Author: peterjang73

“People keep asking me, how close are we to going off the cliff,” says Dr. James Johnson, professor of infectious diseases medicine at the University of Minnesota. The cliffside freefall he’s talking about is the day that drug-resistant bacteria will be able to outfox the world’s entire arsenal of antibiotics. Common infections would then become untreatable.

Here’s Johnson’s answer: “Come on people. We’re off the cliff. It’s already happening. People are dying. It’s right here, right now. Sure, it’s going to get worse. But we’re already there.”

His declaration came in response to a report of a woman in Nevada who died of an incurable infection, resistant to all 26 antibiotics available in the U.S. to treat infection. Her death was reported in the Jan. 13 Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. That kind of bacteria is known as a “superbug” – a family of bacteria resistant to antibiotics. In cases like the Nevada woman, who was infected with Klebsiella pneumoniae, the term “nightmare superbug” has been coined because this particular specimen was resistant to even antibiotics developed as a last resort against bacterial infection.

People in the U.S. have died from so-called superbug infections before. The CDC estimates that 23,000 die every year from multidrug resistant infections. A British report, The Review on Antimicrobial Resistance, estimates that globally, 700,000 people die each year due to infections that are drug-resistant. In many of those cases, the infection’s resistance was discovered too late, perhaps before a last-line, effective drug was finally initiated. In poor countries, those newer, more expensive, antibiotics often are not available.

The Nevada case is different in that resistance was discovered early in treatment, but even the drugs seen as the last line of defense didn’t work. “This one is the poster child because of resistance across the board,” Johnson says.

The woman described in the report was in her 70s and treated in a hospital in Reno, Nevada. About two years ago, on an extended visit to India, she broke a thighbone, according to the report. She had several hospitalizations in India because of infections, says Dr. Lei Chen, of the Washoe County Health District in Reno and an author of the MMWR report. When the patient was admitted to the Reno hospital, health workers discovered that the bacteria specimen tested was resistant to a class of antibiotics called carbapanems — or carbapenem-resistant enterobacteria (CRE). “Before, we could go to carbapenems, and they could reliably squash the bugs,” says Johnson. “This case broke down even our last, great gun.”

Her most recent hospitalization for infection in India had been in June 2016. She was admitted to a hospital in Reno in August, and state health department officials were notified that she had CRE. “Lab results showed she was resistant to all 14 drugs we tested,” says Chen. Further tests at the CDC lab showed resistance to 26 antibiotics. She died in September of multiple organ failure and sepsis. “This was my first time to see such a resistant pattern,” says Chen.

CRE infections are rare in the U.S. The CDC does not require that hospitals report CRE cases but estimates that some 175 cases have been reported in the states as of January 2017. “The majority of (CRE) cases still respond to one or two classes of antibiotics,” says Chen.

CRE infections are more common in India and Southeast Asia. The reasons aren’t clear, but all infections spread more easily in parts of the world with inadequate sanitary facilities. Then, as people cross borders and board airplanes, the bacteria spreads in the same way that brought it to Reno, Nevada. That’s why Dr. Randall Todd, director of Epidemiology and Public Health Preparedness at the Washoe County Health District, says all hospitals should double down on preventive efforts, including a travel history. “It’s important that health-care providers and hospitals keep in mind that our world is ever shrinking,” he says. “When someone comes in, it’s important to know where in the world they’ve been.”

Then, if CRE or other resistant infections are diagnosed, the hospital can set up appropriate precautions, like isolating the patient, and immediately start lab tests to try to find an effective antibiotic.

But in this case, there was no effective antibiotic. “And we’re going to see more of these, from a drip, drip, drip of cases; to a steady drizzle, to a rainstorm,” predicts Johnson. “It’s scary, but it’s good to get scared if that motivates action.”

The action needed is to use antibiotics wisely, in people and in animals, so strains of bacteria don’t get a chance to develop resistance, says Johnson. And to continue research into development of new antibiotics. “We do have some new drugs coming along, so there’s hope,” he says. But as new antibiotics become available, “we have to use them selectively, not willy-nilly.”

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When a solar company wants to test new technology, they bring their panels to the National Renewable Energy Lab near Denver. It’s a place where federal scientists can measure how powerful and long-lasting solar panels are, so consumers know what they are buying.

“A lot of times maybe people don’t even know how to evaluate new technologies appropriately. And so we have a lot of insight and knowledge into the market that can help with some of those decisions,” lab engineer Chris Deline explained.

It’s just one of the Department of Energy’s 17 national laboratories, where research is wide-ranging — from fossil fuel-based energy, to understanding dark matter in the universe. Under the Obama administration, research and development dollars flowed into renewable energy.

There is concern over the future of the labs as President-elect Donald Trump’s pick for energy secretary, former Texas Gov. Rick Perry, takes the hot seat at his confirmation hearing before the Senate Energy and Natural Resources Committee on Thursday morning. Perry infamously called for the department’s elimination while running for the Republican presidential nomination in 2012, and Trump and Perry have at times questioned climate science.

Appearing at Saint Anselm College in Manchester, N.H., as a presidential candidate in 2011, Perry said, “The issue of global warming has been politicized. I think there are a substantial number of scientists who have manipulated data so that they will have dollars rolling into their projects.”

Perry doesn’t have a background in science, but Ken Kimmell with the Union of Concerned Scientists said that’s not the issue: “We do have a concern that a secretary who doesn’t fundamentally accept the science of climate change isn’t necessarily going to direct the assets of the Department of Energy towards advancing that mission.”

On the other hand, Kimmell noted that wind energy took off during Rick Perry’s three terms as Texas governor between 2000 and 2015. It was part of Perry’s “all of the above” energy approach.

In one of his last public appearances, outgoing Energy Secretary Ernest Moniz stressed the importance of clean energy research. “I think we have an innovation edge compared to most,” Moniz said. “But we can certainly lose it if we don’t keep this focus. And that will lead to lost market share. That will lead to lost jobs.”

Then there was that controversial questionnaire — the Trump transition team wanted the names of Department of Energy workers who attended climate change meetings. Moniz refused, and Trump’s team backed away.

Last week, Moniz announced tougher measures for Department of Energy scientists to protect them from political meddling.

Will Donald Trump’s new job as president create ethical conflicts with his long-running role as a business owner?

Trump sees no problem. “I have a no-conflict situation, because I’m president,” Trump said at a recent press conference. He was correctly referring to the federal conflicts-of-interest law that covers Cabinet secretaries, but not presidents.

Still, ethics experts say other restrictions do apply to presidents, setting up serious ethical problems for the new administration.

“A president is not permitted to receive cash and other benefits from foreign governments,” Norm Eisen tells Fresh Air‘s Terry Gross. “And yet, Donald Trump is getting a steady flow of them around the world and right here in the United States.”

Eisen, who served as President Obama’s special counsel on ethics and government reform, has joined forces with Richard Painter, the former chief ethics lawyer for President George W. Bush, to speak out publicly about Trump’s potential conflicts of interests.

Eisen describes Trump’s business entanglements as “frankly and nakedly unconstitutional. … It is extraordinary that we’ll have a president who is violating the constitutional conflicts clause, the so-called Emoluments Clause, as soon as he takes the oath of office,” he says.

Painter concurs with Eisen’s assessment. “The president needs to focus on protecting the United States and American interests in a very dangerous world,” Painter says. “I really hope that President Trump takes the steps he needs to, to be free of conflict of interest in that endeavor.”

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Interview Highlights

On questions that arise because Trump hasn’t released his tax returns and detailed financial reports

Norm Eisen: So many people in the heartland of the country rightly are angry that their lives have been devastated by economic and trade developments of recent years, and also, many of them have themselves or sent their kids abroad to fight America’s wars.

With Donald Trump receiving these enormous sums from foreign governments, and having strong property interests and relationships in many foreign governments, when he makes his decisions on domestic and economic policy, how will we know that he is not using the White House to do deals for himself at the expense of the people who voted for him? When he makes his decisions to use America’s military force, or threaten it abroad, how will we know that he is not putting ordinary Americans’ lives at risk in order to protect his properties, and his pocket, and his wallet, rather than in the best interest of our country?

On how Trump’s business loans could interfere with his ability to regulate banks

Richard Painter: Consider, for the example, the debt from Deutsche Bank. Now Deutsche Bank is a private bank, but we already know about very large loans from Deutsche Bank, and so that’s a dependency relationship, and yet the president is supposed to be regulating or supervising the people who regulate the financial services sector.

They’re talking about repealing Dodd-Frank … and scaling back on bank regulations, making it easier for banks to loan money against collateral, which is almost always real estate, and that’s what they’re talking about doing in this administration, and here’s the President of the United States, dependent upon banks — some government-owned, some private banks, all over the world — think that’s a very serious conflict of interest.

On the chair of the House Committee on Oversight calling the director of the Office of Government Ethics, Walter Shaub, to come before his committee after Shaub criticized Trump’s plan to address business conflicts

Painter: That congressional committee of so-called “oversight” in government reform has been a politicized body engaged in politicized investigations for a long time. … And now what we have is the chairman of the committee, instead of focusing on the serious problems with respect to the president-elect’s conflicts of interests and the potential constitutional violation that we will have on Friday [Inauguration Day] because of the foreign government payments, that committee doesn’t want to focus on that, all they want to do is start to harass the Office of Government Ethics and try to investigate the Office of Government Ethics simply because [Director] Walter Shaub had the courage to speak out and say exactly what I’ve been saying … that the president’s divestiture plan is inadequate. …

This is just pure partisan politics coming out of the House Oversight Committee and I’m embarrassed, as I say, having been a Republican for many years, to see them bringing partisan politics into their work and now harass the Office of Government Ethics for doing its job.

On the security risks posed by having the Trump name on buildings around the world

Painter: Do you want to put the name of the president of the United States on a building in a country with a high risk of terrorist attacks? … I think that’s asking for trouble. … It certainly doesn’t help to have a president who makes insulting comments about other people’s religion — that certainly gets the extremists energized.

I think there’s a serious global security concern with having the president’s name up on these buildings, and we could get sucked into something overseas because something happens to one of those buildings and the people in it.

On the chances that Congress will use its authority to force Trump to end the conflicts of interest he will face as president

Eisen: You might say, Terry, “Wait a minute, Congress is in the hands of the same party as the White House. Are they really going to pivot against Donald Trump?” But let’s remember that the Senate hangs by just a few votes, and there are some very independent-minded Republicans in the Senate, and I think when we get to our first scandal — and scandal will be inevitable with this arrangement that Mr. Trump is maintaining where he’s hanging onto his ownership interests — … I think you’ll see in the Senate that some of those Republicans join with the Democrats to ask for documents, ask for witnesses, to call for hearings. So I think you’ll see some legislative oversight.