotics Solves

Antimicrobiotics solve
ScienceDaily 11 (6/17, http://www.sciencedaily.com/releases/2011/06/110616193740.htm, KF)
ScienceDaily (June 17, 2011) " Super

bugs," which can cause wide-spread disease and may be resistant to

still have their weaknesses . A team of Canadian scientists
discovered that specific mixtures of antimicrobial agents presented in lipid (fatty) mixtures can
significantly boost the effectiveness of those agents to kill the resistant bacteria . This
most, if not all, conventional antibiotics,

discovery was published online in The FASEB Journal. According to a researcher involved in the study, Richard
Epand, Ph.D. from the Department of Biochemistry and Biomedical Science at McMaster University in Hamilton,
Ontario, Canada, "This study

may contribute to overcoming the lethal effects of drug

resistant bacteria that is becoming an increasing clinical problem, particularly in hospitals."

New Tech Solves

The end of illness is closer than we thinkmedicine advancing
fast
Siegel-Itzkovich, 13 Judy Siegel-Itzkovich Is the health and science editor at
the Jerusalem Post. The End of Illness 6/08/2013 http://www.jpost.com/Health-andScience/The-end-of-illness-315870)
After myriad clinical studies on how to prevent disease, there are clear guidelines on what people generally need to do and eat to have a shot a longevity. Yet, from time to time,
recommendations fall to the wayside as new discoveries result in course corrections on the path to long life and health. Gobbling multivitamins, for example, is now out and working

Prof. David Agus, a prominent 48-yearold oncologist at

Cedars-Sinai Medical Center in Los Angeles and author of the bestselling book The
End of Illness, has aimed beyond increasing the numbers of nonagenarians around
the world. He dispenses medical advice aimed at helping people to live robustly
until their last breath like Moses the prophet was gathered unto his fathers without
first suffering from any debilitating illness . Originally published in 2011 in English by the Free Press Division of Simon and Schuster, the
out in the morning following by a day of office work is out.

book has just been translated into Hebrew by Matar. (One hopes that the Hebrew edition will expunge the original endorsement that appears on the English version from Lance
Armstrong, the disgraced seven-time Tour de France winner.) Agus, who comes from a prominent Jewish family his grandfather, Rabbi Jacob Agus, was a theologian and the author of

. The author was invited to attend the

Presidential Conference by President Shimon Peres who is well known for his own
healthy longevity. Agus graduated from Princeton University and received his
medical degree from the University of Pennsylvania School of Medicine. He then did
his residency at Baltimores Johns Hopkins Hospital and completed his oncology
fellowship training at New Yorks famed Memorial Sloan-Kettering Cancer Center,
where he also headed the tumor biology lab. His dealings with cancer led to his
exploration of genetic influences and his co-founding of two California companies
Navigenics, a personal genetic testing company, and Applied Proteomics, which
searches the blood for biomarkers that provide early warning or prevention of
disease. Agus us currently a professor of medicine and engineering at the University of Southern Californias Keck School of Medicine. The 335-pageThe End of Illness, his first
books on Jewish history and philosophy is coming to Jerusalem later this month

book, was on The New York Times bestseller list. At the outset, Agus notes that colleagues were surprised he went to treating and researching cancer because, with exceptions,

theres little hope for survival in many cases, and the cure is as evasive today as it
ever was. Im infuriated by the statistics, disappointed in the progress that the
medical profession has made and exasperated by the backward thinking that
science continues to espouse, which no doubt cripples our hunt for the magic
bullet. He continues: The war on cancer might be ugly and destructive on many
levels. But on a positive note there are many lessons learned in the experience of
this war that can then be used to prevent future wars and maximize peace . After all, the goal
should be to avoid ever having to go to war rather than to win a war. And in the health realm, this is especially true. HIS IDEAL end of life is to live robustly to a
ripe old age of 100 or more. Then, as if your master switch clicked off, your body
just goes kaput. You die peacefully in your sleep after your last dance that evening.
You dont die of any particular illness, and you havent gradually been wasting away
under the spell of some awful, enfeebling disease that began years or decades
earlier. The end of illness, he writes, is closer than you might think.

Protective measures are already in place to stop the spread of

Super Bugs.
Churchill 7, Bernard M. Churchill is the Chairman in Pediatric Urology at Mattel
Childrens Hospital UCLA. Superbug are dangerous, but we are not powerless
against them. November 7, 2007.
http://online.wsj.com/article/SB119439254844384511.html)

Regarding the recent article "Attack of the Superbugs" (Scott Gottlieb, op-ed, Oct.
30), it is correct to point out that the Food and Drug Administration is largely to
blame for the lack of new antibiotics against superbugs such as methicillin-resistant
staphylococcus aureus (MRSA). But Dr. Gottlieb incorrectly diminishes the
effectiveness of preventive measures Numerous studies show that screening and
cleaning can reduce MRSA infections in hospitals by as much as 90%, even in the
absence of new drugs. Screening means identifying incoming patients carrying the
germ, and then taking precautions to prevent it from spreading to other patients
.

. Recent

studies at Rush Medical College in Chicago and Boston University in Massachusetts show that training cleaners not to overlook surfaces and to allow detergents to remain on surfaces for at least three minutes, rather than just giving
a quick spray and wipe, can curb the spread of germs from patient to patient. Can hospitals afford screening and cleaning? They cannot afford not to do it. The evidence is compelling that these steps actually make hospitals more

This two step strategy will

save patients lives immediately, no matter how the bacteria morph. Betsy
McCaughey, Ph.D. Chairman, Committee to Reduce Infection Deaths New York Dr.
Gottlieb's op-ed carries an important message for all Americans. I agree with
everything in his article, but he does not present the full extent of the problem nor
does he address new and hopeful, innovative diagnostic and therapeutic
developments. He discusses antibiotic resistance in well-published "superbugs"
such as MRSA, but antibiotic resistance is also a growing threat in such common
problems as urinary tract infection in nursing homes.
profitable, and require almost no capital outlay. While waiting for the miracle cures, hospitals should implement MRSA screening and thorough cleaning.

Approximately 85 such infections per 100 long-term care beds occur each year. These

organisms show increasing resistance to even potent antibiotics. Dr. Gottlieb also does not mention the dangers of biofilm and nosacomial (hospital acquired) infections. Biofilm is a slime like matrix produced by micro-organisms as a
defense mechanism against their environment. Biofilm is particularly dangerous to hospital patients whose first line defense against infection (their skin) has been breached by injury, surgery (particularly involving implants) and
various types of catheters. This is the main cause of nosacomial infection, which involves two million patients and 90,000 deaths per year in the U.S. Antibiotics are ineffective in preventing and treating biofilm infections. The good

A group that includes UCLA, the Veterans Administration of Greater

Los Angeles and GeneFluidics Inc. of Santa Monica, Calif., and which is funded by
the National Institutes of Health, published a promising new technique in the Journal
of Clinical Microbiology last year. The diagnostic technique can rapidly (under 30
minutes) identify uropathogens in clinical urine by using an electrochemical DNA
biosensor. The biosensor turns the genetic information of the bacteria into an
electrical signal. This is analogous to a telephone, which turns voice into an
electrical signal. Other new methods for rapidly testing antibiotic susceptibility are
also currently being evaluated. Dr. Gottlieb outlines the limitations of current
antibiotics and problems of bringing new antibiotics to the market. Antibiotics are
substances produced or derived from one micro-organism which destroys or inhibits
the growth of other micro-organisms. New antibiotics will be developed. However
progress in antimicrobials will also be made
news is that help may be on the way.

. A new group of hopeful antimicrobial compounds called Aganocides (developed by Nova Bay Pharmaceuticals)

are based on small molecules generated by our own white cells that defend against invading pathogens. In the body these compounds are produced "on demand" and are transient. Important safety features include long shelf life,
stability and very high therapeutic index (kills pathogens at concentrations significantly lower than concentration where it begins to harm human cells). Aganocides also unlikely to be rejected by the immune system and are unlikely
to provoke bacterial resistance. They are also likely to kill bacteria in minutes, kill most, if not all species of bacteria, and kill certain viruses, yeast and fungi. And Aganocides may even kill resistant bacteria and destroy bacteria
protected by biofilm. Current evidence indicates that a normal adult human has more bacteria in his body than his own DNA. In optimal condition, bacteria are divided every 20 to 30 minutes producing billions of pathogens in a

These two facts alone guarantee that bacteria will always present problems for
medical science. But new diagnostic and therapeutic developments will continue to
allow us to be masters of our bodies.
single day.