Pain Week is a publication specifically for Pain Doctors, one I haven’t heard of before. This mini article and Podcast shine a light on a topic those who suffer from chronic pain already know. Pain medication is not being prescribed when needed and specialized pain care is dwelling.

This Podcast is very interesting, we now know why most doctors are running for the hills, as they say.

Melinda

A SINGLE POINT OF ACCESS FOR FRONTLINE PRACTITIONERS

Aug 10, 2020

At the 2018 Department of Justice (DOJ) Opioid Summit, then-Attorney General Jeff Sessions remarked that opioid prescribing had reached its lowest point in 18 years. Still, the DOJ is committed to reducing opioid analgesic prescriptions an additional 30% to 33% within the next 3 years. More than ever, prescribers of controlled prescription medications are under intense scrutiny from lawmakers, regulators, and payers. At the same time, some 50 million adults in the US have persistent pain, nearly 20 million of whom experience pain that interferes with daily life or work activities.

As noted by the Pain Management Best Practices Inter-Agency Task Force (PMTF) in its December 2018 draft report, the trend of healthcare professionals opting out of treating pain has exacerbated the shortage of pain management specialists, leaving some patients without access to individualized care. In this session, a partner in a Washington, DC based health law firm will discuss recent legislative and regulatory activity at the federal level and trends in criminal enforcement. He will also discuss noteworthy developments at the state level and analyze the anticipated benefits, drawbacks, and unintended consequences of such actions on people with pain and those who treat them.

Topics will include the implications of recently passed comprehensive opioid legislation—the SUPPORT for Patients and Communities Act; a draft report on pain management best practices by PMTF and the pushback against it; and efforts to reform the federal approach to investigating controlled-medication prescribers.

• BY MICHAEL C. BARNES
• JD, MIEP

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Stress plays a very important role in our mental health, good stress, and bad stress. Good stress motivates us to move forward, reach new limits, and push us to the next level. Bad stress on the other hand is detrimental to our overall well being and can cause hair loss among other ailments. 

Three types of hair loss that can be associated with high-stress levels are:

• Telogen effluvium. In telogen effluvium (TEL-o-jun uh-FLOO-vee-um), significant stress pushes large numbers of hair follicles into a resting phase. Within a few months, affected hairs might fall out suddenly when simply combing or washing your hair.
• Trichotillomania. Trichotillomania (trik-o-til-o-MAY-nee-uh) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling can be a way of dealing with negative or uncomfortable feelings, such as stress, tension, loneliness, boredom or frustration.
• Alopecia areata. A variety of factors are thought to cause alopecia areata (al-o-PEE-she-uh ar-e-A-tuh), possibly including severe stress. With alopecia areata, the body’s immune system attacks the hair follicles — causing hair loss.

Stress and hair loss don’t have to be permanent. If you get your stress under control, your hair might grow back.

If you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair, talk to your doctor. Sudden hair loss can signal an underlying medical condition that requires treatment. If needed, your doctor might also suggest treatment options for your hair loss.

This article is great news for those who are leary of using DEET to prevent tick bites.  Hopefully, it will be on the market soon. I’m all for using natural products when I can. 

Melinda

By DONALD G. MCNEIL JR.

THE NEW YORK TIMES 

AUG 10, 2020 AT 2:26 PM

An undated photo provided by the Centers for Disease Control and Prevention shows an Asian longhorned tick. The Environmental Protection Agency has approved nootkatone, which repels ticks, mosquitoes and other dangerous bugs for hours, but is safe enough to eat. (James Gathany/Centers for Disease Control and Prevention via The New York Times)

 

Adding a new weapon to the fight against insect-borne illnesses including Lyme disease and malaria, the Environmental Protection Agency on Monday approved a new chemical that both repels and kills ticks and mosquitoes.

The chemical, nootkatone, an oil found in cedar trees and grapefruits, is so safe that it is used by the food and perfume industries.

Nootkatone is considered nontoxic to humans and other mammals, birds, fish and bees, the EPA said in a statement.

Diseases caused by the bites of ticks, mosquitoes and fleas have tripled in the United States in the last 15 years, the Centers for Disease Control and Prevention said in a 2018 report. They include Lyme disease, anaplasmosis and Rocky Mountain spotted fever from ticks; West Nile, dengue, Zika and chikungunya from mosquitoes; and plague from fleas.

In tropical countries, malaria and yellow fever are major killers, and elephantiasis is also spread by mosquitoes. Lethal Crimean-Congo hemorrhagic fever is spread by ticks, and kala azar is spread by sandflies.

Manuel F. Lluberas, a public health entomologist who has worked on mosquito-control campaigns around the world, said that he hoped that nootkatone would be accepted by people who fear synthetic repellents and that it could be made cheaply enough to be bought by foreign aid programs like the President’s Malaria Initiative.

The EPA registration applies only to nootkatone as an active ingredient, the statement said. Any formulations using it in the future will have to be tested and registered separately.

The chemical repels mosquitoes, ticks, bedbugs and fleas — and, in high concentrations, kills them, according to the CDC. It may also be effective against lice, sandflies, midges and other pests, some of which can carry lethal diseases.

It is not oily, lasts for hours and has a pleasant, grapefruitlike scent, said Ben Beard, deputy director of the division of vector-borne diseases at the CDC, naming two grapefruit-flavored sodas.

“If you drink Fresca or Squirt, you’ve drunk nootkatone,” Beard said.

Nootkatone works differently from previous classes of insecticides and can kill bugs that are resistant to DDT, pyrethroids and other common insecticides.

Experts in insect-borne diseases greeted the news with cautious enthusiasm.

“Its use as an insecticidal soap has great potential,” said Duane J. Gubler, a former CDC chief of vector-borne diseases.

One proposed use is in soaps that people in tick-infested areas could shower with, repelling and possibly killing ticks that try to attach to them.

Joel R. Coats, a specialist in insect toxicology at Iowa State University, said his lab had tested nootkatone and found it to be “an impressive repellent but a weak insecticide.”

It repels ticks even better than synthetics like DEET, picaridin or IR3535 do, Coats said, and it is their equal at repelling mosquitoes.

Unlike citronella, peppermint oil, lemon grass oil and other repellents based on plant oils, he added, nootkatone does not lose its potency after about an hour but lasts as long as the synthetics.

Although it can also kill insects, he said, doing that takes so much of the chemical that it may not be practical.

“Most plant terpenes will kill bugs if you go to a high enough dose, but I haven’t seen any data that supports using it as an insecticide,” Coats said, using a term for aromatic oils exuded by many plants to repel invasive insects. “I’ve seen lots of data on it as a repellent.”

Mikkel Vestergaard-Frandsen, owner of the Vestergaard company, which makes insecticide-impregnated nets to fight malaria, said he was interested in the compound but wanted to know more about it.

Because babies sleep under the nets, any insecticide in them must be safe.

In many areas, mosquitoes have developed resistance to the pyrethin-based insecticides now used in nets, which are synthetic versions of a chemical found in chrysanthemum flowers.

A version of nootkatone that can linger in netting fabric for years would have to be developed, but good repellents usually dissolve too quickly for that, he said.

The CDC discovered nootkatone’s repellent properties almost 25 years ago as part of a search for new tick-control compounds to fight Lyme disease, Beard said.

They investigated cedar bark and chips “because there are all these folk tales that cedar repels insects — and people keep their clothes in cedar chests,” he said.

Cedar wood itself had very little effect on ticks, he said, but Oregon State University scientists working with the agency found the terpene oil of the Alaskan yellow cedar to be powerfully repellent. The Latin name of the tree is Cupressus nootkatensis, which comes from the Nuu-Chah-Nulth people of Canada.

It is “not known in great detail” how nootkatone works, Beard said, but it appears to activate octopamine receptors, which in insects send electrical impulses from one nerve cell to the next. Unable to turn off the signal, the bugs twitch to death.

In mammals, adrenaline — which is chemically related to octopamine — performs the same function. But the compound does not trigger adrenaline receptors.

Later the agency realized that the same chemical, originally derived from grapefruit rinds, was used as a flavoring and in perfumes.

The CDC licensed its patent to a Swiss company, Evolva, which isolates the chemical from fermenting yeast.

But doing the safety studies required for EPA registration was too expensive until the 2015-16 Zika epidemic came along, Beard said.

That epidemic prodded Congress to appropriate money for mosquito control, and the CDC transferred some of it to BARDA, the Biomedical Advanced Research and Development Authority, which contracted with Evolva to finish the research.

Zika funding “was the key to moving the boulder up the hill,” Beard said. But because nootkatone works well on both mosquitoes and ticks, he added, “it wasn’t a bait-and-switch.”

c.2020 The New York Times Company

Reason.com

JACOB SULLUM | 4.24.2019 5:00 PM

The CDC decries abrupt, involuntary dose reductions and patient abandonment without acknowledging its responsibility for those unintended but foreseeable consequences.

Deborah Dowell (CDC) 

In a New England Journal of Medicine commentary published today, the authors of the opioid prescribing guidelines that the U.S. Centers for Disease Control and Prevention issued in 2016 reiterate the agency’s recent warning that it does not recommend abrupt or nonconsensual tapering for patients who are already taking high doses of narcotic analgesics for chronic pain. “Unfortunately, some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations,” write Deborah Dowell, Tamara Haegerich, and Roger Chou. Those policies and practices, they say, include “inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice.”

Dowell, Haegerich, and Chou warn that patients forced to reduce their doses “could face risks related to withdrawal symptoms, increased pain, or unrecognized opioid use disorder” and “if their dosages are abruptly tapered may seek other sources of opioids or have adverse psychological and physical outcomes.” They also worry that doctors are responding to the CDC’s advice about the potential risks of opioids by “dismiss[ing] patients from care” or declining to prescribe opioids at all, “even in situations in which the benefits might outweigh the risks.” Dowell et al. say “such actions disregard messages emphasized in the guideline that clinicians should not dismiss patients from care, which can adversely affect patient safety, could represent patient abandonment, and can result in missed opportunities to provide potentially lifesaving information and treatment.” And they note that the guidelines have been improperly applied to “patients with pain associated with cancer, surgical procedures, or acute sickle cell crises.”

The CDC’s recognition that misinterpretation of its guidelines has resulted in needless suffering, patient abandonment, and “adverse psychological and physical outcomes” (including suicide) is welcome, if overdue. “This article should allay anxiety among physicians who prescribe responsibly for patients with chronic pain,” says Sally Satel, a Washington, D.C., psychiatrist who helped organize a March 6 letter to the CDC in which hundreds of health professionals and addiction specialists, including three former drug czars, expressed concern about the unintended consequences of the CDC’s advice. “No longer can any clinician, insurer, health care system, or pharmacist claim ‘the CDC Guideline says’ when it comes to tapering or discontinuation.”

Stefan Kertesz, a University of Alabama at Birmingham pain and addiction specialist who worked with Satel on the letter to the CDC, was also heartened by the NEJM article. “We needed CDC and its guideline’s authors to do precisely what they have done, which was to speak with vigor and clarity to the pressing ethical concern we laid out in our letter,” he says. “In affirming that the guideline did not call for hard dose cutoffs and forced tapers, the guideline’s authors have effectively called for recalibration of policies by insurers, by Medicaid authorities, and by agencies that have set ‘the number of patients above a given dose’ as the primary indicator of bad care.”

The letter to the CDC included testimony from hundreds of patients who have suffered the consequences of that ham-handed approach. “The trauma to patients who have been living in terror these past three years nearly broke my heart many times,” Kertesz says. “The only possible step has been for people familiar with the nexus of science and health policy to speak openly about the problems we have seen, and to trust that most people ultimately want to do what’s right.”

Yet Dowell et al. conspicuously fail to take any responsibility for the unintended but foreseeable harm caused by their advice. When a document is as widely misconstrued as the CDC’s guidelines have been—by insurers, regulators, legislators, pharmacists, and law enforcement agencies as well as clinicians—it is fair to ask how the authors left themselves open to misinterpretation.

According to the guidelines, “Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.” The implication is that doses of 90 MME or more per day are rarely, if ever, medically justified.

It is hardly a stretch for physicians with patients who exceed this arbitrary threshold, including patients who have been functioning well on high doses for years, to worry that they will be perceived as practicing outside the bounds of proper medical care. Given the scrutiny that regulators and law enforcement agencies such as the Drug Enforcement Administration (DEA) have been applying to doctors in response to the “opioid epidemic,” prescribing practices portrayed as extreme and dubious by the CDC are apt to attract unwelcome attention that could jeopardize a physician’s livelihood and liberty.

“We still, unfortunately, have physicians who worry about capriciousness on the part of the DEA,” Satel notes. “That is the next step in efforts to ensure that doctors can continue to serve pain patients who have been benefiting from opioids.” While “the DEA does indeed have a job to do,” she says, “doctors are confused about what could make them a target.”

How doctors respond to anti-opioid pressure will depend on how they weigh their duty to patients against their personal risk. In this context, forced tapering and abandonment were predictable outcomes, even though the CDC guidelines say doctors should reduce doses only when the risks outweigh the benefits and describe the process as collaborative and consensual.

“Clinicians should empathically [sic] review benefits and risks of continued high-dosage opioid therapy and should offer to work with the patient to taper opioids to safer dosages,” the guidelines say. “For patients who agree to taper opioids to lower dosages, clinicians should collaborate with the patient on a tapering plan.”

Dowell et al. complain that “the guideline has been misimplemented,” saying “policies invoking the opioid-prescribing guideline that do not actually reflect its content and nuances can be used to justify actions contrary to the guideline’s intent.” But those nuances were bound to be lost amid the fear and anxiety caused by the government’s crackdown on prescription pain relievers.

Notwithstanding Dowell et al.’s disavowal of “hard limits and abrupt tapering,” that is what happenedacross the country after the CDC guidelines came out, as reflected in this sign at a doctor’s office in Washington state. “Beginning February 2017,” it says, “Morphine Equivalency Dosing WILL decrease until CDC guidelines are met by June 2017. Target is 90mg of Morphine equivalency per day, or less. All medication adjustments will be based on this new clinic policy.”

While decrying involuntary and precipitous tapering, Dowell et al. present the general decline in opioid prescribing as a sign of progress. “Although outpatient opioid prescribing had been declining since 2012,” they write, “accelerated decreases—including in high-risk prescribing—followed the guideline’s release.” Yet the continuing drive to reduce the volume of opioids prescribed in the United States has encouraged doctors, insurers, and policy makers to target patients on high doses, who consume a disproportionate share of the total. Kertesz emphasized that point at a recent conference in Charleston.

Dowell et al. do not acknowledge the downside to the decline in opioid prescribing, which has been accompanied by a surge in opioid-related deaths as both patients and nonmedical users turn to the black market, where the drugs are much more dangerous because potency is highly variable and unpredictable. Nor do they question their emphasis on the 90-MME threshold, which is scientifically problematic for several reasons. It assumes that analgesic effect corresponds to overdose risk and that different opioids can be reliably compared to each other based on fixed ratios. It ignores numerous factors that affect how a patient responds to a given dose of a particular opioid, including obvious considerations such as the patient’s weight, treatment history, and pain intensity as well as subtler ones such as interactions with other drugs (which can suppress or amplify an opioid’s effects) and genetically determined differences in enzyme production and opioid receptors.

“Policies should allow clinicians to account for each patient’s unique circumstances in making clinical decisions,” Dowell et al. write. The CDC’s 90-MME threshold, however it was intended, has in practice encouraged a much less discriminating approach, one that sacrifices patients’ welfare for the sake of conforming with the perceived demands of the federal government.

“The CDC bears full responsibility for how these arbitrary dose levels are being implemented throughout the country and the consequences for the people in pain,” Lynn Webster, a former president of the American Academy of Pain Medicine who signed the March 6 letter to the CDC, told me last year. “I said at the time when they were proposed that if something comes from the CDC as a guideline, it is more than a guideline. It will be interpreted basically as a level of dosing that if you exceed [it], then you are at legal jeopardy.”

JACOB SULLUM is a senior editor at Reason.

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LymeDisease.org

Dorothy Kupcha Leland

07 AUG 2020

Dorothée Lorang, a filmmaker who lives in Nantes, France, has two children. One of them, Axel, is the central character in a remarkable video called “Axel and the True Story of an Imaginary Illness.”

Can you guess what the “imaginary illness” is?

Though under an hour long, the story of Axel and his family packs quite an emotional wallop–along with a lot of critically important information. It is both poignant and illuminating.

We learn about the difficulties of getting properly diagnosed and treated for Lyme disease in France, the pain and frustration of a suffering family, and the indomitable spirit of a little boy who’d rather pretend he’s Batman than undergo pushing and prodding from medical doctors who ultimately don’t believe he’s really sick anyway. (Who can blame him?)

Other issues that play a part: a mother and father’s dogged search for answers when they keep running into brick walls; the question of gestational Lyme disease; the effectiveness of antibiotic vs. alternative therapies; and the importance of Lyme patient activism.

This extraordinary film shares its story in a disarmingly simple way. (When in fact, we all know that Lyme disease can devastate a family in the non-simple manner of a runaway train plunging into a ravine, yes?)

“Axel and the True Story of an Imaginary Illness” doesn’t dispute the complexities involved. Yet, it offers a calm clarity as the parents discover new treatment approaches and weigh the decisions they must make to help their son.

The film is in French, with English subtitles. It’s available on Vimeo, where you can watch a snippet of it for free. Watching the whole thing will cost you $2.83. I found it well worth the price of admission.

Axel au pays des malades imaginaires / Axel and the true story of an imaginary illness from Vivement Lundi !on Vimeo.

(If you decide to rent the film, make sure to click the “CC” button in the lower right-hand corner of the frame. That turns on the English subtitles. I confess, it took me a while to figure that out.)

TOUCHED BY LYME is written by Dorothy Kupcha Leland, LymeDisease.org’s Vice-president and Director of Communications. She is co-author of When Your Child Has Lyme Disease: A Parent’s Survival Guide. Contact her at dleland@lymedisease.org.

Related Posts:

1. TOUCHED BY LYME: Ski champ shares her “LymeLight” in new film 
2. TOUCHED BY LYME: Justin Bieber’s Lyme disease story lights up the internet 
3. TOUCHED BY LYME: Winning video links Lyme to climate change 
4. TOUCHED BY LYME: “When the story of Lyme disease is written, it will be the story of patients standing up and being heard.” 

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LymeDisease.org

03 AUG 2020

By Gabriela Wijegunawardena

Over the past seven years I’ve seen: five primary care doctors, two neurologists, five OB-GYNs, one gastroenterologist, two urologists, one allergist, five dermatologists, five ER doctors, three functional medicine doctors, one ophthalmologist, one naturopath, four physical therapists, seven acupuncturists, and two craniosacral therapists—on a quest to find answers about my health.

I’m not a layperson. I wasn’t lost in the healthcare system. I know healthcare from the inside out. I have been a nurse for 17 years. I researched every doctor before scheduling an appointment. I prepared a list of questions and concerns for each doctor’s visit. Yet my outcome was misdiagnosis and dozens of prescription medications being thrown at symptoms.

Missing the root cause

If I’d been correctly diagnosed from the start, I could have avoided the following: Botox injections to my scalp and occipital nerve blocks to alleviate debilitating migraine pain and occipital neuralgia; an endoscopy; CT scans; MRIs; numerous ultrasounds; and countless lab tests. Not one doctor was able to determine the cause of my health problems. For starters, most weren’t looking for Lyme disease. Medications served as band-aids, and I was faced with the stark reality that the medical establishment I’d served for so long had failed me.

I hiked regularly in the Bay Area and had a dog when odd symptoms began to appear in 2013. Over the years, I would address one symptom, only to have another emerge months later. Sometimes I’d feel relatively okay for months at a time. My health improved somewhat after being treated for gut dysbiosis, worsening migraines, and interstitial cystitis. However, no one could pinpoint the root cause of my growing list of ailments. And I never felt fully well, like my old self.

In 2016, I saw a naturopath who tested me for Lyme disease as part of my new patient workup, using the standard serological ELISA and Western Blot lab tests. I read my results over and over. Negative. Negative. Negative. At the time, I didn’t know about the unreliability of the CDC’s two-tier testing protocol for Lyme disease. I was just told that Lyme had been ruled out. I’d tested negative, had never seen a tick, felt a bite, or had a bull’s-eye rash.

A Diagnosis

My health was in a downward spiral by the start of 2020. I still didn’t know what was causing my decline, I just knew I needed answers. A friend referred me to an integrative doctor who specializes in treating complex cases. It turns out, he’s a member of ILADS and has a lot of experience in recognizing and treating tick-borne illness.

As he looked over my lab results and read my list of chief complaints, he raised the possibility that Lyme disease could be at the root of my health problems. I couldn’t believe it! Had it been Lyme all along? My body was fighting something and perceived everything as a threat. Overactive mast cells translated into a myriad of symptoms ranging from histamine intolerance to anxiety and insomnia. He diagnosed me with mast cell activation syndrome, prescribed medications to stabilize my mast cells, and we agreed to test for Lyme disease via a specialized lab. My physical symptoms were beginning to make sense. I finally felt like I was headed in the right direction.

Health Inequity, Racial Disparities, & Implicit Bias

Once I was officially diagnosed with tick-borne disease, I joined a number of Lyme support groups. I was determined to find answers and connect with others battling the disease. As I explored each group, I noticed most members were white. I yearned to see representation in these groups. Why were so few people of color diagnosed with Lyme and other tick-borne infections?

As I’ve come to learn, there are many layers to that answer. A textbook bull’s-eye rash indicative of Lyme will present differently in people with dark skin. If the assessing doctor isn’t Lyme-knowledgeable, this cardinal sign may be missed. Latinxs are at high risk for contracting tick-borne infections due to occupational exposure. They comprise 44% of ground maintenance workers and 43% of farm workers. Because of health inequity, Black and Brown communities often lack access to healthcare.

Furthermore, access to Lyme-literate medical doctors (LLMDs) is problematic, as most are not in-network with health insurance plans. Thus, the cost of treatment falls squarely on the patient’s shoulders. Language barriers, fear of deportation, work schedules, and seasonal labor are roadblocks to seeking care early on as well. Lastly, a doctor’s bias, implicit or not, will directly impact if and when a diagnosis is made and how a patient’s complaints are treated. One study showed that doctors who harbor pro-white implicit biases aree more likely to prescribe pain medications to white patients than to Black patients.

CDC

Another barrier to diagnosis is the CDC’s rigid definition of Lyme disease. California, where I live, is considered “low-incidence” by the CDC. This means a patient in my state must meet a higher standard to be considered positive for Lyme, as compared to people in “high incidence” states.

The CDC also adheres to the Lyme treatment guidelines of the Infectious Diseases Society of America. According the IDSA, clearing Lyme disease only takes a few weeks of antibiotics. If symptoms persist beyond that, they call it “Post Treatment Lyme Disease Syndrome,” and advise against any further treatment. This also makes it easier for insurance companies to refuse to pay for Lyme medical care beyond the short course recommended by the IDSA.

Now four months into treatment with intravenous and oral antibiotics, I am beginning to see more and more glimpses of “the old me.” I hope to finish up sometime this year. I feel fortunate to have found a treating doctor to help me solve my health puzzle, along with caring and skillful nurses that never miss with IV placement.

I’m also grateful to have found an acupuncturist who has successfully treated Lyme patients for decades. She has helped my body detoxify and feel calmer, month after month. Everyone deserves to have holistic care, with integrative doctors and acupuncturists working collaboratively with a patient-centered approach. Sadly, this is not the case in our broken healthcare system.

Gabriela Wijegunawardena lives in the San Francisco Bay Area. This guest post is adapted from her blog Raising the Revolution.

Related Posts:

1. TOUCHED BY LYME: Arkansas takes baby steps to recognize Lyme disease 
2. NEWS: When medical ailments mimic mental illness 
3. “It should not be this hard.” Doctors don’t recognize tick-borne ills. 
4. Doctors must learn to recognize TBDs in minority populations 

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Thank you for all the wonderful comments about this post each week. I appreciate you taking the time to write me the notes. When I hear about a product someone is using and I can use it, I’m glad they mentioned the product. I hope you find some products you can use in these posts. 

I buy almost everything off of Amazon because they are often less expensive and as a Prime Member we get two-day free delivery. Also, if you use the Amazon Store Card you receive 5% back on all of your purchases. I’m all about saving money and free money! 

Smartfood

White Cheddar Popcorn is my favorite flavor but they have many to choose from. They are low in calories and big on taste. 

Gluten-Free, No Artificial colors or flavors, and no artificial preservatives.

Dr. Jart

Cicapair Tiger Grass Color Correcting Treatment

Our fan-favorite collection of skin soothers is powered by a Centella Asiatica (Tiger Grass) complex to calm sensitive skin, reduce redness, and soothe irritation.

One small jar will last long after the expiration date. I realized mine was about two years old and had to purchase a new jar, the smallest size they had this time. Use this the minute you feel a pimple coming on and by day two it may be completely gone. It’s also great for covering up dark spots on your face. A tiny bit goes a long way! 

Bioderma Laboratire Dermatolocique

I read Victoria Beckham used them, she has great skin so I had to try them. Surprisingly they are less expensive than many facial wipes on the market. I found them on Amazon and buy the two-pack. They are perfect for my sensitive skin. I don’t wear make-up these days so I only use these to clean my face with and a little toner. Available in the UK and many countries. 

Essential Oils

Organic Sweet Orange Spray Hand Sanitizer

They smell is out of this world, no nasty smell, two pumps is all it takes and it dries fast. Your hands even smell good after since it’s made with essential oils. I also love the Lavender scent. I have purchased at Whole Foods in the past but now buy by the case off Amazon, it’s less expensive. Whole Foods charged over $4.00 a bottle the last time I checked. 

For The Dogs

Natural Balance 

Mini Rewards 

We feed our dogs Natural Balance dog food and they love their snacks. We’ve tried every flavor and they haven’t snubbed their nose once. There are no fillers, no artificial flavors or colors, and no corn, wheat, or soy. We put them in Kong toys and they love it. Natural Balance is much better for them than the Kong brand treats and less expensive. 

Melinda

IDEAS.TED.COM

Jul 24, 2020 / Kate Torgovnick May

Imagine, for a moment, living in a world where strep throat wasn’t treatable. Where getting a cut or a blister could be life-threatening, even for people in countries with well-developed health systems.

While this may seem far-fetched, that’s exactly what could happen if our antibiotics lose their ability to treat bacterial infections. For years, scientists have been warning us about this scenario and telling us about the alarming rise in drug-resistant bacteria — but it doesn’t have to be our future.

Read on to learn 9 facts about antibiotics and how they were discovered, how bacteria learn to outmaneuver them, and how a bold idea (supported by The Audacious Project at TED) could help us address this problem.

So how did we get here?

1. We only have penicillin because of a scientist’s vacation and a policeman who grew roses

Penicillin, the first widely-used antibiotic, was discovered in 1928 and went on to revolutionize medicine. But we only have this drug — which treats strep throat, meningitis and more — thanks to a string of random events.

After his annual summer vacation, bacteriologist Alexander Fleming returned to his lab in London. When he was there, he realized that he had forgotten to place a petri dish in an incubator. As a result, an unusual mold was growing there. What’s more, the staph cells that he’d been studying and were clustered around it had actually died. Fleming called the mold “penicillin”, but then he struggled for more than a decade to isolate its active ingredient.

A group of biochemists at Oxford University — Howard Florey, Ernst Chain and Norman Heatley — picked up the charge. In 1940, they succeeded in purifying penicillin and tested it, first on mice and then on its first human subject: a policeman who’d contracted a life-threatening infection after being scratched by a rosebush in his garden.

At the same time, England was deep in the midst of World War II. According to the book The Mold in Dr. Florey’s Lab Coat, the group made a plan for what to do if Germany invaded — they rubbed penicillin spores into their lab coats so they could carry on their work should they have to flee.

That didn’t come to pass, but Florey and Heatley did have to solicit outside help to get penicillin mass-produced. They worked with both pharmaceutical companies and the US government to develop methods for growing penicillin at scale. By 1943, the US was supplying all the Allied forces with this miracle drug, which gave them a huge advantage in treating injuries.

2. Most of our existing antibiotics were found in the dirt — with the help of pilots and missionaries

Penicillin set off a golden age of antibiotic discovery, with scientists racing to identify substances with similar properties. At Rutgers University, agriculture student-turned-microbiologist Selman Waksman systematically tested an astonishing 10,000 soil samples over the course of his career. In 1943, he identified streptomycin, a broad-spectrum antibiotic effective against tuberculosis.

This work quickly got the attention of drug companies, who also set their eyes on searching soil. As public health journalist Maryn McKenna notes, Pfizer commissioned pilots, explorers and foreign correspondents to send back soil samples as they traveled; Eli Lilly, meanwhile, made a deal with the Christian and Missionary Alliance to have its members do the same. Bristol-Myers tapped its shareholders, asking them to mail in soil from wherever they went.

This tactic worked for decades, netting dozens of new antibiotics. But by the mid-1970s, researchers scouring soil samples found themselves discovering the same molecules over and over. Nothing new.

3. Discovery of new antibiotics has slowed, while bacteria are growing resistant to existing drugs 

For the past 40 years, scientists have focused on methods like genomic sequencing to help identify new antibiotics. This process is slow and expensive — it costs roughly $1 billion per drug, says McKenna — and has yielded relatively little in the way of results.

At the same time, bacteria are learning to withstand our available drugs. They’re developing antibiotic resistance — sneaky strategies that prevent an antibiotic from damaging their cells. What’s more, bacteria appear to be getting more and more efficient at this. As McKenna explains in a TED Talk, vancomycin was first prescribed in 1972, and then vancomycin-resistant bacteria emerged in 1988. Imipenem came out in 1985, and resistance was noted in 1998. More recently, daptomycin came out in 2003, with resistance noticeable by 2004.

4. The very use of antibiotics increases the mutation rate of bacteria

Antibiotics are mutagens, which work by attacking a bacteria cell. If they don’t kill it outright, they trigger the cell to fight for survival. So the use of an antibiotic increases the probability of a bacteria cell mutating in a way that gains resistance.

Resistant cells are able to pass on new coding to their offspring with startling speed — bacteria birth a new generation every 20 minutes. Plus, cells are even able to hand off their resistance to other bacteria. As McKenna puts it in her TED Talk, “Bacteria can pass their DNA to each other like a traveler handing off a suitcase at an airport. Once we have encouraged that resistance into existence, there is no knowing where it will spread.”

Resistance can also accumulate. Some communities of cells now have resistance to multiple antibiotics, and these hard-to-kill bacteria are the “superbugs” that you’ve probably heard about.

5. Antibiotic resistance is a natural phenomenon, but overusing antibiotics makes the problem much worse

Given how swift bacteria are at building resistance, the best strategy for ensuring that antibiotics stay effective would be to use them sparingly and only when needed. But that isn’t what we’ve done.

In some countries, antibiotics are available without a prescription, and in Europe and North America, antibiotics are vastly overprescribed by physicians. Too many patients pressure practitioners for antibiotics, even for colds or viruses that can’t be cured by them. According to the US Center for Disease Control, 30 percent of antibiotic prescriptions written in the US — in doctors’ offices and hospitals — are unnecessary.

6. Antibiotic use in livestock and antibacterial soaps are also driving resistance 

In the US, 70 percent of all antibiotics sold are used on farms to fight off infections in livestock and enhance their growth. Antibiotics are also used in the farming of fish and shrimp, as well as in the growing of fruits like apples, pears and citrus even though they’re not always necessary.

Meanwhile, consumers’ use of antibacterial soaps are on the rise. Then, with the COVID-19 pandemic, many people are using hand sanitizer gels and disinfecting wipes much more frequently. It’s the right thing to do while the virus is a threat — but in the long run, it could further stoke resistance.

7. The number of people dying from antibiotic-resistant diseases keep rising 

According to a 2019 report from the World Health Organization, at least 700,000 people are already dying of drug-resistant diseases each year. That number could rise to 10 million annually by 2050, making antibiotic resistant infections more deadly than cancer. We could soon be living in a very different world, one where the medical advances of the last century are wiped away.

8. But there is good news: Artificial intelligence has helped identify the first new broad-spectrum antibiotic in decades

This story promised hope, and that’s where the work of the Collins Lab at MITcomes in. Led by synthetic biologist Jim Collins, the lab has the goal to speed up the process of discovering new antibiotics and replenish our antibiotic arsenal. They’re doing this by harnessing the power of machine learning to screen unprecedented numbers of molecules for antibiotic properties.

In a 2020 study, Collins’ team announced that they have identified a new, highly-potent antibiotic: halicin. Named for HAL 9000, the sentient computer in 2001: A Space Odyssey, it seems to have real superpowers. Halicin rapidly kills E. coli, M. tuberculosis and more, and it’s also effective against the antibiotic-resistant bacteria that cause sepsis and pneumonia.

Equally important, halicin doesn’t appear to trigger mutations like other antibiotics do — while E. coli can develop resistance to other antibiotics in a single day, it wasn’t able to develop resistance to halicin even after 30 days of exposure. While scientists have known about halicin for a while — it was tested as a treatment for diabetes years ago — no one suspected it had antibiotic properties. “It doesn’t look like the antibiotics we know, so it would have been all but impossible for humans to recognize it as an antibiotic,” says Collins.

Thanks to the support of The Audacious Project, the funding initiative housed at TED to catalyze ambitious ideas into action, the Collins Lab is looking to add to our antibiotic toolbox. Their mission is to identify seven new classes of antibiotics to tackle seven of the world’s deadliest bacterial pathogens over the next seven years.

The lab’s work begins by analyzing the antibacterial activity of 100,000 known molecules. From there, they’ll train a machine-learning model to predict — based on their chemical structure — whether the new molecules could kill bacteria. Somewhere in this process, they should find antibiotics perfectly suited to fight ultra-deadly bugs. Researchers can also use what the model learns about antibacterial properties to design entirely new molecules that could be synthesized and tested.

9. Even better: This method might also have an impact on COVID-19 

As Collins shared in his TED talk, he and his team are training an AI platform to search for new antivirals that could treat COVID-19. At the same time, they’re looking to modify the BCG vaccine — currently used to prevent tuberculosis — to include COVID-19 antigens. Finally, they’re working to create a face mask that could continually test its wearer for COVID-19 as they breathe (wow!). They’ll do this by freeze-drying RNA sensors onto cloth.

One last thing: Combating antibiotic resistance isn’t just the work of people like the Collins Lab team. We can each do our part

Next time you’re sick, double-check with your doctor to make sure an antibiotic is really necessary. If it is, be sure to follow the prescription instructions so that you kill the bacteria rather than drive mutation. In your everyday life, you can look for antibiotic-free meat and buy plain soaps rather than antibacterial ones — they’re just as effective on virus particles.

Yes, it’s hard to think about facing another large-scale global health crisis in our lifetimes — but we have a chance to heed the warning this time.

ABOUT THE AUTHOR

Kate Torgovnick May is a journalist and writer based in Los Angeles. A former storyteller at TED, she has worked with the ambitious thinkers of the TED Prize and Audacious Project, helping them share their stories in video and text. She’s also the author of the narrative nonfiction book, CHEER!: Inside the Secret World of College Cheerleaders, and has written for the television series NCIS and Hellcats. Read more about her work at KateTorgovnickMay.com.