Superbug lurking! Drug resistance now a nightmare!

Top health officials in the UK and US warn that resistance of bacteria to medicines is a catastrophe and nightmare, and as serious a threat as terrorism and climate change.



MANY a Malaysian has lost a family member because of an infection contracted during an operation while in a hospital.

Several office colleagues and friends have told me that a close relative had died after being infected by a superbug that was so toxic that it could not be eliminated by antibiotics.

This, in essence, is the problem of antibiotic resistance – that a bacterium can evolve and change so that it becomes immune to the medicines given to a sick patient that are meant to kill it.

When a bacterium becomes resistant to one antibiotic, scientists develop a more powerful antibiotic to kill it. But bacteria can then change to also become immune to the new medicine.

When the dangerous pathogens out-run the drugs developed to combat them, humanity is at risk of losing the race between life and death.

Equally problematic is that many of these incurable diseases are contracted when patients stay in hospitals, especially during operations.

In the past two weeks, two top health officials – the Chief Medical Officer of the United Kingdom Dame Sally Davies and the director of the United States Centres for Disease Control and Prevention (CDC) Dr Thomas Frieden – have sounded the alarm bells.

Davies, the top health official in the UK, warned of a looming “catastrophe” of antibiotic resistance being so widespread that we would be back to a 19th century medical situation, a pre-antibiotic era when many diseases were difficult or impossible to treat.

Frieden evoked a “nightmare” scenario, a “very serious” problem caused by the advance of highly drug-resistant bacteria known as CRE.

A major cause of the acceleration of antibiotic resistance is the inappropriate use of the medicines and the inadequate action (or even inaction) of health authorities.

Drug companies often over-promote the use and sales of their medicines; some doctors over-prescribe or wrongly prescribe antibiotics (sometimes for the wrong ailment); and patients who are not informed enough sometimes pressure their doctors for antibiotics for a quick cure and often do not use the medicines properly by not completing the course of medicines.

There’s not enough action to make the public aware of the proper use of antibiotics, and not enough regulations (or their implementation) to ensure drug companies and medical personnel sell or prescribe the medicines properly.

The alarm raised by the two top health officials was aimed at pushing the regulators and also the patients into action.

Davies, during media interviews, even placed antibiotic resistance on par with terrorism and climate change as critical risks facing the nation.

She said: “Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.

“Routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.

“That’s why governments and organisations across the world, including the World Health Organisation and G8, need to take this seriously.”

Although there has been a great reduction in cases in English hospitals of MRSA (methicillin-resistant Staphylococcus aureus), which is a skin disease, this has been replaced by many times more cases of gram-negative bacteria which are found in the gut.

These bacteria include E. coli and Klebsiella (which causes pneumonia) which are resistant to many drugs.

Besides the new drug-resistant pathogens, resistance is also emerging in old pathogens.

In particular, the report cites tuberculosis, which has re-emerged in Europe in the form of new strains that are resistant to many or even all available drugs.

Another classical disease with increasing drug resistance is gonorrhoea.

Davies’ 152-page report also warned of a “discovery void” with few new antibiotics developed in the past two decades.

“While a new infectious disease has been discovered nearly every year over the past 30 years, there have been very few new antibiotics developed leaving our armoury nearly empty as diseases evolve and become resistant to existing drugs,” said a press release on the report.

Meanwhile, Frieden warned about the rapid spread of CRE or the carbapenem-resistant variety of Enterobacteriaceae, a gro­up of more than 70 bacteria which dwell in the gut, including Klebsiella, Salmonella, Shigella and E. coli.

Carbapenems are powerful drugs that are used as a last resort when the bacteria have become resistant to other drugs.

The occurrence of resistance has risen four-fold in 10 years.

According to Frieden, CRE was found in 4.6% of hospitals and 17.8% of long-term care in 2012.

While resistance is building up, there have been few new antibiotics.

No new classes of antibiotics have been developed since 1987, and none is in the pipeline across the world, said Davies.

“Antimicrobial resistance is a ticking time-bomb not only for the UK but also for the world.
“We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality. This threat is arguably as important as climate change.”

 

GLOBAL TRENDS By MARTIN KHOR

Foot-Notes:

Superbug lurking

 No, not this “Superbug.” W’ere talking about something much more sinister!

Patients receiving long-term or complex medical care in hospitals and nursing homes are at the greatest risk for CRE infection.

The bug is spread mainly by unclean hands, but medical devices like ventilators and catheters increase the risk of infection because they allow the bacteria to get deep into a patient’s body, Frieden said. - RYOT

Overprescribing of antibiotics creates superbugs

These bugs are named and defined by their resistance to the Carbapenem class of antibiotics. Unlike previous superbugs, there are no 'last resort' antibiotics after resistance develops and these stop working.

CRE infections can lead to pneumonia, meningitis, wound infections, sepsis and a host of deadly infections.

"CRE are nightmare bacteria," said Dr. Tom Frieden, director of the U.S. Centers for Disease Control.

"Our strongest antibiotics don’t work and patients are left with potentially untreatable infections."

Resistance to antibiotics continues to be an issue worldwide, with overprescribing and overuse of broad-spectrum antibiotics being the main culprits.

In this week’s Lancet magazine, UK's chief medical officer Dame Sally Davis, said that that antibiotic resistance is "as great a threat to our future as terrorism."

That's because routine surgeries, treatments for cancer and autoimmune disease all leave patients vulnerable to superbug infections.

"If we don't take action then we may all be back in an almost 19th century environment where infections kill us as a result of routine operations. We won't be able to do a lot of our cancer treatments or organ transplants," Davis warned.

The problem is that much of the antibiotic resistance occurs in developing countries where antibiotics are readily available, resources scarce and education around resistance non-existent.

“Antibiotic stewardship has to be a global effort in order to make an impact on resistance,” said Romney, the medical microbiologist in Vancouver.

In addition, no new major antibiotics have been made since the late 1980's because antibiotics can have a short lifespan before superbugs become resistant, making them unprofitable for pharmaceutical companies when compared to the other drugs.

But there is hope. Over the last decade, recognition of antibiotic resistance has led to decreased rates of other superbug classes such as Methicillin-resistant staphylococcus aureus (MRSA) in parts of Canada. - CBS   

Sabah's invaders from the Philippines only flog a dead horse!

EVEN though foreign insurgents make a historical claim to Sabah, the facts of history refute it.

AS Malaysian troops and police continue mopping-up operations to flush out straying remnants of the Lahad Datu standoff, partisans on both sides trade emotive claims and insults.

Analysts, meanwhile, weigh the terms in historical documents like “rent”, “lease” and “cession money” to determine Sabah’s actual status. But not only are these documents read differently in translation (English and Sulu), the terms are also interpreted differently.

It makes more sense to focus on the events and circumstances of history. The known facts reveal at least 16 reasons why the Filipino Sulu claim to Sabah is unwarranted and unworthy of consideration.

First, today’s Philippines as a modern nation state and a republic by definition abrogates a former sultanate whose territory it occupies and whose sovereignty it denies.

The Republic of the Philippines has no claim to Sabah of its own. The on-off claim, originating from Sulu sovereignty made by certain quarters, is only a private matter of some revisionist individuals.

The second reason is that the Sulu Sultanate no longer exists, since there was no provision even for a constitutional monarch. Any claim requires a claimant and the property/territory in question, whether anyone else has effective control and ownership over it.

If the claimant or the territory does not exist, the claim cannot stand. The insurgents and their leader Jamalul Kiram III are only pressing a notional claim, since they cannot represent a defunct entity.

Third, there is no agreed rightful heir to the last Sultan of Sulu, even if an heir were to press the claim. Jamalul’s claim to be that heir is disputed by nearly a dozen other hereditary “royal” personages.

Another reason for rejecting his claim to Sabah comes with denial of his claim to the throne: 10 other “heirs” had renounced all claim to Sabah in 2007. Nine did so in a signed statement, and Rodinood Julaspi Kiram II in a separate declaration.

It does not matter whether Jamalul was among the nine. If he was, he had unlawfully reneged on the signed agreement, and if he wasn’t, he is outnumbered and is challenged 10 ways.

Fifth, when Spain took over the Sulu Sultanate as part of the Philippines, it left North Borneo (Sabah) in British hands. Spain disrupted the Sultanate by removing 18-year-old Sultan Jamalul Kiram II in 1886, replacing him with a rival, only to “reappoint” him six years later.

Britain made North Borneo a protectorate in 1888. Under Spain, the Philippines and most of the Sulu Sultanate with it were going in one direction, while North Borneo and the British went in another.

Eventually, the sultanate was divested of political and administrative powers until it exercised authority only over religious matters. No effective, functioning sultanate existed any more.

Sixth, the death of Sultan Jamalul Kiram II in 1936 saw no successor, since he died childless. His younger brother and anointed successor, Mawalil Wasit, died the same year before he was crowned.

Thus ended the Royal House of Sulu’s lineage. After Spain passed the Philippines, including the territory of the former sultanate (excluding North Borneo) to the United States, the US officially abolished what remained of the sultanate in 1936.

Eighth, the British North Borneo Company also ceased payment to the sultanate that year, indicating that the business sector had considered the 1878 agreement voided. (Payment later resumed only after relatives of the deceased sultan brought the matter to court.)

Ninth, President Manuel L. Quezon of the (then) Commonwealth of the Philippines declared in 1936 that Jamalul Kiram II was the last Sultan of Sulu. To emphasise the point, Quezon said the Philippine government would no longer recognise a Sulu Sultanate.

Britain had been exercising increasing proprietary moves over North Borneo, earning two rebukes from the US (1906, 1920). Britain ignored those reminders and annexed North Borneo in 1946, turning it into a crown colony.

Whatever the moral issues there, it again spelled the end of any vestige of Sulu royalty. For London, it was a justifiable move since it had taken over all the legal obligations of North Borneo.

Tenth, there was no question later (in the 1960s) about Sabah having to obtain independence from Britain. This underlined the fact that Britain was the sole governing authority up to that point.

Then as Sabah’s independence and the Cobbold Commission’s findings led to the scheduled formation of Malaysia on Aug 31, 1963, agitation flared from the Philippines. The date was postponed to Sept 16, such that Sabah was an independent entity for 16 days, ending any remaining claim from an extinct sultanate or the Philippines as belonging to it.

Twelfth, the very act of freely becoming part of the Malaysian federation negated all further claims on the territory by foreign partisans. The new state of Malaysia in its present form is recognised in all international organisations, including the United Nations and Asean, of which the Philippines is also a member.

Although former President Marcos tried to retake Sabah in the 1960s, the claim was later abandoned. At the Second Asean Summit in Kuala Lumpur in 1977, Marcos declared that the Philippines was taking concrete steps to end the claim.

Later, as Marcos’ rule clearly became a dictatorship, he made Punjungan Kiram “interim sultan” for Sulu. But this candidate ran off to Sabah, preferring to be a Malaysian instead.

Marcos then “appointed” Punjungan’s son Jamalul Kiram III successor to a non-existent sultan. This instigator of Lahad Datu is not only a dubious candidate since he is not the son of a sultan, but his claim to authority comes from a discredited and ousted dictator of a republic.

Not least, when President Corazon Aquino’s post-Marcos government planned a new Philippine Constitution in 1987, Malaysia lobbied for wording to end the disturbing claim to Sabah for good.

This would replace “historical right or legal title” with “over which the government exercises sovereign jurisdiction” (i.e. the status quo), which was accepted after the third reading in Congress.

So for Philippine citizens to invade Sabah to lay claim to it clearly violates their country’s Constitution. President Benigno Aquino III’s prosecution of these criminals is fully in accordance with the law.

It is also said that no rightful Filipino claim to Sabah exists because as a country, it had not consistently engaged in the activities of a de facto power there. Not only that, there has also been no consistent Filipino claim to Sabah.

Behind The Headlines by BUNN NAGARA

Related posts:

Sulu history and the Chinese

The former Sulu Sultanate, a foreign problem in history that became Sabah's   
The Sultan of Sulu reclaims eastern Sabah, MNLF among invaders 
Stop paying quit rent to Sultan of Sulu, it’s time to close the chapter   
Filipinos’ Sulu militant group in Sabah must leave Malaysia today

Information innovator

Information technology (IT) is all about innovation. Vish Iyer can’t agree more.

Mobility, social media and big data are all hot-button topics. Cloud computing frees up people from the desk, so an IT system can be managed even on the road. “For a bank, it could be payment via Internet banking or mobile phone,” says the high-flying corporate executive, dapper in a light purple shirt.

Vish Iyer: 'There is no advantage in having 20 or 30 years of experience unless you are ...very merit-driven and work-driven'.



“For an insurance company, it could mean enabling an agent to get quotations and conduct transactions on his or her mobile.” For an airline, pilots no longer carry huge bags with heavy operating manuals. “We put that on an iPad,” he adds.

Few would believe the president for Asia Pacific at Tata Consultancy Services (TCS) has neither training in IT nor a background in engineering. He learns by doing.

Born and raised in Kolkata around the time when India’s first computer arrived, Iyer graduated from St Xavier’s College, one of the city’s best-known educational institutions with a major in taxation and economics.

Now the head of the largest service provider in the Asia-Pacific region based in Singapore, he manages 10,000 employees in 13 countries including Australia, Japan, China and South Korea.

The 45-year-old Indian company, whose clients include Microsoft and ING Group, is the provider of IT services and business solutions, with a turnover exceeding $12 billion and market capitalization of $45 billion on the Bombay Stock Exchange.

It is part of the Tata group, India’s largest conglomerate in seven sectors including communications, engineering and energy, with a revenue of more than $100 billion in the fiscal year 2011-12.

As a certified accountant, Iyer moved on from the financial field to other areas including human resources, marketing, strategy, mergers and acquisition. “I have been a chief financial officer many times,” he tells China Daily Asia Weekly at the TCS Hong Kong office.

But that didn’t stop him from venturing into new fields after three and a half decades. Midway through his career, he moved into a new-born industry in India.

His rationale is: “What matters is how you put your basic training to use and how you quickly learn from the surroundings. You can do anything as long as you have a will to do it, and you are determined to work hard enough.”

He spent a decade at IBM, where he was director of corporate development. IT has since become his longest stint.

He has witnessed the birth of the industry along with the ups and downs. “The IT industry is very fascinating. Every two to three years are completely different. In that sense, everybody got to continuously learn,” he says.

In the IT world, experience doesn’t necessarily give you an edge over the younger generation. Two-thirds of the company’s workforce has about three years of experience and the average age of a TCS employee is just 28.

“There is no advantage (in) having 20 or 30 years of experience unless you are … very merit-driven and work-driven,” Iyer says.

“This is the industry across the world (where) everything looks the same. There is no different standard in the US or Japan. Once you are inside IT, it is the same. It talks the same language and (has the same) quality level.”

The capability to locate young talent matters for the industry. To Iyer, the Chinese mainland not only has a staggering domestic market but also vast trained manpower resources.

TCS is among the first Indian companies to enter the Chinese mainland as the first wholly-owned foreign enterprise. The IT consultancy commenced its operations in Shanghai in 2002, then established a development center in Hangzhou in Zhejiang province in October of the same year. Its banking products are used by Bank of China in more than 40 provinces.

Iyer sees the potential to substantially increase China’s TCS workforce from its current number of 3,000 people, as the company’s sales growth in China outpaces that in the Americas. TCS now has relations with 20 colleges in China.

“Our business is all about people,” he says. “At the end of the day, we need to find out where are these talents available for serving our customers. China is very important from that point of view — as a pool of talent. It’s equally important for the size of the economy, too.”

“We are very bullish about China,” he said in a previous interview. “Its full potential has not yet been harnessed … We’re looking to leverage its position as an innovation center and a hub for the Northeast Asia region.”

TCS has started to provide a ground-breaking cloud-based service that enables smaller banks and credit unions to establish their own Internet, mobile and ATM facilities by paying a monthly fee. “A village bank need not have an IT department, but the same technology that empowers a (central bank) is now available to small and medium enterprises.”

The TCS pioneer project has found a home in the world’s second largest economy. iCity or the Intelligent City, utilizes smart technologies and collective intelligence to improve a city’s livability and sustainability.

These cities will be built on cloud infrastructure that makes them easy to run. Every citizen will own a personalized information page for health records and blood pressure measurements and even get health alerts and doctors’ advice.

Imagine buildings that glean energy from the sun and rain, reducing energy consumption, and embedded software in cars and traffic poles that automatically monitor local traffic. At the same time, healthcare and consumer services are dispensed to citizens at home, saving time, cost and valuable resources.

An iCity project in southern China’s port city of Guangzhou is slated for a soft launch later this year. More blueprints are on majors’ drawing boards in first- and second-tier Chinese cities, including Tianjin, Ningbo and Chengdu.

“The Indian IT industry over the last 20 years has done exceedingly well,” Iyer says. “Works of best quality are from this industry. There (has been) a lot of proud achievements — so it’s an exciting place to be in.”

But when asked about the most exciting moment in his life, the president’s answer has surprisingly nothing to do with his career. “The day when my daughter was born, and when I was holding her in my hands,” he says, with a gentle smile.

“Lots of people talk about work-life balance. I think each person has to find that balance himself … Family influence is a strong support for the profession I pursue, so there are no conflicts or contradiction.”

Looking back, Iyer has been with his two children — his 23-year-old daughter and 18-year-old son — through every important step of their life. “I (accompany) them through every exam, drop them off and pick them up after classes, and consult their teachers for college admissions. As long as you enjoy it, you’ll find time for doing it,” he adds.

Technology has been the savior for this family man with a hectic business schedule with long hours of frequent travel.

“I am on the road 50 or 60 percent of the time. Each month, I am outside my hometown for 20 days,” he says. “My children have grown up with me spending a lot of time at work. But this is a world of Facebook, email and Skype. That’s what we do now,” he says.

What makes his day? Iyer answers professionally without a second of hesitation: “To satisfy a customer in a meeting.”

Then comes the personal bit: “Followed by a relaxing dinner with my wife.”

By jennifer@chinadailyhk.com 

Vish Iyer
President of Tata Consultancy Services (TCS), Asia Pacific

Career Milestones:
2010: Becomes president of TCS Asia Pacific
2008: Serves as CFO of global business operations at TCS
2006: Takes up post as head of corporate strategy at TCS
1996: Becomes director of corporate development at IBM Global Services
1991: Joins Tata Elxsi as executive vice-president

QUICK TAKES:
Hobbies:
Playing golf. The question is not how well you play but whether you enjoy the time. Whatever I do, I enjoy. It’s a great opportunity to meet people.
Business philosophy:
I always believe in ... simple communication with the customer and the employee. There is no point promising things that you cannot deliver. Whatever you promise, you deliver. Whatever you don’t deliver, you don’t promise.
If you were to do one thing differently in life?
I can’t think of one thing. I do things that I enjoy doing.
How to kill time on the road:
I spend a lot of time watching movies on the plane. My favorite stars are Jackie Chan and Amitabh Bachchan, who hosted India’s version of the game show Who Wants to Be a Millionaire?

Born: December 8 in a Year of the Snake