Well, this is bad news.

Hi again, constant readers - yes, eye-deep again in a chapter, and sinking. About which: Is there anyone there who remembers staph 80/81 and would like to talk about it? Email me, address in the right-hand bar.

And now to the bad news. I am coming to this story late, but truthfully I am not even sure how late, as it seems to have trickled out without fanfare, and different media have covered it at different times over the past month. At any rate: The FDA has quietly reversed a decision it took last summer, and will allow cephalosporins, a human medicine, to be used without restriction in food animals.

What's a cephalosporin? The best-known one is the very commonly used drug Keflex (cephalexin), which you might take for tonsillitis or bronchitis - not a drug that you want to stop working because bacteria have developed resistance to it. (Yes, MRSA already has.)

Supporting material, tracking backward: A notice from the National Academies of Science news office from two days ago is here. An NPR story from Dec. 29 is here. A lengthy essay hosted by food-safety expert/attorney Bill Marler is here. A statement from the Pew Charitable Trusts' Campaign on Human Health and Industrial Farming, dated Dec. 12, is here. A short story from the Wall Street Journal, dated Dec. 9, is here.

Here's where I think this all ends up: On Nov. 25, the FDA put a note in the Federal Register announcing that it was reversing its earlier, July 3 decision to put curbs on the "extra-label" — anything not specifically allowed by the label — use of cephalosporins in animals. (Here's a July 16 Q and A explaining what it was prohibiting.)

The reason for the revocation of the ban/permission to use without restrictions, the FDA said in the Nov. 25 notice, was that it had gotten so many public comments on the ban — which was supposed to take effect Nov. 30 — that it decided the only appropriate action was to lift the ban until it could fully consider whether to reimpose it. And, because it was a revocation of a previous order and not a new order, it did not have to give advance notice.

As to what this means, consider this stinging op-ed from John Carling, former governor of the very agricultural state of Kansas, and chairman of the Pew Commission, which produced a mammoth report last year on industrial-scale agriculture:

The rest of the world has leapt ahead of us on this issue. In Europe, antibiotics have long been eliminated from food production. South Korea followed suit this summer. Our refusal to turn away from this practice could cost us markets for our food products overseas and, by extension, precious jobs here at home.
The Pew Commission was composed of farmers, doctors, veterinarians, economists and other talented professionals who took on the challenge of finding a model that would allow U.S. farmers and ranchers the freedom to pursue their livelihoods in a way that does not adversely impact public health, the environment and the economies of their communities.
We believe we found such a model, and it included phasing out the indiscriminate overuse of antibiotics.
Changing the way agriculture works in this country will likely prove challenging, and involve many difficult decisions.
It's a tragedy that on this occasion the FDA took the easy — and more dangerous — way out.

Recommending a blog

The nonprofit New America Foundation has a new blog, the New Health Dialogue, that is largely written by my friend and colleague Joanne Kenen. Joanne was for many years the health policy reporter for the wire service Reuters; she and I were Kaiser Family Foundation media fellows a year ago. If you're at all interested in the deep questions of health care in America — what we spend, how we make decisions (or don't) on spending, and why it's all such a mess — Joanne's blog is an excellent place to start. I've added it to the blogroll on the right.

As promised last month

Not MRSA but worth reading, I hope: My big project on post-Katrina New Orleans, a narrative profile of the leader of the city's "mental health SWAT team," has been published by MORE Magazine.

Read "After the Deluge" here, and then please take a moment to think what you might do to help the recovery of a fabled and shamefully abandoned city. New Orleans is not even close to being over Katrina. It needs all the help it can get.

Typing and fingerprinting: Who pays?

More on the issue of doing more microbiology to track the epidemiology of CA-MRSA (raised in an exchange below between me and Medifix, to whom many thanks for being my first commenter!). In my slog through the endless and growing MRSA literature, I came across a paper that poses the problem much better than I did.

In Use of Routine Wound Cultures to Evaluate Cutaneous Abscesses for Community-Associated MRSA (Annals of Emergency Medicine, July 2007; cite here, no abstract), Fredrick Abrahamian and Sunil Shroff of UCLA School of Medicine say that cultures and susceptibility testing are not always necessary. The tests might not be needed, for instance, if a skin/soft-tissue infection suspected of being MRSA is going to be incised and drained without antibiotics being prescribed; or if antibiotics are going to be prescribed, but physicians already know local susceptibility patterns and plan to order a drug that will provide coverage. In both cases, having additional information about the strain infecting the patient is not going to make any difference to the patient's treatment.

That information will make a difference to understanding the local, regional, national epidemic. But as Abrahamian and Shroff say: "One must determine if it is ethical to make an individual pay the cost of a test for a perceived public health benefit."

The obvious answer is to say the CDC should do it — they are after all the arbiters of population-level public health. Only, you know, their budgets have been being cut...

And to Scott McPherson for the bloglove hat-trick!

Journalists aren't really accustomed to people liking us, so I'm a little dizzy. But huge thanks also to Scott McPherson, who was sweet enough to mention my first book, on the CDC's outbreak SWAT teams. Scott's day job is in the thick of politics — he's the chief information officer for the Florida House of Representatives — and he regularly nails the disconnect between public-health policy and the messy real world. Read him here.