This seems like it ties into an article from The Atlantic last year [1] on the under appreciated threat of increasing antifungal resistance. In particular, there are lots of antifungal agents out there that are fit for use on plants, but only a very small number triazole agents that are safe for humans. It should be completely illegal worldwide to use triazoles in anything except prescription treatments. This isn't even like antibiotics where there is necessarily overlap between mammalian usage in agriculture vs humans, there are non-triazole non-human safe agents that won't hurt plants one bit.
An important takeaway from that article was that it's not too late: agricultural azole usage is actually a fairly recent thing in much of the world and hasn't been in the US for example long. Quoting:
>"Until recently, the United States was exempt from concerns about azole-resistant Aspergillus. Azole use here has historically been low, a small percentage of what happens in Europe—though the numbers that record it, kept by the U.S. Geological Survey, may be incorrect because submitting them is voluntary. Nevertheless, tebuconazole use in the United States rose five times over from 1995 to 2015; the crops that accounted for the most use were wheat and corn. Meanwhile, a Centers for Disease Control (CDC) poll of state health laboratories found no cases of resistance as recently as 2014. But last month, the CDC disclosed that 10 patients treated in the United States have been diagnosed with triazole-resistant Aspergillus bearing the mutations associated with agriculture. In a report in its weekly bulletin, the agency analyzed the records of seven of them. Four of them had never received azoles before they were diagnosed with the resistant strain. Three of the patients died."
It's worth trying to stamp down on it legally ASAP. But it needs more public attention and political pressure, which makes this report that health authorities have been covering up the seriousness even worse.
We have representatives at the national and state/providential level. Write each of them letters about how they can represent you in this regard, maybe seasonally. As @acct1771 suggested, share this concern with others in your community. Encourage them to write a letter as well.
I follow Hank Green's advice [0] about how to do so. Be specific, be respectful, demonstrate you checked hiso'er past, relevant votes.
> Health officials say that disclosing outbreaks frightens patients about a situation they can do nothing about, particularly when the risks are unclear.
They could go to a hospital that isn't having an outbreak. Why isn't that an option for most patients?
> Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks.
This seems like an agreement against the interests of the populations that the C.D.C. is supposed to protect, even if (temporarily) in the interest of hospitals involved in outbreaks ... yet another example of regulatory capture.
On the one hand I can see that this policy would make hospitals more likely to report potential outbreaks and cooperate with the C.D.C. On the other hand the secrecy would result in dead patients who could have gone elsewhere and survived. Or people that need hospital treatment avoiding all hospitals.
Can anyone point to a good argument that such secrecy -- even after the infection has been verified -- is good policy?
You indirectly mentioned it in passing (through the corollary), but it's a very real issue: hospitals simply would not report anything. This would even encourage hospitals to do things such as ensuring that things such as this are not detected. No need to report an outbreak if you don't/can't detect it! This is a particularly great example of unforeseen consequences. Though in this case (and many) these unforeseen consequences can actually be quite foreseen if you just consider practical reactions to things.
And as a consequence of the above, the current system is also likely more beneficial for patients as well because hospitals need not worry about anything other than doing as optimal a job as possible. Something like this sounds like it stands a good chance of eventually spreading everywhere. And so would you be safer at a place that has or has not detected it? Obviously you'd be better off in a place without it, but again once we introduce those unforeseen consequences a place not detecting it is absolutely not the same as a place not having it. By contrast the place that has it has indicated that they are actively screening for it and presumably doing all they can to try to manage it.
> This would even encourage hospitals to do things such as ensuring that things such as this are not detected
Trial lawyers in New York created an organization [0] that systematically maps sidewalks and streets to identify cracks and holes that cause slip-and-fall accidents.
They provide these maps and supporting data to the city for free, and in the process they can prove that the city had constructive knowledge of the risk.
That way the city can't avoid liability by claiming they didn't know.
It seems that a similar "service" could alert hospital managers to the risk of C. auris, and thereby neutralize intentional ignorance as a defense.
City streets and sidewalks are readily publicly viewable, though, while medical facilities go to great lengths to not let people see whether they've screwed up.
I agree it'd be extremely useful, but it's a harder problem to get visibility into.
Your guess on the rationale of not requiring disclosure of outbreaks is correct, according to the LA Times [1]. In some states, hospitals face no penalty for failure to report outbreaks to even the CDC. This does result in preventable deaths.
Irrational people sometimes hold a certain position. We should avoid making it so that rational parties could also reasonably come to hold that position.
To be fair, we don't vaccinate against smallpox anymore because the risks of the vaccine outweigh the benefits.
It's not prima facie irrational to believe that the risks of other vaccines outweigh the benefits. I've never heard of anyone being persuaded by being insulted, so perhaps we should instead approach the anti-vaxxers with hard data showing how yes, their concerns are in fact grounded in fact, but there are also other facts that make vaccination the right decision in most, but not all, cases.
Concern over making things worse by spreading the infection, or by doing more harm by scaring patients into moving to another hospital when that move is itself risky?
Remember the great 2001 anthrax scare? Emergency rooms got flooded with people thinking they had anthrax (they didn't) and it caused serious problems because it used up resources needed to help people with real problems.
The scary part is the people with these infections ultimately come from the community. They have been walking around and these bugs are at the grocery stores you shop, the restaurants you eat, and the gym you visit. The hospitals just test regularly so we know about it. But ultimately these bugs will do their rounds and people who are susceptible will run into it. I worry about the future with antibiotic resistance. Imagine an eye infection that would not go away. Or a toothache that just got worse. I hope one day we can solve all the issues around antibiotics.
You're right. They're called communicable diseases for a reason after all.
Fortunately for us, antibiotic resistance is maladaptive when antibiotics are not present. Using them intelligently will cause resistant strains to be out-competed.
It is so incredibly stupid on so many levels to be spraying antifungals into the environment. Not least because of the resistance problem. There are many ways that fungus interacts with plants and animals. Destabilizing the base of some critical food chain to get 10% better crop yields seems like a bad idea for us to do.
Generally they're referring to the thin veneer of blue and green on the surface of the planet. Things would have to get pretty heinous for humans to go extinct, but many species are already threatened.
Lots of species will survive no matter what we do, but humans are among the delicate majority.
I realize this is subjective, but to me, biodiversity is obviously far and away the greatest thing in the known universe. It's astounding we (humans in the aggregate) care so little for it.
Are they always? My partner was nearly loosing her marbles because someone threw a ball into a thermal vent in NZ (I agree it's unsightly and lame). Or that science show was throwing bag of soap every day to trigger a geyser in Rotorua.
It's like mostly poisonous gas and water, chill down!
The food companies pocket the extra margins -- and the seed/pesticide companies ensure a constant market for their wares (which they also patent)...
(Add to that that untold tons of perfectly good produce are destroyed every year to keep prices high when production quota are exceeded).
Besides, it's not because of lack of money going around the globe that people have to spend between 30% and 50% of their income for food. It's because of lack of distribution of money (i.e. income inequality).
Also, fungi are the world champions of biological warfare. They're where we got the idea of antibiotics from in the first place. Mycotoxins are nasty business too. This is not a battle we're going to win by brute force.
Several billion years of evolution can trump some experts trying to come with a clever solution in a short time. Same way we haven't eradicated the common flu, cancer and tons of other things that still get billions in research every year either after a century of trying...
A "spanish flu" like situation can lead to hundreds of millions dead in this much more interconnected era (cheap flights etc) compared to 1910s...
Welcome to the beginning of the new dark age, with doctors scared to care for patients with certain diseases. Were higher crop yields really worth it? When do we finally start taxing (even retroactively) externalities?
That was supposed to be the "great engine" of capitalism dogma.
That self-interest, and doing things for one's local gains, ends up to the benefit of everybody.
It started with Adam Smith: ""It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity, but to their self-love, and never talk to them of our own necessities but of their advantages"."
and ended up in ever increased praises of self-interest (Ayn Rand, etc) over communal values and morality.
I find it amusing that so many people read his "Wealth of Nations" and founded edifices on it, while conveniently ignoring his other book: "The Theory of Moral Sentiments"¹
1: Relevant quote: “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortune of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it.”
> rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans
Another looming side effect of mono-cropping — planting huge fields of a single, highly specialized cultivar with very low genetic diversity.
Many of these cultivars are reliant on huge amounts of fertilizer, insecticide and fungicide. They produce high yields when times are good, but come with massive vulnerabilities and large negative externalities.
There has been some movement in recent decades away from typical industrial agriculture toward more diverse planting and sustainable and scientific farming, which in the long run produce healthier soil, crops and environment. Sadly this is still fairly niche and not applied to the millions of acres of single crop areas around the globe, mostly because it’s still super cheap to pump fields for all their worth with cash crops.
Unless we adopt a more difficult path, we’ll be paying for our cheap calories in more ways than just algae blooms and drug-resistant fungus. But I guess the same could be said about everything, climate change et al.
I think a different term needs to be adopted by now, since climate change is perhaps only half the story.
Yes, the greenhouse gases from converted fossil fuels used for transportation and the release of energy to do work, all of which leads to global warming, is of great concern, and in terms of survival of our species, matters very much.
But there are a number of looming adjacent narratives that go hand-in-hand with climate change, but are not necessarily of climate change alone, while human activity beyond the use of fossil fuels is certainly at the heart of the matter.
Fish dying off, colony collapse disorder, birds disappearing, general insect volume depletion throughout zones of historically higher activity, radiological contamination of the ocean by at least one major nuclear incident, the pacific garbage patch and microplastics in general, chemical pollution of waterways, disruptive hydroelectric dams, fracking, slag lagoons (ruptured and unruptured), superfund sites like the gowanus canal as a particular expample of a failure to clean up even one hazardous zone in a major city, pesticides in general (even ignoring insect populations as keystone species and colony collapse). The list goes on.
Beyond just climate change, the grand scope of human activity has some serious detrimental side effects, with deep ramifications for the world around us. Yes it's getting hotter, and the weather patterns are strange, but taken together with other issues, the big picture is that The Anthropocene as a period of time represents itself a challenge of challenges.
That we now can safely call this The Anthropocene is enough to say we have a problem, as we become a force of nature unto itself. This being The Anthropocene is akin to us being the asteroid that killed the dinosaurs. Terrible lizards though they were, we are worse.
We are the asteroid. Don't call is merely climate change. Call it The Anthropocene, and understand that the full scope of human activity is the full scope of the problem.
It's amazing to me how little (if ever) they bring up massive antibiotic overuse in agriculture. High density farms for pigs, cattle, chickens, etc. are goal directed evolution experiments for antibiotic resistance.
80% of the antibiotics consumed in the US are used in animal agriculture[1]. 2/3 of infectious diseases in humans have animal origins. Along with horizontal gene transfer, antibiotic misuse in agriculture is overwhelmingly responsible for antibiotic resistance in the US.
As someone who often gets secondary bacterial infections from initial viral infections, I often have to fight with well-intentioned prescribers in order to get adequate treatment so I don't end up in the hospital a few days later.
I was wondering why they didn't just irradiate the infected room and did a preliminary online search. I'm not a specialists and the following are not specific to Candida Auris, but it seems some of these organisms actually thrive under radiation. Reminded me of The Andromeda Syndrome.
Interesting and scary how much of it is in the New York area. I wonder if its similar to the AIDS epidemic in that a combination of immigration and local social patterns make big cities much more susceptible to these things than elsewhere.
It's not just antibiotics, but some types of vaccines are creating evolutionary pressure and new strains of the pathogen. E.g. for pertussis
> it is thought that B. pertussis is adapting under acellular vaccine mediated immune selection pressure, towards vaccine escape [1]
> an increase in asymptomatic infection with concomitant increases in transmission and increased selection pressure for Bordetellapertussis variants that are better able to evade vaccine-mediated immunity than older isolates [2]
A non-trivial amount of what I work on is better diagnostics for C. auris. It's remarkably nasty stuff, especially the multi-drug resistant strains! One of those projects where I'm glad I'm on the analysis side of things, and not growing out collections of "interesting" isolates.
Nah, that's really stupid. Agriculture is a human need. If you let your crops infected by fungi, you get famines (incidentally something non-capitalist countries are often known for). I take it anti-capitalists would rather have millions die from hunger?
Germ is a layman's term for "microorganism", or perhaps "pathogen", both of which most assuredly include all the little things that make people sick: viruses, bacteria, fungi, etc.
I read this earlier today and have been mulling it over and over in my head. Think of how many fungi we encounter on a daily basis. We know that breadmakers' sourdough will contain customized microbes based on the breadmaker. What if candida auris was on the skin of the breadmaker? Shit....
For about 7 years, I've been battling undiagnosed Candidiasis. Cutting down wheat and sugar dramatically has mostly eliminated my symptoms, though when I get careless it comes back.
I've talked to three doctors about my symptoms, and done various tests, which don't show anything. None of them seemed to accept the idea that it could be caused by Candida. It's interesting to see it getting some media attention, though certainly this particular report makes me a bit nervous.
This article has little to nothing to do with chronic Candida albicans infection, which might or might not exist.
Having spent a lot of time in and around various "health food" type communities, I don't see any reason to believe that so-called Candidiasis is actually a fungal infection. It's some kind of chronic inflammatory condition, that's all we know. Anything beyond that is speculation.
True, nothing to do with the article but Candida Albicans does exists in the gastrointestinal tract of about half the population.
It's a commensal organism that sometimes overgrow and becomes pathologic under opportunistic circumstances: it's quite common to see it rise after an antibiotic treatment which kills the bacteria that keep this fungi in check.
Excessive consumption of bread ord sugar also fuel its proliferation
I had this in 2001 when I had a very bad bout of the flu. Toward the end, food started to taste like sand. There were really no other symptoms, though that was bad enough. Went to the doc and he asked if I had HIV (answer: no). He said he'd never seen it in a healthy person. He gave me some lozenges that were almost worse than the original problem. About 3-4 weeks later it was mostly gone. It minorly flared up in the years after that, if I had a cold and skipped brushing my teeth.
It may sound very strange, but I've been free from candidiasis for the last year after I've used Vyvanse 70mg (Lisdexamfetamine) for 1 month to treat a focus problem.
It caused me a big and risky dehydration of my body as a side effect that I don't known why (nor my doctors), but it eliminated candidiases from my body, and I wasn't using any other medication at that time.
Sometimes it's difficult to get a diagnosis, and sometimes you end up with crap doctors who run more or less the same tests for every patient and write off anyone that doesn't match as a hypochondriac/lunatic/time-waster. And sometimes doctors literally know less about your condition than you do yourself.
If you've never been in this position yourself, I can understand why you'd be sceptical of the OP's claims, and indeed I'm sure there are lots of people that are convinced they have a particular condition despite what tests say.
For context, I was written off by my NHS neurologist because I didn't match his standard battery of tests. My circumstances and symptoms pointed strongly to a small fiber neuropathy, but he scoffed and said it was very unlikely, and refused to do a skin biopsy to confirm it. Instead he labelled me with fibromyalgia, and hoped I'd disappear - but when questioned it was abundantly clear he literally knew next to nothing about fibromyalgia, and presumably used it as a generic label for "time wasters". Eventually I did get him to do the biopsy - which they fucked up. When the results were negative, he again tried to get rid of me, and I had to fight to get him to redo it properly - lo and behold, it was positive.
I had a very similar experience with endocrinology - I have a rare endocrine condition, but the symptoms point absolutely towards a specific diagnosis - instead, I was basically told to "stop this silly nonsense", and it wasn't until several years later that I was diagnosed. NHS endocrinologists have a terrible reputation for anything that isn't diabetes.
People rave about how wonderful the NHS is, but my (unfortunately substantial) experience has been shambolic. It's my observation that doctors (and consultants and registrars alike) don't update any of their knowledge or training since they left medical school, even if that was 40 years previous; they have no interest in recent medical developments; they have no interest in writing case studies or undertaking research; they could basically be replaced by a flow chart.
Myself, I was increasingly certain I had an undiagnosed condition for years. My symptoms grew worse and it became apparent that they exceeded the bounds of normality. Doctors brushed off my questions with responses I knew weren’t true. Finally I was diagnosed with celiac disease, which explained why I was so tired after meals (I had thought it was a type ii or iv food allergy, which tests can’t easily detect unlike the type i (anaphylactic). It can make you tired 4-36 hours after ingesting a food). So as of 3-4 years ago I was saying I definitely had some undiagnosed food allergy or problem with eating.
Sounds like they have been convinced of it by their own symptoms but it has not had a proper diagnosis.
In my own life experience this is common. People bounce around the medical system with varying diagnoses for many ailments, at various levels of confirmation, and sometimes the doctors aren't sure either.
There is some distinction to be made between the verbs "convinced of" and "diagnosed with". Not to downplay anyone's medical conditions, but there's lots of FUD surrounding candida, too much money on the table, and we should all be careful with terms.
I have ADHD. I have had it my entire life. I was "diagnosed" with it when I was 14. I was therefore "undiagnosed" for 14 years.
Similarly, cars can have problems that a mechanic can't figure out how to fix. These are generally called undiagnosed problems, but they're still there.
Sure, but this person implied that they had been to doctors and the doctors disagreed with their own self-diagnosis. That's a very different thing than simply not having been diagnosed.
An important takeaway from that article was that it's not too late: agricultural azole usage is actually a fairly recent thing in much of the world and hasn't been in the US for example long. Quoting:
>"Until recently, the United States was exempt from concerns about azole-resistant Aspergillus. Azole use here has historically been low, a small percentage of what happens in Europe—though the numbers that record it, kept by the U.S. Geological Survey, may be incorrect because submitting them is voluntary. Nevertheless, tebuconazole use in the United States rose five times over from 1995 to 2015; the crops that accounted for the most use were wheat and corn. Meanwhile, a Centers for Disease Control (CDC) poll of state health laboratories found no cases of resistance as recently as 2014. But last month, the CDC disclosed that 10 patients treated in the United States have been diagnosed with triazole-resistant Aspergillus bearing the mutations associated with agriculture. In a report in its weekly bulletin, the agency analyzed the records of seven of them. Four of them had never received azoles before they were diagnosed with the resistant strain. Three of the patients died."
It's worth trying to stamp down on it legally ASAP. But it needs more public attention and political pressure, which makes this report that health authorities have been covering up the seriousness even worse.
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1: https://www.theatlantic.com/science/archive/2018/11/when-tul...