Fear the Reaper

I am going to go out on a limb here and write about a subject that I know next to nothing about. But that's part of the problem... Imagine the sensation it would cause in the news media: a new disease appears in the US, killing hundreds, then thousands, then tens of thousands per year. The death rate closes in on 100,000 people per year. People are terrified, the medical community launches a massive campaign to control and eradicate the new pestilence, the federal government creates a new bureaucracy, a special arm of the CDC to deal with this growing death toll. Here's the weird thing. It's here, and we may well top 100,000 dead per year soon in the US. There is no media outrage, no massive federal programs, and precious little available public information at all about it. The disease? MRSA: methicillin-resistant staphlyococcus aureus. This "superbug", a virulent strain of staph, has a chilling death rate: about 20-30% of the people who get it die from it. This is a highly variable statistic, because most of these infections are occurring in hospitals, and the people who are there are already very ill, and often immune-compromised. This so-called health-care-associated MRSA (HA-MRSA) is to be distinguished from the growing number of cases of community-associated MRSA (CA-MRSA) which account for around 15% of the incidence. In fact, getting the total US death toll number is rather difficult to do, because hospitals don't want to report these deaths and have actively lobbied against state laws requiring them to do so. In California, I am happy to say, The Governator signed into law in September a bill requiring such reporting (though he killed such a bill a year ago!) As of October, only half the states in the country had such laws. (Interesting aside: in 2003, then-Illinois state senator Barack Obama championed such legislation and got it passed.) Maybe the media is finally getting the story. The Seattle Times recently had an editorial on the subject, lashing out at the hospital industry for bring this pestilence upon us, after an investigative report. Okay, so what about that 100,000 number? Okay, I made that up. But in 2005, it is documented all over that there were about 19,000 deaths in the US, and infection rates were climbing very, very rapidly. In California the Department of Health Services estimated about 9,600 deaths from hospital related infections, which extrapolates to around 80,000 deaths nationwide. Not all of these are MRSA, clearly. But I am going to take a wild guess that the 9,600 number was low-balled. It is striking that we don't know how many people are dying from MRSA, but it could become the fifth or sixth leading cause of death soon. There are a lot of things that need to change, not least of which: - There need to be more media stories; people need their awareness raised. - The government, and the CDC in particular needs to get very serious about getting accurate statistics out and available openly. - Hospitals need to put in place whatever measures they can, from copper door knobs to better MRSA screening on intake, to better staff education (no pun intended) on infection control. - There should be a major research effort launched to understand the new-gen superbugs like MRSA, C. difficile, and the lovely new one from the Iraq battlefield, A. baumanni. I guess what I find most chilling here is the almost unbelievable cynicism of the hospital/health insurance companies who actively fight against having to report statistics on MRSA infection rates. To me, it just underscores a general conclusion that I have formed in the past several years: our health care system should not be managed by organizations that have a profit motive. Think about it: the free market has not produced an efficient, responsive health care system. The profit-based health insurance industry has only created an enormously expensive bureaucratic layer whose main effect has been to drive up health care costs at quadruple the inflation rate while continually restricting actual health care services, and has left 50 million Americans with no health care coverage at all. I blame them.