jenny mccarthy wants your kid to get measles: autism, vaccines, and stupid idiots

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eh, whatever:

Antibiotic overuse: Stop the killing of beneficial bacteria
• Martin Blaser
Nature
24 August 2011
Concerns about antibiotics focus on bacterial resistance — but permanent changes to our protective flora could have more serious consequences, says Martin Blaser.

The average child in the United States and other developed countries has received 10–20 courses of antibiotics by the time he or she is 18 years old1. In many respects, this is a life-saving development. The average US citizen born in 1940 was expected to live to the age of 63; a baby born today should reach 78, in part because of antibiotics. But the assumption that antibiotics are generally safe has fostered overuse and led to an increase in bacterial resistance to treatments.
Other, equally serious, long-term consequences of our love of antibiotics have received far less attention. Antibiotics kill the bacteria we do want, as well as those we don't. Early evidence from my lab and others hints that, sometimes, our friendly flora never fully recover. These long-term changes to the beneficial bacteria within people's bodies may even increase our susceptibility to infections and disease. Overuse of antibiotics could be fuelling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations (see graph).

We urgently need to investigate this possibility. And, even before we understand the full scope, there is action we should take.

Bacteria have lived in and on animals — constituting their microbiome — since multicellular life evolved about 1 billion years ago. Hosts derive many benefits from their bacterial guests2: the Bacteroides species that dwell in the colon synthesize our required vitamin K; gut bacteria help us to resist invading organisms.

An oral or injectable antibiotic diffuses through the bloodstream and affects targeted pathogen and residential microbiota alike. And evidence is accumulating that our welcome residents do not, in fact, recover completely3 or are replaced in the long term by resistant organisms4.

Collateral damage

In the early twentieth century, Helicobacter pylori was the dominant microbe in the stomachs of almost all people. By the turn of the twenty-first century, fewer than 6% of children in the United States, Sweden and Germany were carrying the organism. Other factors may be at play in this disappearance5, but antibiotics may be a culprit. For example, a single course of amoxicillin or a macrolide antibiotic, most commonly used to treat middle-ear or respiratory infections in children, may also eradicate H. pylori in 20–50% of cases.

“Each generation could be beginning life with a smaller endowment of ancient microbes than the last.”

In humans, eradicating H. pylori affects the regulation of two hormones produced in the stomach and involved in energy balance, ghrelin and leptin. And as H. pylori has disappeared from people's stomachs, there has been an increase in gastroesophageal reflux, and its attendant problems such as Barrett's oesophagus and oesophageal cancer. Could the trends be linked?

H. pylori is a risk factor for peptic ulcers and stomach cancer, but a microbe probably wouldn't have been so pervasive if it didn't carry some benefit to its host. Indeed, large studies we performed have found that people without the bacterium are more likely to develop asthma, hay fever or skin allergies in childhood6. Stomachs that lack H. pylori seem immunologically quite different from those that do not, and infection of young mice with H. pylori protects against experimental asthma7.

There is other evidence that antibiotics cause shifts in microbial composition that may bring long-term physiological changes. For instance, as farmers have discovered, continuous, sub-therapeutic doses of many different antibacterial agents cause animals to gain weight with less food. And the earlier that antibiotics are started, the more profound the effects. In my laboratory, we have preliminary evidence in a mouse model that changes in body fat and tissue composition are associated both with low-dose antibiotic treatment that mimics farm use, and with high-dose treatment similar to those used to treat childhood infections.

The changes in our microbiome may even be fuelling the transmission of deadly organisms such as methicillin-resistant Staphylococcus aureus5 and Clostridium difficile8. This is not an enormous surprise, because one of the important roles of an intact microbial ecosystem is to resist intrusions by pathogenic organisms.

To better understand the long-term effects of antibiotic use, we need to compare the microbiomes of antibiotic-using and antibiotic-free populations. We are working with Maria Gloria Dominguez Bello at the University of Puerto Rico in San Juan and her colleagues to study people living in remote regions in the Amazon who either have never received antibiotics or who have had very limited recent exposures.

If antibiotics do cause long-term physiological changes, we may not be able to wait until we fully understand the problem before changing our approaches. Knowledge gleaned from farms indicates that early life is most crucial, triggering physiological changes that are difficult to reverse later on.
Consequently, we should reduce the use of antibiotics during pregnancy and childhood. Antibiotics — particularly penicillins — are now given routinely to between one-third and one-half of all women during pregnancy or nearing childbirth in the United States and other developed countries. Babies acquire their founding bacterial populations from their mothers while passing through the vagina at birth. So each generation — particularly the 30% or so of infants born via Caesarian9 — could be beginning life with a smaller endowment of ancient microbes than the last5.

When antibiotics seem warranted — such as in the 30% of pregnant women with group B Streptococcus, which causes serious infection in about 1 in 200 newborns — we must better assess which mothers need to be treated, or whether a vaccine might be preferable.

Targeted attack

Another precautionary step would be to develop specific agents to stabilize at-risk residential microbial populations, such as effective probiotics. We also need new, narrow-spectrum antibacterial agents to minimize collateral effects on the microbiota. This is an admittedly huge task, which will require providing incentives for the pharmaceutical industry to develop targeted classes of antibacterial agents and, importantly, better diagnostics that rapidly identify the problematic agent.

We may also need to start replacing what has been lost over the past 70 years. Along with receiving standard vaccinations, for instance, one day, children whose microbiome has been genotyped could be given inoculations of specific strains of H. pylori to reduce their chance of later developing allergies or asthma, then receive narrow-spectrum antibiotics later in life to eliminate the bacterium and lower the risks of peptic ulceration and gastric cancer.

The ease of worldwide travel is increasing our global vulnerability to pathogens, just as our ancient microbial defences are eroding. We must make use of the available technology to protect and study our bacterial benefactors before it is too late.

kkvgz, Tuesday, 6 September 2011 17:03 (ten years ago) link

well yeah - in the long term, antibiotics will be the secondary cause of the demise of the species imo, with the proximal cause being the antibiotic-resistant bugs that evolve in response to overuse of antibiotics

pathos of the unwarranted encore (underrated aerosmith bootlegs I have owned), Tuesday, 6 September 2011 17:37 (ten years ago) link

That and moving to the suburbs to have lawns and dogs, apparently.

BIG ROOSD aka the WTCdriver (Phil D.), Tuesday, 6 September 2011 17:40 (ten years ago) link

An acquaintance from the Inf. Dis. Society of Americas said that she and her colleagues got *death threats* after the IDSA published clinical practice guidelines on Lyme which said that chronic Lyme was not a real deal and docs needed to knock it off with the long term antibiotic therapy.

Those chronic lyme people are as scary as the vaccine nutjobs imo.

quincie, Tuesday, 6 September 2011 17:51 (ten years ago) link

i've also read that doctors who published a study that Chronic Fatigue might be partly psychological have received death threats. even better irony there, i guess...

goole, Tuesday, 6 September 2011 18:01 (ten years ago) link

wtf

unwarranted display names of ilx (mh), Tuesday, 6 September 2011 18:03 (ten years ago) link

"I would kill you if I wasn't so tired all the time from my chronic fatigue syndrome."

Tal Berkowitz - Vaccine advocate (DJP), Tuesday, 6 September 2011 18:05 (ten years ago) link

Holy shit, after reading about "chronic lyme" and finding out there's an organization of apparent believers that it's an ongoing thing, I am shaking my head and groaning

unwarranted display names of ilx (mh), Tuesday, 6 September 2011 18:07 (ten years ago) link

ew

Tal Berkowitz - Vaccine advocate (DJP), Tuesday, 6 September 2011 18:08 (ten years ago) link

sweet dn you have there

unwarranted display names of ilx (mh), Tuesday, 6 September 2011 18:09 (ten years ago) link

I'm imagining those as growing out of his hand and I am flipping the fuck out.

kkvgz, Tuesday, 6 September 2011 18:12 (ten years ago) link

lime disease is no laughing matter

Tal Berkowitz - Vaccine advocate (DJP), Tuesday, 6 September 2011 18:15 (ten years ago) link

Is that when you forget to wash off the limes before slicing them, putting them in your drink, and realizing your g&t is ruined and make horrible faces?

unwarranted display names of ilx (mh), Tuesday, 6 September 2011 18:17 (ten years ago) link

thx for the article, kkvgz

An acquaintance from the Inf. Dis. Society of Americas said that she and her colleagues got *death threats* after the IDSA published clinical practice guidelines on Lyme which said that chronic Lyme was not a real deal and docs needed to knock it off with the long term antibiotic therapy.

yeah, they were ~not pleased~ by this:

Physicians and laypeople who believe in the existence of chronic Lyme disease have formed societies, created charitable foundations, started numerous support groups (even in locations in which B. burgdorferi infection is not endemic), and developed their own management guidelines.5 Scientists who challenge the notion of chronic Lyme disease have been criticized severely.

The attorney general of Connecticut has begun an unprecedented antitrust investigation of the Infectious Diseases Society of America, which issued treatment guidelines for Lyme disease that do not support open-ended antibiotic treatment regimens.2 In some states, legislation has been proposed to require insurance companies to pay for prolonged intravenous therapy to treat chronic Lyme disease. The media frequently disregard complex scientific data in favor of testimonials about patients suffering from purported chronic Lyme disease and may even question the competence of clinicians who are reluctant to diagnose chronic Lyme disease. All these factors have contributed to a great deal of public confusion with little appreciation of the serious harm caused to many patients who have received a misdiagnosis and have been inappropriately treated.

from http://www.nejm.org/doi/full/10.1056/NEJMra072023

remembrance of schwings past (gbx), Tuesday, 6 September 2011 18:18 (ten years ago) link

Belief molds perception of reality; believing is seeing.

Blind Diode Jefferson (kingfish), Tuesday, 6 September 2011 18:28 (ten years ago) link

I'm obviously slow, I can't wrap my head around this Lyme disease controversy. I get why the whole Autism/vaccination debate persists, but I don't get the Lyme disease one at all. Can someone explain?

Moodles, Tuesday, 6 September 2011 19:10 (ten years ago) link

it sounds like there are people who don't really have Lyme's Disease and test negative for it, but they have chronic fatigue and so they diagnose themselves with "Chronic Lymes" which isn't actually a thing that exists?

the wheelie king (wk), Tuesday, 6 September 2011 19:12 (ten years ago) link

So it's about being able to claim you have a disease vs. you're really just lazy/depressed.

Moodles, Tuesday, 6 September 2011 19:13 (ten years ago) link

that was supposed to be a question...

Moodles, Tuesday, 6 September 2011 19:13 (ten years ago) link

and I guess some people are taking regular antibiotics for their "chronic Lyme's" which is a really bad idea

the wheelie king (wk), Tuesday, 6 September 2011 19:15 (ten years ago) link

Sounds to me like they may or may not have had lyme disease, probably test negative for it, but still are lethargic and think they're going to cure that by taking antibiotics for the long term.

mh, Tuesday, 6 September 2011 19:22 (ten years ago) link

it sounds like there are people who don't really have Lyme's Disease and test negative for it, but they have chronic fatigue and so they diagnose themselves with "Chronic Lymes" which isn't actually a thing that exists?

― the wheelie king (wk), Tuesday, 6 September 2011 19:12 (25 minutes ago)

Yes, this is curious. CFS almost always begins with some sort of viral/medical episode (which is part why CFS patients are so angered by claims it's "all in their head"), so it seems more likely that they had lyme's disease at some point and now have CFS as a result. Which is why the antibiotic treatments are useless.

Matt Armstrong, Tuesday, 6 September 2011 19:44 (ten years ago) link

Sounds pretty stupid as a trend, but not as malevolent as the whole anti-vaccination thing.

Moodles, Tuesday, 6 September 2011 19:46 (ten years ago) link

Unless there start to be enough of them that bacteria with broad-spectrum antibiotic resistance start to flourish and spread to the rest of the population

mh, Tuesday, 6 September 2011 19:50 (ten years ago) link

there's a lot to talk about in terms of chronic disease that has a greater or lesser psych component manifesting as physically felt symptoms - I think going w/"so it's in their heads!" is unproductive really, and

So it's about being able to claim you have a disease vs. you're really just lazy/depressed.

well - "depressed" close, "lazy" no I don't think. I think the deal is actually that people are different and there really isn't one model for how to be a healthy person, but society & its expectations are set up on around the concept of a healthy baseline for wakefulness/productivity/energy that doesn't really take into account different individual levels of tolerance for activity/stimulation/pain etc. my own I'm-not-an-MD take on a number of these syndromes is that in some cases people are expressing a need to put a name to the vague feeling that there's something wrong with them - that if they don't live up to an idea of "normal" that they have, then the way they feel every day needs to be pathologized for them to feel "ok," in a weird sense.

pathos of the unwarranted encore (underrated aerosmith bootlegs I have owned), Tuesday, 6 September 2011 19:55 (ten years ago) link

^^ very otm, the normal you have at different ages varies, too, and your needs can change accordingly.

I have a family member who has exhibited some of the signs that typify something autoimmune like lupus, but it turns out that for some conditions like that, you have to manifest a certain number of symptoms over years to really qualify for a specific diagnosis. Until then, it's just, "Hey, I guess you have some weird symptoms, maybe we'll figure out what's up with that."

mh, Tuesday, 6 September 2011 19:59 (ten years ago) link

if they don't live up to an idea of "normal" that they have, then the way they feel every day needs to be pathologized for them to feel "ok," in a weird sense.

totally

remembrance of schwings past (gbx), Tuesday, 6 September 2011 20:21 (ten years ago) link

my own I'm-not-an-MD take on a number of these syndromes is that in some cases people are expressing a need to put a name to the vague feeling that there's something wrong with them - that if they don't live up to an idea of "normal" that they have, then the way they feel every day needs to be pathologized for them to feel "ok," in a weird sense.

― pathos of the unwarranted encore (underrated aerosmith bootlegs I have owned), Tuesday, September 6, 2011 7:55 PM (1 hour ago)

to put it another way: let's say chronic fatigue isn't a "disease" per se but instead just a permanent downgrade of one's health/ energy level caused by an immune system response to some viral infection/trauma at some point (usually epstein-barr, but I know a person who got it after open-heart surgery). Why not just treat it as a disability? Why does it have to be either mental illness or a physiological disease?

Matt Armstrong, Tuesday, 6 September 2011 21:17 (ten years ago) link

I think you just described a cause, though?

mh, Tuesday, 6 September 2011 21:20 (ten years ago) link

I'm gonna tread lightly here, but since no one has actually elaborated the etiology if CFS to a degree that is widely accepted, it still gets called a "syndrome". This says nothing about the severity/disability of the condition, but the actual cause of CFS is an open question iirc

remembrance of schwings past (gbx), Tuesday, 6 September 2011 21:58 (ten years ago) link

"of"

remembrance of schwings past (gbx), Tuesday, 6 September 2011 21:58 (ten years ago) link

this is why it's generally regarded as a diagnosis of exclusion fwiw

remembrance of schwings past (gbx), Tuesday, 6 September 2011 21:59 (ten years ago) link

EBV as etiological agent has been more or less ruled out iirc

But hey, I'm not saying that certain types of feeling like shit are OK and other types of feeling like shit are less OK. If you feel like shit, that is a problem. But it does not mean you have chronic lyme. You can acknowledge and legitimize the significance of feeling like shit without acknowledging and legitimizing theories like vaccination -->autism, EBV-->CFS, and lyme-->chronic lyme

quincie, Tuesday, 6 September 2011 23:43 (ten years ago) link

Interesting that its linked with "chronic lyme" (lol wow) because over here, or with people I know more to the point, the CFS thing is linked to somethign called "fybromyalgia" and I have no idea what that even IS, but it seems to result in these vaguely achy, very tired women (always women?) going to doctors constantly, being told they cant find anything wrong with them, and sinking time and money into a ton of crazy/random treatments, none of which ever seem to work.

Silent Hedgehogs (Trayce), Tuesday, 6 September 2011 23:44 (ten years ago) link

I get this weird back/shoulder pain occasionally that I can't figure out why - it's probably muscular, but I was looking online to see if I could find what is causing it, and 'fibromyalgia' kept popping up. I'd never heard of it but it sounds so vague I don't think it was anything to do with my problem, but I guess a 'diagnosis of exclusion' is always going to seem like an answer.

kinder, Tuesday, 6 September 2011 23:53 (ten years ago) link

speaking of vaccines, the NEJM has an interesting thing on the progress being made in the world of HIV vaccines....p cool

remembrance of schwings past (gbx), Thursday, 8 September 2011 00:50 (ten years ago) link

link?

remy bean, Thursday, 8 September 2011 01:09 (ten years ago) link

ha yeah duh, sorry. on iPhone, will post

remembrance of schwings past (gbx), Thursday, 8 September 2011 01:10 (ten years ago) link

this is kind of a booming post imo:
http://www.nejm.org/doi/full/10.1056/NEJMp1107189

remembrance of schwings past (gbx), Thursday, 8 September 2011 01:17 (ten years ago) link

friend of mine doing work in Africa put up an interesting post on his blog the other day, too (posted in the Africa brb thread) that mentions how HIV/AIDS is really a chronic disease now for many ppl, which is sort of mirrored way of looking at that NEJM piece.

remembrance of schwings past (gbx), Thursday, 8 September 2011 01:19 (ten years ago) link

the ny-er blog rebuttal of bachmann's claim was excellent & concise

and my soul said you can't go there (schlump), Wednesday, 14 September 2011 10:47 (ten years ago) link

some of the comments over at NRO were excellent and concise, too! while i doubt this single issue will sink her, i think that her stance on the HPV vaccine is going to make a lot of conservatives sit up and go "wait what"

remembrance of schwings past (gbx), Wednesday, 14 September 2011 14:53 (ten years ago) link

HPV vaccine promotes promiscuous sex and that's bad and if you get cervical cancer then your church and community will chip in money to pay for your treatment because insurance is bad.

mh, Wednesday, 14 September 2011 14:59 (ten years ago) link

An example of right wing blogs melting down. (Not so much the otherwise batshit author, who here is essentially sane on the point and the relevant issues, but check the comments.)

Ned Raggett, Wednesday, 14 September 2011 15:54 (ten years ago) link

We had some of the same issues in the UK, but the government listened to scientists rather than crazies. Of course if the crazies are the government...

Zonules of Zinn (dowd), Wednesday, 14 September 2011 19:45 (ten years ago) link


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