Antibacterial Products May Do More Harm Than Good Antibacterial Soaps and Other Cleaners May Actually Be Aiding in the Development of Superbacteria

Article 1 June 07, 2007/ SCIENTIFIC AMERICAN Strange but True: Antibacterial Products May Do More Harm Than Good Antibacterial soaps and other cleaners may actually be aiding in the development of superbacteria. By Coco Ballantyne

Tuberculosis, food poisoning, cholera, pneumonia, strep throat and meningitis: these are just a few of the unsavory diseases caused by bacteria. Hygiene—keeping both home and body clean—is one of the best ways to curb the spread of bacterial infections, but lately consumers are getting the message that washing with regular soap is insufficient. Antibacterial products have never been so popular. Body soaps, household cleaners, sponges, even mattresses and lip glosses are now packing bacteria-killing ingredients, and scientists question what place, if any, these chemicals have in the daily routines of healthy people.

Traditionally, people washed bacteria from their bodies and homes using soap and hot water, alcohol, chlorine bleach or hydrogen peroxide. These substances act nonspecifically, meaning they wipe out almost every type of microbe in sight—fungi, bacteria and some viruses—rather than singling out a particular variety.

Soap works by loosening and lifting dirt, oil and microbes from surfaces so they can be easily rinsed away with water, whereas general cleaners such as alcohol inflict sweeping damage to cells by demolishing key structures, then evaporate. "They do their job and are quickly dissipated into the environment," explains microbiologist Stuart Levy of Tufts University School of Medicine.

Unlike these traditional cleaners, antibacterial products leave surface residues, creating conditions that may foster the development of resistant bacteria, Levy notes. For example, after spraying and wiping an antibacterial cleaner over a kitchen counter, active chemicals linger behind and continue to kill bacteria, but not necessarily all of them.

When a bacterial population is placed under a stressor—such as an antibacterial chemical—a small subpopulation armed with special defense mechanisms can develop. These lineages survive and reproduce as their weaker relatives perish. "What doesn't kill you makes you stronger" is the governing maxim here, as antibacterial chemicals select for bacteria that endure their presence.

As bacteria develop a tolerance for these compounds there is potential for also developing a tolerance for certain antibiotics. This phenomenon, called cross-resistance, has already been demonstrated in several laboratory studies using triclosan, one of the most common chemicals found in antibacterial hand cleaners, dishwashing liquids and other wash products. "Triclosan has a specific inhibitory target in bacteria similar to some antibiotics," says epidemiologist Allison Aiello at the University of Michigan School of Public Health.

When bacteria are exposed to triclosan for long periods of time, genetic mutations can arise. Some of these mutations endow the bacteria with resistance to isoniazid, an antibiotic used for treating tuberculosis, whereas other microbes can supercharge their efflux pumps—protein machines in the

1 cell membrane that can spit out several types of antibiotics, Aiello explains. These effects have been demonstrated only in the laboratory, not in households and other real world environments, but Aiello believes that the few household studies may not have been long enough. "It's very possible that the emergence of resistant species takes quite some time to occur…; the potential is there," she says.

Apart from the potential emergence of drug-resistant bacteria in communities, scientists have other concerns about antibacterial compounds. Both triclosan and its close chemical relative triclocarban (also widely used as an antibacterial), are present in 60 percent of America's streams and rivers, says environmental scientist Rolf Halden, co-founder of the Center for Water and Health at Johns Hopkins Bloomberg School of Public Health. Both chemicals are efficiently removed from wastewater in treatment plants but end up getting sequestered in the municipal sludge, which is used as fertilizer for crops, thereby opening a potential pathway for contamination of the food we eat, Halden explains. "We have to realize that the concentrations in agricultural soil are very high," and this, "along with the presence of pathogens from sewage, could be a recipe for breeding antimicrobial resistance" in the environment, he says.

Triclosan has also been found in human breast milk, although not in concentrations considered dangerous to babies, as well as in human blood plasma. There is no evidence showing that current concentrations of triclosan in the human body are harmful, but recent studies suggest that it acts as an endocrine disrupter in bullfrogs and rats.

Further, an expert panel convened by the Food and Drug Administration determined that there is insufficient evidence for a benefit from consumer products containing antibacterial additives over similar ones not containing them.

"What is this stuff doing in households when we have soaps?" asks molecular biologist John Gustafson of New Mexico State University in Las Cruces. These substances really belong in hospitals and clinics, not in the homes of healthy people, Gustafson says.

Of course, antibacterial products do have their place. Millions of Americans suffer from weakened immune systems, including pregnant women and people with immunodeficiency diseases, points out Eugene Cole, an infectious disease specialist at Brigham Young University. For these people, targeted use of antibacterial products, such as triclosan, may be appropriate in the home, he says.

In general, however, good, long-term hygiene means using regular soaps rather than new, antibacterial ones, experts say. "The main way to keep from getting sick," Gustafson says, "is to wash your hands three times a day and don't touch mucous membranes."

Article 2 What's Holding Up the Digital Revolution? Electronic records could improve care and cut costs, but no one can agree on who should pay the bill.

At first, Dr. Glen Landesman feared the electronic record system he and his two partners installed in their New Jersey family practice. While his computer-savvy colleagues eagerly anticipated eliminating bulky paper records, Landesman worried that his ability to care for patients would suffer as he struggled with the new technology. "I am not a computer person at all," he says. "So I was very resistant." Five years later, Landesman has been won over. With the electronic system, new prescriptions are automatically checked against existing ones for adverse interactions—and then sent directly to the pharmacy. Doctors and patients receive regular reminders about screenings and vaccinations. And in the long run, the practice will save money. "We improved in both efficiency and quality, and we're adding to our bottom line." says Landesman.

That kind of success is exactly what electronic health-record proponents envisioned three years ago when President Bush called for all medical data to be converted to a digital format by 2014 through the creation of a national health-information system. At the time, less than 10 percent of hospitals and doctors' offices had adopted digital recordkeeping, largely because of concerns about patient privacy—with sensitive data zooming through cyberspace. Then there was the cost; it runs about $100,000 for an individual practice and more than $50 million for a large hospital. Critics also complained that the federal government's support for the project, only $40 million in the first year, meant the administration's push was more talk than action.

Despite the continued presence of those obstacles, it appears that electronic records are winning supporters. The use of digital systems increased 20 percent from 2005 to 2006, according to a recent report by the Centers for Disease Control. "Now offices are lined up around the corner to get on board," says David Krusch, chief medical-information officer at the University of Rochester Medical Center. "They're fighting over who comes next."

A RAND study has estimated that electronic records could improve efficiency and reduce medical errors enough to cut the nation's annual health-care bill by $80 billion. But so far, improvements have been largely confined to the nation's wealthier medical facilities. Many doctors worry that small hospitals and individual practices—which deliver roughly half of the country's medical care—could fall further and further behind, either because they can't afford to go digital or because the cheaper systems they do have money for aren't good enough to make a difference.

Article 3 Blame It on Biofuels

Cornflake makers and socialists alike are pointing to green fuel for high food prices. Are they right?

By Barrett Sheridan /Newsweek International /Aug. 20-27, 2007 issue

HIGH food prices always hit the poor hardest, and these days there is plenty of bad news. Corn prices are nearly $4 a bushel, almost double their 2005 level. In Mexico, for instance, that translates into a 50 percent rise in the price of corn tortillas, which has elicited protests from tens of thousands of workers. Many blame the burgeoning U.S. biofuel industry, centered around corn-based ethanol, for the crunch. Fidel Castro says diverting corn into fuel is a "tragic" turn of events for the world's poor, while Venezuela's Hugo Chávez calls it "craziness."

They aren't the only ones pointing the finger at biofuels for high prices—food makers like Kellogg's are also. While biofuels are a convenient scapegoat, global food economics are a complex phenomenon. A surge in global food demand, high oil prices, uncooperative weather, currency fluctuations and biofuels all play a part in explaining the new, stratospheric world of food economics.

About a third of the recent corn-price rise is "just a currency issue," says Peter Timmer, an agricultural economist at the Center for Global Development. The dollar has plummeted against most of the world's currencies, and since most internationally traded foods are priced in dollars, the price hikes lose some of their bite abroad. "If you look at food-price inflation from a euro-currency perspective," he says, "it doesn't look as bad as it does in dollars."

Bad weather has also played its part. Drought in Australia ravaged its wheat crop last year, and exports fell by more than 20 percent. Recent flooding in China has destroyed 5.5 million hectares of wheat and rapeseed, and an abnormally dry growing season across northern Europe threatens grain yields. Longer term, Timmer sees two worries: that these are early signs of a climate change, and that there is no new Green Revolution underway to create tougher crops. "Agricultural scientists are quite concerned about the lack of a pipeline of new technology," he says.

Rising oil prices hurt, too. Food expert Michael Pollan has said that the most "worrisome" aspect of food production is how much energy it consumes. Each step from reaping to packaging uses additional energy—and with oil at close to $80 a barrel, that adds up. Most food packaging is plastic, which is made from oil, and common plastics like polypropylene cost up to 70 percent more

4 today than they did in 2003, says Andrew Falcon, the CEO of C&M Fine Pack, which sells containers to U.S. restaurants. Retailers like Wal-Mart tried to absorb these costs by squeezing greater efficiency out of their suppliers, says Falcon, but eventually had to pass on the price increases. Taken together, these factors, from weather to bio-fuels to oil, contribute about 30 percent to the recent price hikes.

But perhaps the most significant factor is rising wealth, particularly in the developing world. Since 2002, the combined GDP of the 24 largest emerging markets has doubled, according to Bank of America, and per capita income has risen by nearly 14 percent a year. As families get richer, they can more regularly indulge in meat and dairy products. In China, beef consumption has gone up by 26 percent since 2000, and pork, which was already popular, rose by 19 percent. Even in India, where much of the population is vegetarian, chicken consumption has almost doubled since 2000. "This is an economic-development success story," says Lawrence Goodman, head of emerging-market strategy at Bank of America. But it's also a story of placing greater demands on our grain crops, since seven kilograms of feed go into every kilogram of beef.

The rise of per capita income in emerging markets is itself responsible for as much as one third of the current food-price inflation, say experts. With wealth rising, the globe warming and no technological fix in sight, higher food prices are unlikely to be a short-term phenomenon (as they would be if the ethanol craze were the primary cause). The good news may be that more poor people will get rich enough to buy corn anyway.

Article 4 You've Got to Have ... Genes: A new study says that how we choose our friends is strongly influenced by genetic factors.

Almost everybody knows by now that genes play an important role in everything from how our bodies react to nutrients to our predisposition to some cancers to whether or not we get depressed. A forthcoming study in the Archives of Psychiatry says that we can add how we choose our friends to the growing list of traits strongly influenced by genetic factors. A team of Virginia Commonwealth University researchers found that genes, alongside environment, strongly influence who we choose as friends. The researchers studied the peer groups of approximately 1,800 male twins, having each subject describe the level of social deviance among their friends, such as how many of their friends got drunk, used or sold drugs, or damaged property. The research showed that an individual's selection of friends--whether they chose to socialize with fewer or more socially deviant peers--was shaped by genetic factors. Not only did the researchers find that selection of friends has a genetic basis, but also that the influence of genes actually increased over time, as individuals gain autonomy in selecting their peers and building their social world. NEWSWEEK’s Sarah Kliff spoke with lead author Kenneth Kendler, a professor of psychiatry in VCU's School of Medicine, about the role that genes play in determining our environments and our friendships.

How do genes play into behavioral decisions, such as selecting our friends and creating our social world? When you’re considering behavior and genetics, you can think of the brain as a transducing device, where the genes help structure the brain. The brain then influences our behavior, although environment plays a big role too. Our behavior then dramatically influences our physical and especially our social environment. We’ve seen that a variety of what used to be considered solely environmental risk factors, things like difficulties with marriages, rates of accidents, levels of social support, are partially influenced by your genotype. Take depression, for example. Part of the way that genes might influence your risk for depression is by influencing your temperament, by making you have somewhat more conflicted relationships and by increasing marital conflict, which then feeds back on you to increase your risk of depression.

One of the most interesting findings of your study is not just that there are genetic influences on peer selection, but that those influences become stronger over time. Why do genes play an increasingly important role as we get older? To a large extent, as you move from childhood into adolescence into adulthood, much of what is driving you in the creation of that social world is your genes. Your family environment is pretty important when you’re a kid, but becomes less important over time. When you’re 8 years old, your friends are your neighbors, friends of your family, and you’re pretty much going to spend time with

6 your school group. When you move forward in time, what happens developmentally is that you have more and more capacity to shape your own world. You start making wider friendships, get a bicycle, then an automobile, then you leave home at the age of 18 or 19. You make important decisions about whether you’re going to go to college or join the army. Your individual specific environment is pretty important once you leave home. More and more, your own social environment becomes your responsibility that you’ve created and not that of the constraint of your family when you’re a prepubescent child.

As we gain autonomy over our social environments, how do our social groups change? And how do genes become more influential? Imagine a person who is shy, likes to follow authority, very much enjoys doing socially acceptable tasks. He or she might have grown up in a family not so much like that, but by the time she’s 16, she’s finding a local church group of people like herself; at the age of 18 she decides to go to a Christian university. Her temperament allows her to shape more and more of her social world. By the time she’s 25 she’s made her own life that way. The opposite story is that you can have a hell-on-wheels 9-year-old, who thinks that nothing is more fun then getting into fights. At 10 years old, you find him by a heavily trafficked road throwing rocks at cars because he thinks that’s fun. That’s the kid who is going to get in trouble. He makes his own life too, but by the time he’s 25 he’s going to be able to shape himself much more. It’s not that the temperament or genetic dispositions are not there early on. But it’s the capacity you have increasing with time to be able to shape your own life. You really do get to make your own life as you grow up

Article 5 Weird Science: Top unexplained mysteries From hairy beasts to humming deserts, these mysteries go unexplained -- Benjamin Radford/ 5/25/2007/Newsweek Ten unexplained phenomena Science has the power to harness energy, allow human flight, help cure the sick, and explain much about the world. But as amazing and beneficial as science is, it cannot explain everything. Scientists may never know exactly how the universe began, or help to settle matters of faith. The same is true for the paranormal world. Though science can explain many strange phenomena, some mysteries remain to be solved -- often because there is simply not enough information to reach a definitive conclusion.

Some of these phenomena may one day be fully understood, as many things that were once mysterious or unexplained (such as the causes of disease) are now common knowledge.

The body/mind connection

Medical science is only beginning to understand the ways in which the mind influences the body. The placebo effect, for example, demonstrates that people can at times cause a relief in medical symptoms or suffering by believing the cures to be effective -- whether they actually are or not. Using processes only poorly understood, the body's ability to heal itself is far more amazing than anything modern medicine could create.

Psychic powers and ESP Psychic powers and extra-sensory perception (ESP) rank among the top ten unexplained phenomena if for no other reason than that belief in them is so widespread. Many people believe that intuition is a form of psychic power, a way of accessing arcane or special knowledge about the world or the future. Researchers have tested people who claim to have psychic powers, though the results under controlled scientific conditions have so far been negative or ambiguous. Some have argued that psychic powers cannot be tested, or for some reason diminish in the presence of skeptics or scientists. If this is true, science will never be able to prove or disprove the existence of psychic powers.

Near-death experiences/life after death People who were once near death have sometimes reported various mystical experiences (such as going into a tunnel and emerging in a light, being reunited with loved ones, a sense of peace, etc.)

8 that may suggest an existence beyond the grave. While such experiences are profound, no one has returned with proof or verifiable information from "beyond the grave." Skeptics suggest that the experiences are explainable as natural and predictable hallucinations of a traumatized brain, yet there is no way to know with certainty what causes near-death experiences, or if they truly are visions of "the other side."

UFOs There is no doubt that UFOs (Unidentified Flying Objects) exist -- many people see things in the skies that they cannot identify, ranging from aircraft to meteors. Whether or not any of those objects and lights are alien spacecraft is another matter entirely; given the fantastic distances and effort involved in just getting to Earth from across the universe, such a scenario seems unlikely. Still, while careful investigation has revealed known causes for most sighting reports, some UFO incidents will always remain unexplained.

Déjà vu Deja vu is a French phrase meaning "already seen," referring to the distinct, puzzling, and mysterious feeling of having experienced a specific set of circumstances before. A woman might walk into a building, for example, in a foreign country she'd never visited, and sense that the setting is eerily and intimately familiar. Some attribute deja vu to psychic experiences or unbidden glimpses of previous lives. As with intuition, research into human psychology can offer more naturalistic explanations, but ultimately the cause and nature of the phenomenon itself remains a mystery.

Ghosts From the Shakespeare play "MacBeth" to the NBC show "Medium," spirits of the dead have long made an appearance in our culture and folklore. Many people have reported seeing apparitions of both shadowy strangers and departed loved ones. Though definitive proof for the existence of ghosts remains elusive, sincere eyewitnesses continue to report seeing, photographing, and even communicating with ghosts. Ghost investigators hope to one day prove that the dead can contact the living, providing a final answer to the mystery.

Mysterious disappearances People disappear for various reasons. Most are runaways, some succumb to accident, a few are abducted or killed, but most are eventually found. Not so with the truly mysterious disappearances. From the crew of the Marie Celeste to Jimmy Hoffa, Amelia Earhart, and Natalee Holloway, some people seem to have vanished without a trace. When missing persons are found, it is always through police work, confession, or accident (never by "psychic detectives"). But when the evidence is lacking and leads are lost, even police and forensic science can't always solve the crime.

Intuition 9 Whether we call it gut feelings, a "sixth sense," or something else, we have all experienced intuition at one time or another. Of course, gut feelings are often wrong (how many times during aircraft turbulence have you been "sure" your plane was going down?), but they do seem to be right much of the time. Psychologists note that people subconsciously pick up information about the world around us, leading us to seemingly sense or know information without knowing exactly how or why we know it. But cases of intuition are difficult to prove or study, and psychology may only be part of the answer.

Bigfoot For decades, large, hairy, manlike beasts called Bigfoot have occasionally been reported by eyewitnesses across America. Despite the thousands of Bigfoot that must exist for a breeding population, not a single body has been found. Not one has been killed by a hunter, struck dead by a speeding car, or even died of natural causes. In the absence of hard evidence like teeth or bones, support comes down to eyewitness sightings and ambiguous photos and films. Since it is logically impossible to prove a universal negative, science will never be able to prove that creatures like Bigfoot and the Loch Ness monster do not exist, and it is possible that these mysterious beasts lurk far from prying eyes.

The Taos hum Some residents and visitors in the small city of Taos, New Mexico, have for years been annoyed and puzzled by a mysterious and faint low-frequency hum in the desert air. Oddly, only about 2 percent of Taos residents report hearing the sound. Some believe it is caused by unusual acoustics; others suspect mass hysteria or some secret, sinister purpose. Whether described as a whir, hum, or buzz -- and whether psychological, natural, or supernatural -- no one has yet been able to locate the sound's origin.

Article 6 Fat Zones: Does where you live influence what you eat? A new study says ZIP codes are surprisingly accurate predictors of obesity. From Newsweek 31 Aug., 2007

ZIP codes are more than just a way to deliver mail, they can say a lot about their residents—and not just the ones living in California’s famed 90210. In a study published in the September issue of the journal Social Science & Medicine, University of Washington researchers found that adults living in ZIP codes with the highest property values were the slimmest, and those living in ZIP codes with the lowest property values were the fattest. The findings show that there is significant geographic variation in the obesity problem, and that this variation is very much tied to socioeconomic status and diet. Is this yet another reason for Americans to feel bad about not living on McMansion row? Would people lose weight if they moved to a tonier town? NEWSWEEK’s Karen Springen talked to the study’s lead author, Adam Drewnowski, director of the Center for Public Health Nutrition and professor of epidemiology and medicine at the University of Washington in Seattle.

You looked at 8,803 people in 74 ZIP codes in the Seattle area and found that those living in areas with the highest property values were the thinnest. The inverse was true for those living in the lowest-property-value ZIP codes. Why? Is it because they have less disposable income to spend on healthy food, and they feel less safe going outside and exercising? Adam Drewnowski: It's a combination of everything. We're using where people live as an index of what's called socioeconomic position, which is usually predicted by education and income and occupation. We think that knowing where people live—not the exact address, but the neighborhood—tells you a lot about poverty and wealth. For most Americans, their biggest single asset is their house. If you live in a nice neighborhood with nice property values, that tells us something about who you are. For example, property values determine taxes, which in turn determine support of schools. The nature of the neighborhood determines access to healthy foods.

Do ZIP codes affect grocery stores? Take a look at Whole Foods [the organic supermarket] in Seattle, I think now they're in three locations. One is by the University of Washington, which means education. The second is on the east side, close to Microsoft, which means income and education. The third is downtown. Nice stores set themselves up in areas with buying power. In underserved or disadvantaged poor neighborhoods, you will not get very much other than, in some cases, fast food. People will be buying their groceries at the gas station.

11 ust how much fatter are people who live in ZIP codes with lower property values? If we looked at the median prices of residential properties, for each $100,000 of added value, obesity rates go down by 2 percent. In Mercer Island, the median house price is around $1.5 million and the obesity rate is around 5 percent. In the worst areas, in south King County, the median asking price is $270,000 and the lowest asking price is about $10,000 for a manufactured home. The obesity rate there is around 28-30 percent.

Do you think the ZIP code effect would hold true in other parts of the country? We know it holds in New York City because the department of health there conducted a survey of 10,000 residents in all five boroughs a couple of years ago. Those were not ZIP codes, they were neighborhoods. The department of health noted that if you go from the Upper East Side over to East Harlem, the obesity rates quadruple, from 7 percent to about 28 percent, and the rates of diabetes go up seven times, from 2 percent to 14 percent. You are, in fact, in a different world.

Article 7 Outsourcing makes tainted food hard to trace Use of outside suppliers, many brand names adds safety issues, critics warn

Try searching for a culprit in the 90 brands caught up in the recent recall of canned chili, stew and other products, and you weave back to a single manufacturer. That also was the case in recalls of spinach, pet food and frozen meat.

Companies increasingly are paying others to make the foods we eat — or the ingredients in them — and then selling it under multiple brand names. And that has prompted a growing debate about food safety.

“If people cannot trace a product back to a supplier, the supplier has no incentives to keep their processes as clean and effective, in terms of food safety, as possible,” said Caroline Smith DeWaal, director of food safety for the Center for Science in the Public Interest, a consumer group.

But the food industry and regulators chalk up to coincidence the rash of recent major food safety recalls and the consolidation of food production

Financial reasons “One reason we are seeing this is because it’s becoming a common industry practice,” said Dr. David Acheson, who leads the Food and Drug Administration’s food safety efforts. Acheson said he knew of no evidence that outsourcing production is inherently less safe than traditional arrangements in which companies make what they sell.

Outsourcing makes financial sense for companies unwilling or unable to establish or expand manufacturing operations. Established manufacturers can use excess capacity to fill orders for others.

For some specialty products that require expensive machinery — like pet food — a limited number of contract manufacturers, such as Menu Foods, make products that are sold under dozens of brands.

“Being able to develop a product without having to sink a lot of money into fixed, tangible capital is every entrepreneur’s dream,” said Michael Sykuta, director of the Contracting and Organizations Research Institute at the University of Missouri-Columbia. 13 Store-brand or private-label products account for much of the growth in the food outsourcing business. Supermarkets, drug stores and mass merchandisers ring up more than $65 billion in store brand sales annually.

That amounts to one in every five items they sell, according to the Private Label Manufacturers Association.

Creating vulnerability But critics of the outsourcing of production warn that it creates increased vulnerability of the food supply. The manufacturer no longer is directly accountable to consumers, but to other companies, they maintain, they maintain.

That makes for a long supply chain with several stops before a product reaches consumers, said Jean Kinsey, co-director of the Food Industry Center at the University of Minnesota. “And not everyone along the way has the same vested interest in its safety.”

The Grocery Manufacturers Association counters that there would be no reason for co-manufacturers or co-packers to skimp on food safety.

“If we use the classic term, ’barking up the wrong tree,’ that would be the case here,” said Craig Henry, who helps oversee scientific and regulatory activities at the industry group.

But some food safety advocates say that when problems arise with foods made under contract, sorting out who made what can delay recalls or public health warnings.