Are the Germs Winning?
It may seem surprising that germs are still a critical issue in the 21st century. After all, we're a technically sophisticated society with such health advancements as well-sealed clean homes, water disinfection, sterilization of medical equipment, refrigeration, indoor plumbing, immunizations, and antibiotics. All of these innovations have helped to control and eradicate infectious diseases and have improved the quality and length of our lives. For example, the average American baby born in 2000 is expected to live 80 years, compared to the 47 years expected for a baby born in 1900.
Nonetheless, at the beginning of a new millennium filled with medical promise and scientific breakthroughs, we face a public health crisis fueled by misinformation. The simple truth is this: Not only do we remain far from victory in the battle against infectious diseases, but overkill--our modern approach to germs that focuses on killing them beyond what is reasonable or necessary--often results in stronger strains of bacteria and more difficult-to-treat infections that can make the situation worse instead of better.
The tragic events of September 11, 2001, reminded all Americans of our vulnerability, both as a nation and as individuals. As a member of the National Academy of Sciences panel on arsenic in drinking water, I was briefing some staff members at the White House the morning of September 11. I can attest to my own fear as we ran from the building during the emergency evacuation just before American Airlines Flight 77 crashed into the Pentagon. The subsequent anthrax scares served as a dramatic warning that we must be better prepared as a nation for terrorist and biological attacks.
Perhaps what we haven't heard enough is that we must also prepare as individuals. This must start with a better public understanding about germ-related risks and what we can do to manage them--not just the bioterrorism risks, but the everyday risks too. Let's put this in perspective. People panicked when the first cases of anthrax were confirmed following the September 11 attacks, and yet at the same time, a study by researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta had estimated that approximately 5,000 Americans die each year--more than 10 each day--as a result of food-borne illnesses.
In addition, our arsenal of pharmaceuticals is becoming less and less effective. The germs keep changing, becoming more resistant to the antibiotics and other antimicrobial agents that we rely on to kill them. A report from the Institute of Medicine estimated the annual cost of treating antibiotic-resistant infections could be as high as $30 billion. National and international agencies, including the U.S. Food and Drug Administration, the World Health Organization, the CDC, and popular books have sounded the alarm that the overuse and misuse of antibiotics is fueling a resistant-bacteria epidemic demonstrated by the following statistics and incidents:
- Thirty percent of the cases of Streptococcus pneumoniae, which causes meningitis, bloodstream infection, and pneumonia and is one of the most dangerous pathogens for children and the elderly, are now resistant to penicillin. Studies report outbreaks of resistant infections in day care centers.
- Gonorrhea infections resistant to penicillin and tetracycline became so widespread that the CDC recommended newly developed antibiotics like ciprofloxacin (Cipro) for treatment, and now reports of infections resistant to the antibiotics continue to emerge.
- A powerful, multidrug-resistant form of Salmonella has appeared in the United States, Canada, and Europe, in one case infecting farmers and their cattle.
- Several strains of Staphylococcus aureus, which causes the staph infections prevalent in hospitals, are now resistant to vancomycin, one of the most powerful antibiotics available.
- Strains of Staphylococcus aureus are now appearing outside of hospitals, with an outbreak involving seven members of a Vermont high school wrestling team in 1993 and 1994, documented in Archives of Internal Medicine.
- Tuberculosis is making a dramatic and frightening comeback, with cases on the rise, increasingly involving more of these resistant bacteria. For example, a study in the Journal of Pediatrics documented a 1993 outbreak of drug-resistant tuberculosis in a California high school.
Of course, many other examples exist. Even the reactions to the anthrax scares in October 2001 raised concern as millions of Americans rushed to get the antibiotic ciprofloxacin, also called Cipro, resulting in shortages of the drug in some pharmacies. Results of a study conducted late in 2001 suggested that approximately two million Americans might have actually taken Cipro unnecessarily, just as a precaution, thinking that they might have been eventually exposed to anthrax. We lack any information about how many of them may now harbor antibiotic-resistant bacteria as a result.
Public health agencies are so alarmed by the drastic increases in difficult-to-treat bacterial infections that they've mounted global campaigns to monitor them, and the medical establishment bombards physicians with data on the dangers of antibiotic overuse and misuse. Yet patients continue to clamor for the drugs. As pharmaceutical companies scramble to develop new prescription medicines to treat increasingly resistant strains of germs and manufacturers feed the public demand for nonprescription over-the-counter germ killers, the result is a marketplace crowded with a dizzying array of antimicrobial products. The problem is that no one is really talking to the public about its critical role in effective germ risk management. Unfortunately, hard evidence shows that if we don't stop the overkill as individuals, we not only risk sabotaging our own health, but we will inadvertently contribute to a serious public health crisis.
We've got to begin by educating ourselves about overkill. Even after all of the press coverage of anthrax contamination since September 11, 2001, confusion remains about what germs are, how they affect our health, and what we should do about them. Yet before we go further, check out the following myths about cleanliness and disease--along with some interesting scientific truths.
Myth: All bacteria are bad.
Truth: In large part, the impact of bacteria and viruses on your health depends on how and where they invade your body. Some "good" bacteria can be deadly if they get into the wrong place. For example, Escherichia coli (E. coli) live quite peacefully in your digestive tract, where they help you to process food; in fact, you depend on them for your survival. But if E. coli find their way into your bloodstream, they can be deadly. Even if a "bad" bacterium like E. coli O157:H7 makes it into your body, it can be harmless if it is cleared from your system without finding a way to attach to your body and reproduce.
Myth: Antibiotic overuse is not very common.
Truth: As early as 1998, a study by the Institute of Medicine estimated that approximately 20 to 50 percent of the 145 million annual antibiotic prescriptions given to outpatients and in emergency rooms, and 25 to 45 percent of the 190 million annual antibiotic prescriptions for hospitalized patients, are not medically justified. Antibiotics have no affect on nonbacterial illnesses, which include the flu, most colds, and some ear and sinus infections. Today's health professionals are in a very precarious position regarding antibiotic therapy, particularly if patients demand it--and studies show that many patients do. If a physician takes a wait-and-see approach, and the patient later develops a severe bacterial infection, that physician could be charged with negligence.
Myth: New medical breakthroughs are reducing the instance of asthma.
Truth: According to the National Heart, Lung, and Blood Institute, the incidence of asthma in the United States is now 1.75 times more common compared to what it was in 1980. Perhaps even more frightening, the incidence of asthma in children less than 4 years old is 2.6 times what it was in l980. Although scientists are still exploring the relationships between immune development and disease, hygiene may play a vital role. Researchers have even developed one theory, called the Hygiene Hypothesis, that our modern, squeaky-clean lifestyles are partially to blame for a variety of illnesses, including allergies and asthma. Many other theories are also being investigated, including the possibility that children are spending more time in less clean environments and association of disease with the increase in smoking among women of childbearing age.
Myth: The bathroom is the most unsanitary room in the home.
Truth: Your kitchen has the highest levels of bacterial contamination, particularly in damp areas. Your sponge or dishcloth, drain, cutting board, and faucet handle are some of the biggest bacterial culprits in your home.
Myth: You can't do anything to protect yourself from germs--getting sick is normal.
Truth: A wide range of strategies exists to reduce the risks from germs; taking action is up to you. For people at very high risk, simple steps like boiling drinking water and eating only thoroughly cooked foods may dramatically reduce risks, but for most people this would be overkill. The action you take should be appropriate for your individual situation.
As a professional health-risk analyst, I have repeatedly raised the issue of germs as an urgent topic for public concern. Yet in addition to being a scientist, I'm a wife and the mother of two young children and like you, I worry about my family as I read the terrifying headlines--the ones that cover daily breaking news stories about the hazards of the germ world, whether it's E. coli on your toothbrush, Salmonella in your orange juice, or fears about anthrax. Instead of being scared by the news, however, I grow increasingly frustrated and disappointed because I realize that consumers aren't getting all the information they need to make informed decisions. Without that information, consumers may miss opportunities to avoid or prevent illness or worse in their family.
Most important to understand is that there is no one-size-fits-all approach when it comes to dealing responsibly with germs because it inevitably will go too far for some and not far enough for others. That's why I decided it was time to step in and apply my own particular expertise--assessing risks and identifying ways to reduce those risks--to balance the concerns of the medical and public health establishments with the needs of the average consumer. The cold, hard fact is that germs do cause illness. Yet many leading scientists are warning that we risk disaster if we continue to take antibiotics when they aren't needed, sterilize everything we touch, and attempt to shield our children from every germ.
So where should we draw the line? Again, a balanced approach is critical. And finding that proper balance--one that you tailor to your situation and that empowers you to play an active role in improving and protecting your health--is the purpose of this book.
How This Book Can Help
Unlike other books on the subject of germs and your health, Overkill places you, the reader, at center stage by focusing on your personal risk factors for contracting germ-related illnesses. As you read through the book, you will see that it quickly moves beyond a description of the bacterial problem and on to page after page of personalized self-help tips that you can use right now as you boost your immunity, stay healthy, and reduce your dependence on prescribed medications.
Here's how we'll accomplish this.
In chapter 1, Germs at a Glance, I'll give you the basic facts about germs--what they are, what they do, how they get around, and more. I also provide important historical context to explain how we got into the Age of Overkill and to help you appreciate the growing concern about antibiotic resistance. I share some eye-opening statistics to show you the global magnitude of this problem and to explain why it's time for all of us to enter the Age of Risk Management.
Chapter 2, Calculating Your Risk Quotient, is perhaps the most important chapter in the book. Here I'll help you focus on your personal health and that of your family using a detailed questionnaire that analyzes your risk factors for infection. Fifty questions are divided into five categories: Personal and Family Characteristics, Current Health Status, Personal Hygiene and Home Care Practices, Food Preferences and Preparation, and Occupation and Leisure Activities. After you've completed this revealing questionnaire, you'll tally up your score to find your Risk Quotient (RQ), a number ranging from 1 (lowest risk) to 5 (highest risk). This number will be used throughout the remainder of the book to identify your optimal approach to health care, child care, home and work environments, and food preparation.
You'll learn how to improve your immunity and overall well-being in chapter 3, Protecting Your Health. Chris D. Meletis, N.D., author and dean of naturopathic medicine and chief medical officer at the National College of Naturopathic Medicine in Portland, Oregon, has provided us with a wide variety of natural remedies for the 31 conditions most commonly treated (or mistreated) with antibiotics, including acne, bronchitis, colds, ear infections, gum disease, sinus infections, and urinary tract infections. These remedies are custom-tailored for readers of every Risk Quotient. The goal of this chapter is to suggest some effective alternative ways to prevent and treat common conditions so that you don't call your doctor to demand a prescription for antibiotics every time you sneeze.
Chapter 4, Caring for Your Children, is a must-read for every parent or parent-to-be. Here I explain the Hygiene Hypothesis--the theory that a child's immune system requires stimulation to prevent an imbalance resulting in allergies, asthma, and even such autoimmune diseases as rheumatoid arthritis and diabetes--and other competing theories. Using the RQ calculated in chapter 2, you will learn how to determine the best day care center for your child, how often you should clean toys and playthings, and a variety of other tips designed to keep your child healthy. Natural remedies for 16 childhood conditions commonly treated with antibiotics are also included, along with warning signs that indicate your child requires immediate medical attention.
Household germs is a hot topic, with startling media stories about new strains of E. coli and other bacteria on everything from our cutting boards and sponges to toothbrushes and telephones. In chapter 5, Hygiene in the Home, I will accompany you on a virtual tour of your home and identify all the possible culprits lurking in your kitchen, bathroom, and laundry room as well as point out the "small stuff" that you don't have to worry about. As in the previous chapter, I will detail an individualized approach for handling hygiene based upon your Risk Quotient. I will also offer a variety of effective natural cleaners that can clean your home without setting up a breeding ground for resistant bacteria.
A CDC study estimates that food-borne microbes cause a staggering 76 million incidences of illness in the United States each year, resulting in more than 300,000 hospitalizations and approximately 5,000 deaths. In chapter 6, Eat, Drink, and Be . . . Wary? you'll learn how you and your family can avoid food-borne illness. I'll identify the steps you should take to store and prepare food in the safest way possible. In addition, I'll identify the most common food safety mistakes as well as offer simple solutions. I'll also give you the latest scoop on two controversial food issues: genetic engineering and irradiation.
I will go into more detail on how to provide additional safety and security for those at high risk or in special living circumstances in chapter 7, Strategies for Special Situations. Whether you're a 60-year-old grandparent about to spend a week caring for a new infant, a pregnant woman about to enter the hospital, a middle-aged person with a compromised immune system, or the child of an aging parent who is entering a nursing home, I will give suggestions on how you can optimize wellness in any situation.
And finally, in the Epilogue, I provide a look forward into the Age of Risk Management, particularly in these uncertain times when we continue to face the frightening threat of bioterrorism.
Here's to Your Health!
So, are the germs winning? Is cleanliness playing a dirty trick on us? No single easy answer applies to everyone. If we take the radical, dangerously obsessive approach toward germs that I call overkill, then the answer may well be yes. But it doesn't have to be that way. By learning more about germs, the risks they pose, and how we can reduce those risks, we can protect our own health and the health of the world at large. To that end, this book will provide you with the information and tools you need to determine a balanced approach that works for you and your family.
Let's get started!