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Saturday, May 26, 2018

Chicken safety fear as chlorine washing fails bacteria tests


The chlorine washing of food, the controversial “cleaning” technique used by many US poultry producers who want access to the British market post-Brexit, does not remove contaminants, a new study has found.
The investigation, by a team of microbiologists from Southampton University and published in the US journal mBio, found that bacilli such as listeria and salmonella remain completely active after chlorine washing. The process merely makes it impossible to culture them in the lab, giving the false impression that the chlorine washing has been effective.
Apart from a few voluntary codes, the American poultry industry is unregulated compared with that in the EU, allowing for flocks to be kept in far greater densities and leading to a much higher incidence of infection. While chicken farmers in the EU manage contamination through higher welfare standards, smaller flock densities and inoculation, chlorine washing is routinely used in the US right at the end of the process, after slaughter, to clean carcasses. This latest study indicates it simply doesn’t work.
Currently, chlorine-washed chicken is barred from entry to the EU on animal welfare grounds and has become a contentious issue for opponents of liberal trade deals with the US post-Brexit.
Previous studies with similar findings have been dismissed by the US poultry industry as producing “laboratory-only” results with no relevance to the real world. “We therefore tested the strains of listeria and salmonella that we had chlorine-washed on nematodes [roundworms], which have a relatively complex digestive system,” said Professor William Keevil, who led the university team. “All of them died. Many companies and scientists have built their reputations promoting anti-microbial products. This research questions everything they’ve done.”
The study tested contaminated spinach, but Keevil insists the findings apply equally to chicken. “This is very concerning,” he said. The issue, he argues, is less to do with the chicken itself, the contamination of which can be managed by thorough cooking. “It’s that chlorine-washed chicken, giving the impression of being safe, can then cross-contaminate the kitchen.”
The British government has given a series of mixed messages over its willingness to accept chlorine-washed chicken into the UK as part of any post-Brexit trade deal with the US. While Michael Gove, the environment secretary, has insisted animal welfare standards will be maintained, the trade secretary, Liam Fox, told MPs last November: “There are no health reasonswhy you couldn’t eat chickens that have been washed in chlorinated water.”
In a speech delivered last month, Fox referred to “myths” being used to stymie free trade agreements. Last year, Wilbur Ross, the US commerce secretary, insisted the UK would have to accept American foodstandards if it was to secure a trade deal. According to a poll by the consumer association Which, 72% of the British population is opposed to the introduction of chlorine-washed chicken on to the British market.
Recently published analysis by the British food and farming pressure group Sustain, found that the incidence of food poisoning in the US could be 10 times higher than in the UK. The US Centers for Disease Control and Prevention reports that about 380 people die each year in America from foodborne salmonella poisoning. Public Health England reports that, between 2005 and 2015, there was not a single death from salmonella poisoning in England and Wales.
Kath Dalmeny, the chief executive of Sustain, described the Southampton research as a wake-up call. “Those dead nematodes are telling us something,” she said. “This research suggests US chlorine washing may give a false impression of food safety. Proper food safety relies on clean production methods with high animal welfare, resilience to disease, and full traceability and labelling – not just end-of-pipe chemical washes.”
Infection is a recognised hazard of all intensive poultry farming and the UK is not immune, with campylobacter regarded as a major problem within the British chicken flock. Incidences of human illness as a result of campylobacter peaked at nearly 115 per 100,000 of the UK population in 2012, but have since declined as new contamination control measures have been put in place.
A protest against US chlorinated chicken outside the Conservative party conference in Manchester last October.
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 A protest against US chlorinated chicken outside the Conservative party conference in Manchester last October. Photograph: Alamy Stock Photo
“The US vigorously champions chemical washes,” said Richard Griffith, the chief executive of the British Poultry Council. “But this hides the shortcomings in their production methods and belies their attitude both to food safety and being open with consumers. It seems that the US, even with growing scientific evidence, is still trying to offload food on us of higher risk and lower quality than our own.”
Liam Fox declined to comment further on the efficacy of chlorine washing for chicken. However, a government spokesperson said: “We have been clear that we will not lower our high food safety and animal welfare standards as a result of any future free trade agreement.”
The Food Standards Agency went further, essentially tying the hands of British negotiators, by pointing out that only water safe for human consumption can be used to remove surface contamination from poultry carcasses in EU countries. “The current rules will remain in place after the UK leaves the EU,” the FSA said.
Tom Super of the National Chicken Council, the trade association for American chicken farmers, described the concerns over chlorine washing raised by the new study as “silly”, and stressed that America is the second-largest exporter of chicken in the world. “We export product safely to more than 100 countries around the globe,” he said. “We’ve been feeding the same chicken to our families for decades. This has never been an issue of science, rather one of politics and protectionism.”

Abiomed to enter S&P 500 index May 31


S&P MidCap 400 constituent ABIOMED (ABMD) will replace Wyndham Worldwide (WYN) in the S&P 500, Wyndham Worldwide will replace Microsemi Corp. (MSCC) in the S&P MidCap 400, and PRA Health Sciences Inc. (PRAH) will replace ABIOMED in the S&P MidCap 400 effective prior to the open of trading on Thursday, May 31. Wyndham Hotels & Resorts (WH) will be added to the S&P MidCap 400 effective prior to the open of trading on Friday, June 1, replacing GameStop Inc. (GME), which will be removed from the S&P MidCap 400 effective prior to the open of trading on Monday, June 4, and GameStop will replace Fred’s Inc. (FRED) in the S&P SmallCap 600 also effective prior to the open of trading on June 4. New S&P MidCap 400 constituent Wyndham Worldwide, which is changing its name to Wyndham estinations Inc. and its ticker symbol to WYND, is spinning off Wyndham Hotels & Resorts in a transaction expected to be effective on June 1. Post spin-off, Wyndham Destinations will remain in the S&P MidCap 400. GameStop has a market capitalization more representative of the small-cap market space. Fred’s is ranked near the bottom of the S&P SmallCap 600. Perspecta Inc. (PRSP) will replace Office Depot Inc. (ODP) in the S&P MidCap 400, and Office Depot will replace Roadrunner Transportation Systems Inc. (RRTS) in the S&P SmallCap 600 effective prior to the open of trading on Monday, June 4. S&P 500 constituent DXC Technology Co. (DXC) is spinning off Perspecta in a transaction expected to be effective on June 1. Post spin-off, DXC Technology will remain in the S&P 500. Office Depot has a market capitalization more representative of the small-cap market space. Roadrunner Transportation Systems is ranked near the bottom of the S&P SmallCap 600.

Keryx med may delay dialysis need in patients with advanced kidney disease


Results from an open-label investigator-sponsored study assessing Keryx Biopharmaceuticals’ (NASDAQ:KERX) Auryxia (ferric citrate) in patients with advanced chronic kidney disease (CKD) showed its potential for delaying the need for dialysis. The data were presented at ERA/EDTA in Copenhagen.
The study evaluated ferric citrate compared to standard-of-care (SOC) treatment in late-stage non-dialysis dependent CKD patients who were not expected to start dialysis within eight weeks of study initiation. Participants were randomized 2:1 to receive either a fixed dose of Auryxia (two tablets per meal) or SOC.
In the ferric citrate group, 76 of 133 patients completed the nine months of the study. 30 initiated dialysis, 16 terminated early, eight received a transplant and three died.
In the SOC group, 29 of 66 patients completed the study. 31 initiated dialysis, four terminated early and two died (dialysis results should be based on those who completed the study but 31 > 29).
Geoffrey Block, M.D, Director of Clinical Research at Denver Nephrology says, “The data from this study suggest that administering ferric citrate to late-stage pre-dialysis patients not only improves biochemical parameters associated with chronic kidney disease, but also has the potential to delay the need for dialysis. With the impact of ferric citrate across multiple aspects of CKD, it is worth further investigation to determine which of these many factors is contributing to the reduced risk of renal replacement therapy observed in this study.”

To repel ticks this summer, try insecticide-treated clothes


Outdoor enthusiasts: Here’s a bit of good tick-fighting news just in time for Memorial Day weekend and the unofficial start of summer.
A new U.S. government study confirms that insecticide-treated clothes marketed for preventing tick-borne ills do, in fact, thwart the pests.
In lab tests of clothes bought from one manufacturer, researchers found that the garments either quickly caused ticks to fall off, or rendered them unable to bite.
The study involved three types of ticks that, in the United States, are major carriers of disease—including Lyme disease, Rocky Mountain spotted fever, and what’s known as southern tick-associated rash illness, or STARI.
The clothes were pretreated with permethrin, a synthetic form of an insect-thwarting compound from the chrysanthemum flower. It’s used in insecticide sprays and shampoos and creams that treat lice and scabies.
Several companies already market permethrin-treated shirts, pants, socks and other , as a way to ward off disease-transmitting pests. The new study adds to evidence that the garments are indeed toxic to ticks, according to senior researcher Lars Eisen, of the U.S. Centers for Disease Control and Prevention.
“All tested tick species and life stages experienced the ‘hot-foot’ effect after coming into contact with permethrin-treated clothing,” Eisen said.
That, he explained, made the ticks drop off of “vertically oriented” clothes—which would simulate a pair of pants when a person is standing.
In addition, Eisen said, when the ticks were in contact with the clothes for up to five minutes, they lost their ability to move normally—and to bite.
There are still questions, he noted, including what types of clothing offer the best protection in the real world.
The CDC already recommends permethrin as one tactic for avoiding tick bites. It says that people can “treat clothing and gear, such as boots, pants, socks and tents, with products containing 0.5 percent permethrin.”
The agency further says that “pretreated clothing is available and may be protective longer.”
Thomas Mather is director of the University of Rhode Island’s Center for Vector-Borne Disease and its TickEncounter Resource Center.
He said the new findings, published May 24 in the Journal of Medical Entomology, offer more support for the tick-fighting garments.
“This can be a pretty effective way to stop ticks,” said Mather, who was not involved in the study.
In his own research, Mather found there are benefits even with permethrin-treated summer clothes that leave some skin uncovered—shorts, T-shirts, socks and sneakers.
His team had a group of brave volunteers watch a movie while allowing lab-raised, disease-free ticks to crawl on their bodies. Some wore regular clothes, some wore clothes with permethrin—either pretreated or with the insecticide added using home kits. Those wearing either kind of treated clothing ended up with far fewer live ticks on their bodies by the end of the movie.
While people can use permethrin on their regular clothes, the pretreated garments hold up to many more washings, according to Mather—up to 70.
Some people may be wary of chemically treated clothes. But, Mather said, the amount of permethrin in clothing is very low: A solution containing only 0.5 percent of the pesticide is “dried into” the fabric.
According to the U.S. Environmental Protection Agency, research indicates that permethrin is “poorly absorbed” through the skin, and there’s no evidence that treated clothing could be harmful to children or pregnant women.
U.S. military members have been using permethrin-treated uniforms since the 1990s, the EPA noted. According to Mather, the garments may also be a good bet for people whose jobs keep them outdoors—or for gardeners or anyone else who spends time in places where tick exposure is a concern.
Eisen pointed to some other CDC-recommended ways to cut the risk of -borne ills: Avoid wooded and brushy areas with high grass and “leaf litter”; walk in the center of outdoor trails; use EPA-registered repellents containing ingredients such as DEET, picaridin or oil of lemon eucalyptus; thoroughly check your body and clothes for ticks after being outdoors; and shower within two hours of coming back indoors.
More information: Lars Eisen, Ph.D., research entomologist, U.S. Centers for Disease Control and Prevention; Thomas Mather, Ph.D., director, Center for Vector-Borne Disease, and TickEncounter Resource Center, University of Rhode Island, Kingston; May 24, 2018, Journal of Medical Entomology, online
The CDC has more advice on how to avoid tick bites.

Brain’s frontal lobe could be involved in chronic pain, and thus pain relief


A University of Toronto scientist has discovered the brain’s frontal lobe is involved in pain transmission to the spine. If his findings in animals bear out in people, the discovery could lead to a new class of non-addictive painkillers.
For 20 years, Min Zhuo, a professor of physiology in the Faculty of Medicine, has been intrigued by invisible pain, in particular chronic pain with no obvious cause. He has long suspected that the standard way of viewing spinal pain – it must come from injury or tissue inflammation – and the usual understanding of how to treat it – block it from entering the spinal cord – wasn’t telling the whole story.
Now, Zhuo has shown in mice and rats that some spinal pain actually begins in the brain’s frontal lobe, an area previously thought to be uninvolved. And he has shown how treating the pain in this area could be effective at preventing chronic pain. Zhuo published his results May 16 in the journal Nature Communications.
“When doctors can’t see anything wrong to cause , often they think patients are making it up,” says Zhuo. “But pain that originates in the frontal lobe would be very different from pain that comes from a physical injury, like a herniated disc. There wouldn’t necessarily be any injury to see. That’s because our personality and emotions live in this region. If the frontal lobe can produce physical pain, that pain would be deeply tied to emotions like anxiety.”
Scientists already knew that the prefrontal cortex was in some way involved in pain because it would light up in scans of people in pain. But that activity was always thought to be symptom not cause, says Zhuo.
“When you have extreme anxiety, more neurotransmitters are released that end up causing pain in the spine,” he says. “Normal functions like walking shouldn’t be painful. But this flood of neurotransmitters sends the spine into hyper drive, and it starts treating ordinary sensations like pain. That could explain why anxiety can cause  and make you think you’re having a heart attack. Or why some people experience pain when you touch them. I believe this helps to explain why  causes .”
The good news is that pain from the frontal lobe seems to be transmitted in a simple, direct way to the spine – making it relatively easy to shut down. Neurons in the frontal cortex send signals all the way down the spinal cord, says Zhuo, whereas  from other areas of the brain are mediated by a complex network.
In animals, Zhuo found that pain was associated with increased neurotransmitters released from the frontal cortex. He was able to lessen pain by reducing the amount released. His next step is to test this process in people.
Those who suffer from anxiety along with neuropathic  would likely benefit from a painkiller targeting the , says Zhuo.
More information: Tao Chen et al. Top-down descending facilitation of spinal sensory excitatory transmission from the anterior cingulate cortex, Nature Communications (2018). DOI: 10.1038/s41467-018-04309-2

CDC IDs outbreak trends tied to treated recreational water


Outbreaks associated with treated recreational water with confirmed infectious etiology are usually caused by CryptosporidiumLegionella, or Pseudomonas, according to research published in the May 18 issue of the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Michele C. Hlavsa, M.P.H., from the CDC in Atlanta, and colleagues describe 493 outbreaks associated with treated  reported during 2000 to 2014.
The researchers found that 58 percent of the 363 outbreaks with confirmed infectious etiology were caused by Cryptosporidium, 16 percent by Legionella, and 13 percent by Pseudomonas. Overall, 24,453 cases were identified in the 363 outbreaks; 89, 4, and 3 percent were caused by CryptosporidiumPseudomonas, and Legionella, respectively. Of the eight reported deaths, at least six occurred in persons affected by outbreaks caused by Legionella. The leading setting was hotels, which were associated with 32 percent of the 493 outbreaks. The outbreaks had a bimodal temporal distribution: 56 percent started in June to August, and 9 percent started in March.
“Assessment of trends in the annual counts of outbreaks caused by CryptosporidiumLegionella, or Pseudomonas indicate mixed progress in preventing transmission,” the authors write. “Pathogens able to evade chlorine inactivation have become leading  etiologies.”
More information: Abstract/Full Text

When is insurance not really insurance? When you need pricey dental care


This was how I learned all about the Great Divide between medicine and dentistry — especially in how treatment is paid for, or mostly not paid for, by insurers. Many Americans with serious dental illness find out the same way: sticker shock.
For millions of Americans — blessed in some measure with good genes and good luck — dental insurance works pretty well, and they don’t think much about it. But people like me learn the hard way that dental insurance isn’t insurance at all — not in the sense of providing significant protection against unexpected or unaffordable costs. My dental coverage from UC-Berkeley, where I have been on the public health and journalism faculties, tops out at $1,500 a year — and that’s considered a decent plan.
Dental policies are more like prepayment plans for a basic level of care. They generally provide full coverage for routine preventive services and charge a small copay for fillings. But coverage is reduced as treatment intensifies. Major work like a crown or a bridge is often covered only at 50 percent; implants generally aren’t covered at all.
In many other countries, medical and dental care likewise are segregated systems. The difference is that prices for major procedures in the U.S. are so high they can be out of reach even for middle-class patients. Some people resort to so-called dental tourism, seeking care in countries like Mexico and Spain. Others obtain reduced-cost care in the U.S. from dental schools or line up for free care at occasional pop-up clinics.
Underlying this “insurance” system in the U.S. is a broader, unstated premise that dental treatment is somehow optional, even a luxury. From a coverage standpoint, it’s as though the mouth is walled off from the rest of the body.
My humbling situation is not about failing to brush or floss, not about cosmetics. My two lower front teeth collapsed just before my 40th birthday. It turned out that, despite regular dental care, I had developed an advanced case of periodontitis — a chronic inflammatory condition in which pockets of bacteria become infected and gradually destroy gum and bone tissue. Almost half of Americans 30 and older suffer from mild to severe forms of it.
My diagnosis was followed by extractions, titanium implants in my jaw, installation of porcelain teeth on the implants, bone grafts, a series of gum surgeries — and that was just the beginning. I’ve since had five more implants, more gum and bone grafts and many, many new crowns installed.
At least I’ve been able to get care. The situation is much worse for people with lower incomes and no family support. Although Medicaid, the state-federal insurer for poor and disabled people, covers children’s dental services, states decide themselves on whether to offer benefits for adults. And many dentists won’t accept patients on Medicaid, child or adult, because they consider the reimbursement rates too low.
The program typically pays as little as half of what they get from patients with private insurance. For example, as Kaiser Health News reported in 2016, Medicaid in Colorado pays $87 for a filling on a back tooth and $435 for a crown, compared with the $150 and $800 that private patients typically pay.
“It’s really a labor of love to do it,” said Dana Lubet, a recently retired dentist in Madison, Wis., who estimated Medicaid paid only a third of his costs. Accepting too many, he said, “could easily kill your practice.”
A few years ago, while in his mid-50s, Nick DiGeronimo, a facility maintenance worker at a New Jersey sports center, obtained private insurance coverage through the Affordable Care Act, hoping to get treatment for progressive tooth decay.
He needed two implants but, to his dismay, the plan did not cover them. To pay the $10,500 bill, he had to take out loans. “Dental insurance is basically useless,” said DiGeronimo. “It’s a sham, a waste of money, and another case of the haves versus the have-nots.”
As for older Americans, many lose employer-based dental coverage when they retire even as they suffer from increasing dental problems. Among those 65 and older, 70 percent have some form of periodontal disease, according to the Centers for Disease Control and Prevention. Yet basic Medicare plans do not include dental coverage, although options exist for seniors to purchase it.
Overall, in 2015, almost 35 percent of American adults of working age did not have dental insurance. By contrast, only about 12 percent of American adults under 65 did not have medical insurance in 2016. That lack of coverage and treatment can diminish economic and social opportunities — for instance, it can be costly at work or in a job interview not to smile because of unsightly or missing teeth.
Eventually, poor prevention and treatment can become a medical problem — leading to serious, and occasionally deadly, health consequences. In an infamous 2007 case — described by Mary Otto in her book “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America” — Deamonte Driver, a 12-year-old boy in Maryland, died after a tooth infection spread to his brain. The family’s Medicaid coverage had lapsed.
Research has demonstrated links between periodontal infections and chronic conditions like diabetes and cardiovascular disease. Studies have found associations between periodontitis and adverse pregnancy outcomes, such as premature labor and low birth weight. Tooth problems also hinder chewing and eating, affecting nutritional status.
The split between the medical and dental professions, however, has deep roots in history and tradition. For centuries, extracting teeth fell to tradesfolk like barbers and blacksmiths — doctors didn’t concern themselves with such bloody surgeries.
In the U.S., the long-standing rift between doctors and dentists was institutionalized in 1840, when the University of Maryland refused to add training in dentistry and oral surgery to its medical school curriculum — leading to the creation of the world’s first dental school.
Dentists have in some ways benefited from the separation — largely escaping the corporate consolidation of American medicine, with many making good livings in smaller practices. Patients often willingly pay out-of-pocket, at least to a point.
Some people deliberately forgo dental coverage, considering it less urgent than having insurance against medical catastrophes. “You might not get a job as hostess at the restaurant, but by the same token people that have a lot of missing teeth live to tell the tales,” Lubet said.
With fluoridation and advances in treatment, many Americans have come to take the health of their teeth for granted and shifted their attention to more cosmetic concerns. And the dental field has profited from the business.
In my experience, which includes extensive travel in other countries, Americans often seem disoriented or even horrified when confronted with imperfect dentition. During my period of intense dental care here, I hated wearing temporaries and often braved the public with missing front teeth. I found myself routinely reassuring people that, yes, I knew about the gap, and yes, I was having it dealt with.
Meanwhile, the bold line between what is covered or what is not often strikes patients as nonsensical.
Last fall, Lewis Nightingale, 68, a retired art director in San Francisco, needed surgery to deal with a benign tumor in the bone near his upper right teeth. The oral surgeon and the ear, nose and throat doctor consulted and agreed the former was best suited to handle the operation, although either one was qualified to do it.
Nightingale’s Medicare plan would have covered a procedure performed by the ear, nose and throat doctor, he said. But it did not cover the surgery in this case because it was done by an oral surgeon — a dental specialist. Nightingale had no dental insurance, so he was stuck with the $3,000 bill.
If only his tumor had placed itself just a few inches away, he thought.
“I said, what if I had nose cancer, or throat cancer?” Nightingale said. “To separate out dental problems from anything else seems arbitrary. I have great medical insurance, so why isn’t my medical insurance covering it?”