Why Transforming FDA Makes Sense

During the Bush Administration I, along with many others, was a harsh critic of the US Food and Drug Administration (FDA). The criticisms that I levied against the agency were mainly based on its inability to adequately maintain the safety of the American drug and food supply and Bush’s repeated attempts to politicize the organization and render it useless. That said, it is amazing how much has and will change at the agency during the Obama Administration. To wit, Margaret Hamburg, the current FDA Commissioner yesterday announced plans that would dramatically transform the agency and largely change the way it does business.

In an unusually rare special report entitled “Pathway to Global Product Safety and Quality” Hamburg points out the monitoring problems currently facing the agency and proposes a four-point plan on how to fix them. To understand the importance of this document it is necessary to point out some little know facts about the American food and drug supply.

First, almost two-thirds of all fruits and vegetables and nearly 75 percent of all seafood consumed by Americans is imported. This year the number of these types of food shipments is expected to grow to 24 million through 300 or more ports. A little as a decade ago, the agency was responsible for overseeing and policing six million shipments annually. Second, it is estimated that over 80 percent of the active pharmaceutical ingredients (APIs) found in approved drugs are made in manufacturing plants found mainly in China, India and Latin America. Because of funding and “manpower” shortages, most of these API manufacturing facilities are rarely inspected for regulatory compliance. According to the report, many kinds of antibiotics, oncology drug and other medications are no longer produced in the US or in many cases anywhere in the Western world. Finally, roughly 50 percent of all approved medical devices sold in the US are made in foreign production facilities.

In 2008, government officials determined that the agency would need approximately 13 years to inspect all foreign drug manufacturing plants, 27 years to check every foreign medical device production facility and a whopping 1,900 years to check every foreign food production plant! This is because FDA has only several hundred inspectors who are empowered to perform these inspections. Consequently, only a fraction of the food and APIs imported to the US are inspected. For example, less than one pound in a million of imported seafood gets as much as a “visual inspection” to determine whether or not it is fit for American consumption. This led the report’s authors to contend that “the safety of America’s food and medical products remain under serious threat.”

Yet, despite this ongoing threat, Republican lawmakers last week voted to cut the agency’s budget rather than increase it to perform the necessary number of food and drug inspections. Further, the same lawmakers oppose any corporate or consumer fees, whether voluntary or forced, to help to underwrite the inspections calling them an unacceptable tax. This has forced the agency to enlist the help of regulators in other nations to create a global coalition or network to perform the required inspections to insure the regulatory compliance and safety of foods, drugs and devices imported into the US. While the FDA has limited cooperation agreements with regulators in Europe and other Western countries, it just recently stationed its own inspectors in emerging markets like China, India and Central America. In theory this should work. However, in the past, some of the governments of these countries have refused to fully cooperation with FDA. Further, and perhaps more problematic, is that regulatory agencies in some other countries are largely corrupt or nonexistent. Finally, some outspoken former FDA employees and critics contend that improvements in the communication between FDA in Washington and its field offices in US states may be necessary before the agency can effectively enlist the cooperation of foreign regulators.

There is no doubt that contaminated foods, counterfeit medical devices and tainted drugs are increasingly finding their way into the US. It is FDA’s legislated responsibility to insure that all foods and drugs sold in the US are safe and effective for all Americans. Republican lawmaker’s refusal to increase FDA’s budget to allow the agency to fulfill its mandate is unconscionable and indefensible. The safety and health of all Americans is critically important for the well being of the nation and ought to take precedent over budget shortfalls and a looming US trade deficit.

Until next time...

Good Luck and Good Job Hunting!!!!!!

 

Common Causes of Food borne Illnesses

The Centers for Disease Control (CDC) in Atlanta, GA estimates that there are about 48 million illnesses caused by food borne bacteria each year. As many of you know, the incidence of outbreaks of Salmonella gastroenteritis is growing steadily and it seems that a week can’t go by without a report of a new outbreak. For those of you who are so inclined, the CDC publishes a weekly report entitled Morbidity and Mortality which tracks and reports the incidence of infectious diseases in the US. 

Interestingly, most food borne disease outbreaks primarily result from improperly handling, storing, transporting or preparing of raw food stuffs and consequently are easily preventable. To that end, the folks at Nursing Schools.net sent me a link to a post on their website that describes ways in which to better manage raw foods that can help to prevent or minimize the incidence of food borne illnesses in the US. An excerpt of the post is shown below.

The 12 Most Common Causes of Food Poisoning

**It is important to point out that the term “food poisoning” is anachronistic because in the past, it was not clear what was responsible for the illnesses caused by tainted food. While not currently used much in food microbiology circles, food poisoning (or intoxication) was historically used to describe ingestion of food that contained bacterial toxins but no living bacteria and caused disease. Staphylococcal “food poisoning” is the most common type of food intoxication that causes disease. In contrast, food borne illness is used to describe disease caused by ingestion of contaminated food containing live bacteria which subsequently colonize the lower gastrointestinal tract, invade the intestinal mucosa and thereby cause disease.**

Raw or undercooked food. Whether you're cooking at home or going out, eating food that hasn't been cooked thoroughly or brought to the appropriate temperature can put you at high risk of developing food poisoning. While you might enjoy rare steak, runny eggs or certain raw veggies, these foods can all carry bacteria when they are not cooked long enough or hot enough to kill off the offending particles. Common bacteria found in undercooked food include Escherichia coli, Salmonella and Campylobacter. Be safe instead of sorry and ask that your food be cooked through or use this chart when at home.

Food that is not stored at the proper temperature. While simple common sense would tell you that leaving foods like meat and dairy products out of refrigeration makes them unfit to eat, temperature regulation can be a bit more complicated. Refrigerators can malfunction, foods can be forgotten on the counter and instructions on labels can be misread. To keep yourself safe, always check the temperature on your fridge and freezer. They should be at 40 degrees F and zero (0) degrees F respectively. Always read the label to see what foods will need be refrigerated immediately and which have to be cooled after opening. If you plan to freeze foods, do it within 2 days of purchase. This can help prevent some very serious bacteria from growing and making you sick.

Letting food sit out. Most of us are smart enough to not let refrigerated foods sit out, but sometimes we can forget to put away the leftovers or want it on hand at a party. In order to keep these foods safe to eat and avoid some common bacteria taking hold, you should always put leftovers away as soon as you can. If you're serving food at a party, keep hot food at 140 degrees F or warmer, cold foods at 40 degrees F. Never leave perishable food out for more than two hours, especially if the weather is warm. This will help ensure that neither you nor your guests end up sick.

Not washing hands before eating or preparing food. Contamination of foods from dirty hands is a big cause of many cases of food poisoning. Always wash your hands thoroughly before and after handling foods at home (for at least 20 seconds) and only eat at restaurants with strong showings in health department assessments. Additionally, always make sure your hands are clean before eating food as well, especially if you will be touching them. Without these precautions, you could put yourself at risk of coming in contact with bacteria like staphylococcus-aureus and Clostridium perfringens.

Contamination of other foods by raw meat. Cross-contamination of foods is a major health issue and one that many out there should be highly conscious of avoiding at home. When juices from contaminated meat get onto cutting boards, hands and into the refrigerator, contamination can spread to other foods, some of which you might not plan to cook at all. It is essential to keep raw meat, poultry and fish separate from other foods. Always wash any utensils, countertops and cutting boards that have come in contact with them immediately, sanitizing them with bleach and water, or even having separate tools for handling meat can be a big help.

Eating raw shellfish. Raw oysters may be a delicacy, but ingesting them doesn't come without some serious risks. Oysters from the Gulf of Mexico are commonly contaminated with Vibrio vulnificus bacteria which can cause mild to serious food poisoning. Additionally, even oysters that do not come from this region are often left un-refrigerated for several hours while being brought to shore. While you may be fine after eating raw oysters, be aware that ingestion of these shellfish uncooked is a big risk and could lead to serious health issues.

Improper canning. Canning foods at home has been a common practice for several decades, but it's one that needs to be carefully monitored in order to ensure that the food being preserved won't carry contaminates along with it. Botulism is perhaps the most common bacteria contaminant in improperly canned food, and is one of the most serious and potentially deadly forms of food poisoning out there. Always boil jars and lids to be used in canning to kill off any lingering bacteria and make sure that all cans are properly sealed. Improper canning can also happen with foods you get off grocery store shelves so look out for bulges, discolored food, or seepage.

Ingesting expired food. We've all done it at one point or another, but eating expired food comes with a big risk for food poisoning attached. Always check expiration dates before ingesting any food in your home or purchased at the store. If there is no date on the package, no packaging or only a sell by date, use the government guidelines for cold storage to help you determine if a food is safe to eat or not.

Not heating or reheating thoroughly. You might think that you only have to worry about food poisoning in foods that haven't already been cooked, but that's not entirely the case. You should also be careful with foods that you're reheating, especially if they've been hanging out in your fridge for more than a couple of days. When reheating foods, make sure that meats reach a temp of at least 160-170 degrees F and that other foods come to around 165 degrees F. This will ensure that any bacteria that might have made its way into the food will be killed off and that you'll be able to avoid a common cause of food poisoning.

Not washing produce thoroughly before preparation. Even those seemingly innocuous veggies can be the source of food poisoning if not washed and prepared properly. Prior to reaching your table, there's no telling how many things they may have come in contact with, so always clean any fruit or vegetables with a soft kitchen brush and water (or a pre-prepared veggie wash) to ensure that any bacteria it contains will be largely washed away. This is especially important with foods that you do not plan to cook. While foodborne illness is more commonly caused by meats, recent outbreaks of Salmonella and E. coli have originated in spinach and tomatoes.

Unclean cooking utensils and surfaces. When it comes to food safety, cleanliness matters. Dirty kitchens attract mice and rats that can spread disease and also create ideal places for bacteria to grow and thrive and access your food. It's essential to keep any space you plan to cook in and any tools you plan to use highly sanitized. The USDA advises putting a tablespoon of bleach into one gallon of water to create a sanitizing liquid. This can help prevent any bacteria hanging out in your kitchen from getting on food and will ensure that none are able to cross contaminate one another.

Unpasteurized foods. For the most part, people are fine after eating foods that are unpasteurized, provided they have been stored and served in a safe manner. Yet for those with compromised immune systems, who are pregnant and the very young and very old could be at risk for food poisoning from these. Commonly pasteurized foods include milk, cheeses, yogurt, ice cream, ciders and juices. Unpasteurized versions of these foods can carry Salmonella, E coli, and Listeria monocytogenes, which can make individuals very sick

While these precautionary and preventative tactics will help to reduce food borne illnesses, it will not eliminate them completely. But, it is a good place to start to improve food safety and public health!

Until next time...

Good Luck and Good Job Hunting!!!!!!

 

TWiM Episode 4: Cantaloupes and Salmonella Gastroenteritis

On episode #4 of the podcast This Week in Microbiology, Vincent, Cliff, Margaret, and Michael review foodborne bacterial illness in the context of outbreaks associated with cantaloupes and Lebanon bologna.

Right click to download TWiM #4 (51 MB .mp3, 75 minutes).

 

Links for this episode:

Subscribe to TWiM (free) on iTunesZune Marketplace, via RSS feed, by email or listen on your mobile device with the Microbeworld app.

 

 

FDA Update: Product Recalls, Social Media and Biosimilar Guidelines

Whether you like President Obama or not, the changes he made in the leadership at the US Food and Drug Administration (FDA) is beginning to yield results. After just two years, the agency is well on its way to modernization and overcoming its descent into the dark ages during the failed Bush Administration.

Mark Senak, the intrepid author of the EyeonFDA blog has been assiduously following and blogging about many of the new things going on at the agency. First, in a post a last week, Mark noted that FDA has updated its website and created a product recall page that collects recall information on all of the products that it regulates and deposited it in an easy to find product recall page. With product recalls in the food and life sciences industry increasing in frequency, this page will help to alert consumers about tainted products before learning of them on the nightly news. 

Second, Mark points out that FDA has finally entered the 21st century and is now fully engaged in social media.

“FDA begins to join the 21st Century launching a Facebook page that has been long anticipated on this blog. FDA has not completed the Social Media Quadrant - (1) a blog, (2) several twitter feeds (3) a YouTube channel, and (4) a Facebook page.  And as added good measure, the agency opened a Flickr page.  The agency is now fully engaged in activities that many in the industry it regulates think is forbidden them.... And the beat goes on.”

Finally, earlier this week FDA announced that it would hold long-awaited public hearings to get input on proposed biosimilar regulatory guidance. As Mark duly notes, this process is likely to be contentious and protracted.    

"The FDA has set November 2-3 for a meeting to get input on a wide span of questions regarding the development of a regulatory pathway for biosimilars.  The scope of the questions is demonstrative of the number of outstanding issues the agency faces and will likely result in a protracted process. "

Central to the debate (and ultimate success of biosimilars) is the question of interchangeability and substitution of name brand products with biosimilar molecules. According to Mark, the agency will focus on the following questions

"What factors should the agency consider in determining whether a proposed interchangeable biological product can be "expected to produce the same clinical result as the reference product in any given patient?"

"What factors should the agency consider in evaluating the potential risk related to alternating or switching between use of the proposed interchangeable biological product and the reference product or among interchangeable biological products?"

What has become patently obvious to many of us who have been following the debate over the last decade is that unless biosimilars are interchangeable or substitutable for brand name biologics, the commercial success of the biosimilar industry may be in serious jeopardy. Put simply, there is no question that safe and effective biosimilars can be manufactured; the real question is whether or not physicians will prescribe biosimilar products if they are required to be branded by regulatory agencies. This is because physicians are reluctant to switch patients to new biologic products if a patient is doing well on a currently prescribed regimen. Since most physicians pay little attention to drug pricing, it is highly unlikely that they will switch a patient to product simply because there may be a 20 percent reduction in drug price. And, unless biosimilar products are deemed interchangeable with their branded counterparts, pharmacists (based on insurance formularies) will not be able to offer patients a generic equivalent of a name brand biologics. 

With the cost of biologic treatments skyrocketing, it will be interesting to see what the agency will do with this question.

Until next time...

Good Luck and Good Job Hunting!!!!!!

 

Salmonella, Turtles and Frogs...Oh My!

As many BioJobBlog readers may know by now, my PhD thesis focused on elucidating the underlying pathogenic mechanisms that contributed to the pathogenesis of Salmonella gastroenteritis. Salmonella gastroenteritis, which is primarily a food-borne illness, occurs in approximately 1.4 million Americans each year. Most people who develop Salmonella gastroenteritis recover without treatment within four to seven days. However, some people develop diarrhea so severe they are hospitalized and can become critically ill. According to a former lab mate, who accidentally infected himself, Salmonella gastroenteritis is much worse than the mild form of the disease described in many microbiology textbooks!

While I haven’t performed any research in this field for about 30 years, I still consider myself to be a Salmonella expert (go figure). Therefore, it should come as no surprise that a newspaper article entitled “Salmonella outbreak linked to pet frogs”— that appeared in the Salt Lake Tribune several weeks ago—caught my eye.

According to the article, a 31-state Salmonella outbreak (which was first detected in Utah was linked to pet frogs. The U.S. Centers for Disease Control and Prevention (CDC) in Atlanta started a national investigation to find the source of the outbreak this past summer, after five Utahans were infected by the strain of S. typhimurium a common cause of gastroenteritis (I knew getting a PhD would useful one day). In all, 85 people across several states developed gastroenteritis and nearly two-thirds had had some contact with frogs. Most of the patients were children and among those whose outcomes are known, almost a third required hospitalization. None died.

The source of the outbreak was eventually linked back to a single frog breeder in California that distributed the African dwarf frogs thought to be responsible for the multi-state outbreak. According to CDC officials, the bacteria were likely spread through contact with the tanks' water, not the frogs themselves. Of those who supplied information to the CDC, 30 percent said they cleaned the frog's aquarium in the kitchen sink and 35 percent used the bathroom basin.

While this last bit of information wasn’t remarkable, I finally—after almost 30 years as card carrying microbiologist—realized how the urban legend about Salmonella and turtles got started! Like many kids, I had a pet turtle. I remember my parents cautioning me about handling the turtle because I would get sick (of course I handled the turtle and never got sick). Later on, as a microbiology undergraduate student, I learned about the relationship between Salmonella and turtles and that turtle had been associated with Salmonella gastroenteritis outbreaks in the past. An interesting but inconsequential fact because I no longer owned a pet turtle.

Early on as a graduate student, I learned that it takes a minimum of about 108 salmonellae to cause gastroenteritis. At the time, I wasn’t thinking much about turtles and failed to realize that the large dose required for infection pretty much ruled out the likelihood that picking up a turtle would almost certainly result in Salmonella gastroenteritis. Although reptiles and amphibians harbor Salmonella in their gastrointestinal tracts, a child would have to suck on an infected turtle (or eat its poop) to get a large enough inoculum to initiate an infection—now this is where the PhD training become evident. However, if parents clean their children’s infected tanks in kitchen or bathroom sinks and then fail to wash their hands or the sinks with disinfectant, the number of salmonellae present in these environments would be sufficient to cause disease if infected food or water was ingested. And, this is what likely happened in the frog outbreak; based on the epidemiological data presented by CDC investigators

So, what is the lesson of this story? While it is true that turtles and frogs may carry Salmonella (in a separate study 21 percent of frogs from 16 retailers tested positive) the likelihood of developing gastroenteritis after touching or briefly handling frogs or turtles is extremely low. However, it is not a good idea to handle them for long periods of time without washing your hands before your next meal or cleaning their tanks in areas where food is prepared or people brush their teeth! Food borne illnesses are easy to prevent if appropriate personal hygiene is practiced and foods are prepared and cooked according to recommended standards. 

Finally, it took a long time, but I can now feel comfortable around turtles. This is probably a good thing—my friend Pete is a turtle fanatic and he constantly wants me to pick up his pets!

Until next time...

Good Luck and Good Job Hunting!!!!!!!!!!

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The Importance of Digital Communications During Infectious Diseases Oubreaks

As we all know, the H1NI pandemic has been raging on for close too 10 ten days now. Curiously, “Fear & The Flu: The New Age of Pandemics” is the title this week’s cover story in Newsweek magazine. From an informational standpoint point, “this may be too little, too late”—as the old saying goes. While the Internet has been around for over twenty years now, government agencies, most notably the US Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) continue to rely almost exclusively on old media to communicate with the American public during infectious disease outbreaks. Apparently, the administrators who run these government agencies haven’t been listening closely enough to President Obama’s assertion that “we live in the digital age.”

Communications between the public and government health officials is vital when trying to manage and control infectious disease outbreaks. “Every single government agency as well as companies and non-profits need to be digitally literate and competent in a time of pandemic” asserts Eye on FDA blogger Mark Senak. For their performances in recent infectious disease outbreaks, Mark gives CDC an “A” for effort—although there is substantial room for improvement. FDA on the other hand didn’t fair as well. “The FDA is not nearly as sophisticated in terms of digital. Their only Twitter account is for food recalls.  And their YouTube channels are all confusing and unorganized. They have a long way to go.”

The Internet was originally designed as a digital tool to transmit and move large amounts of information from one place to another. That said, it is also a powerful communication vehicle that can be used to broadcast valuable, scientifically-accurate information during infectious disease outbreaks by leveraging social media tools like Twitter, Facebook and instant messaging. To that end, it’s time for public health agencies to recognize the power of digital media and craft communication plans that can be implemented in the next infectious disease outbreak.

Until next time...

Good Luck and Good Job Hunting!!!!!!

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Another Day--Another Salmonella Outbreak

Tainted pistachio nuts are the culprit for this week’s Salmonella outbreak.  Fortunately, Kraft Foods’ quality unit was doing its job and was able to alert consumers about the problem before the outbreak reached epidemic proportions. At present, there are only two suspected cases of Salmonella gastroenteritis that may be linked to tainted pistachios. The contamination has been traced back to a California company which, according to reports, is the second leading producer of pistachios in the US.

As I have mentioned several times before, Salmonella outbreaks are nothing new and not out of the ordinary in the food industry. However, what is new is the growing lack of regulatory compliance that seems to be pervasive at American food manufactures. Many blame declining food safety on the US FDA’s lack of trained inspectors. While this may play a role, I believe that the real problem lies with the failure of many food industry executives to make a commitment to quality outlined in FDA’s Current Good Manufacturing Practices (cGMPs). 

I have been teaching cGMP to biotechnology students for the past six years or so.  I always tell them that the regulations are meaningless unless management makes a commitment to quality. And, the only way to accomplish this is by insisting that all manufacturing taking place at a company stringently adheres to all GMP regulations and guidelines. For those you who may not be familiar with cGMPs, they are the minimum regulatory standards that must be met to insure US product (food, drugs and cosmetics) quality and safety.

Over the past decade or so, Americans have grown accustomed to a wide variety of choices when it comes to raw and processed foods. To meet demand, US food manufacturers must source and import fruits, vegetables, spices and other foodstuffs from all over the world. Regardless of the origin of a food source, cGMPs clearly state the onus is on the manufacturer (not the supplier) to perform the necessary tests to insure food safety and quality. The recent spate of Salmonella outbreaks suggests that some food manufacturers are either cutting corners or don’t fully understand what testing is necessary to guarantee food safety. Unless something changes, Americans confidence in the safety of US food supply will continue to wane.

Until next time...

Good Luck and Good Easting (avoid pistachios)

 

Breaking Up Is Hard To Do: Should FDA Be Split Into Two Independent Agencies?

I just returned from a weekend of teaching regulatory affairs to biotechnology students at Georgetown University where I tried to convince them that the US Food and Drug Administration (FDA) is fundamentally sound despite its near demise during the Bush administration. Even before the Bush-induced wreckage, the agency was chronically understaffed, under funded and had serious leadership and morale problems. This, coupled with two nationwide Salmonella outbreaks in the past year, several highly publicized drug recalls, and steadily declining drug approval rates has prompted its critics to propose that FDA be split into two separate agencies—one that oversees the drug industry and another that would have responsibility for cosmetic and food safety. For those of you who may not know, FDA became responsible for oversight and regulation of the food and drug industries, in addition to the drugs, after passage of the Food, Drug and Cosmetic Act in 1938.

Drug industry advocates and longtime FDA critics contend that the agency as it exists today can no longer effectively oversee and insure the safety of American food and drug supplies. Critics argue that the history of FDA suggests that the agency focuses on medical products and only focuses on food safety when a crisis comes up. And when they occur, FDA is so distracted that it interferes with the drug review/approval process. While this is what FDA critics want you to believe, it is simply not the case. Despite its recent problems, the FDA has historically done an outstanding job when it comes to drug and food safety—when it is funded and staffed to appropriate levels.

Unbeknownst to the American public, food borne illnesses are very common and Americans are only alerted when the outbreaks reach a certain size. While the recent Salmonella outbreaks were larger in scope and breadth than past outbreaks, they were not extraordinary. However, they were extremely media worthy at the time that they were reported on. You may recall that at the time of the outbreaks, the American economy was beginning to fail and there was an inordinate amount of China, Mexico and free trade bashing going on in the US. Unfortunately, the news media decided to exploit the outbreaks to make a case that Americans ought to reduce their reliance on imported foods—a practice that was beginning to cut into the revenues of the US agriculture and food industries. Ironically, the Salmonella outbreaks might have been prevented if the production facilities (owned by American companies) were compliant with FDA mandated quality control and assurance regulations which were designed to insure food safety.

Drug industry advocates who argue that FDA ought to be split into two separate agencies have financial interests rather than safety concerns in mind.  As an investment banker or VC will tell you, slow, new drug approval rates can have serious financial consequences for the companies that are developing them—it can literally cost a company millions of dollars a day for every day the drug is kept off the market.  Interestingly, when FDA increased its drug approval rates in the late 1990s and early 2000s, there weren’t many industry insiders advocating a break up of the agency. Only recently, as FDA has become more risk adverse which in turn, has caused the new drug approval rates to slow again have critics begun to call for massive organizational changes at FDA.

Like I told my biotech students over the weekend, the only mechanism by which FDA can insure food and drug safety is by conducting regular inspections of drug and food manufacturing facilities. Unfortunately, FDA hasn’t been able to keep up with its mandatory inspections schedule because the agency has been under funded and poorly staffed for over a decade. Several FDA inspectors, who I talked with suggested that routine inspections of manufacturing facilities takes place every three to five years rather than every two years as required by FDA regulations. While in theory this shouldn’t affect a company’s ability to remain compliant with FDA regulations, in reality it does. Put simply, pharmaceutical and food companies, like most other for profit industries are incapable of policing themselves in the absence of regulatory oversight.

I ‘m not certain that the agency needs to be split into two separate agencies to continue to insure the safety of the American drug and food supplies. What I know is the agency needs more funding and much larger numbers of trained inspectors to be successful. In my opinion, the safety of the American food and drug supplies can only be guaranteed if the companies regulated by FDA make a commitment to quality manufacturing and play by the rules.

Until next time...

Good Luck and Good Job Hunting!!!!!!!!!

 

Dr. Margaret Hamburg Tapped As New FDA Commissioner

According to a report on NPR’s All Things Considered program, the Obama Administration has nominated Margaret Hamburg, MD to head the US Food and Drug Administration. Dr. Hamburg is a former health commissioner in New York City who has worked on issues surrounding infectious diseases and bioterrorism. In New York, she instituted a needle-exchange program to help prevent the spread of HIV. She also set up a program, in which health workers went to tuberculosis patients’ homes to help them manage their drug regimens.

A Harvard Med School graduate, Dr. Hamburg was an assistant secretary of health and human services during the Clinton administration and now works at the Nuclear Threat Initiative, which tries to cut the threat from nuclear, chemical, and biological weapons. She opposes abstinence-based sex education in public schools and has been a critic of the marketing practices of the pharmaceutical industry. Further, Dr. Hamburg is a leading advocate for changes in the nation’s public health policies and infrastructure, from local health departments to the highest levels of government. Finally, after eight years of mismanagement and poor leadership, the agency has somebody at the helm with intelligence, experience and is an advocate for change. 

Kudos to Team Obama!

Until next time...

Good Luck and Good Job Hunting (FDA is hiring)!!!!!

 

A New Year and Another Salmonella Food Poisoning Outbreak

Salmonella enteriditis, an organism dear to my heart (luckily not my posterior small intestine) is a common cause of food poisoning. As some of you may know, I did my PhD thesis work on Salmonella gastroenteritis (aka food poisoning) and I like to think that I am something of an expert on the topic. 

Typically, Salmonella food poisoning outbreaks are localized and rarely reach epidemic proportions. However, there have recently been two major nationwide Salmonella outbreaks in the US —one in 2007 and now in early 2009.

The current outbreak has afflicted 388 people in 42 states and may be caused by the same strain (Saint Paul) that was responsible for the 2007 outbreak. Ultimately, the 2007 outbreak was linked to contaminated tomatoes. The jury is still out on the cause of the most recent outbreak. Needless to say, CDC scientists are scurrying to quickly identify the source of the current outbreak because it took the agency over 5 months to conclusively identify the culprit in the 2007 epidemic. Not surprisingly, many grocery stores and restaurants suffered financially because of the outbreak.

Many of you may be wondering why Salmonella food poisoning is becoming such a problem in the US. I don’t believe that the strains responsible for the most recent outbreaks are more virulent than the ones that have traditionally caused more localized outbreaks. Instead, the reliance of food manufacturers and grocery store chains on one or two major food distributors (rather than multiple suppliers) is likely responsible for the severity and breadth of these nationwide outbreaks. This suggests that regulatory agencies ought to more closely scrutinize the microbiological quality of the operations of the major distributors. I believe that those efforts would greatly reduce the likelihood of future major outbreaks of food poisoning.

Until next time.


Good Luck and Good Job Hunting (avoid raw vegetables, undercooked poultry and raw eggs)
 

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Chinese Food and Your Heart

Somebody once said “Jews know two things—suffering and where to find good Chinese food”. Since I am Jewish, it is not surprising that I have experienced a fair amount of suffering throughout my life and, wherever I go, I seem to know where to find “good” Chinese food.  That said, my interest was piqued when I found a post in Yahoo Science News entitled “Study finds Chinese food good for your heart”. Given my lifelong fondness and penchant for Chinese cuisine, I thought that all of that eating that I had done had finally paid off. Unfortunately, after reading the subtitle of the article; “Chinese red yeast rice reduces repeat heart attacks/mortality rates” I realized that my joy and optimism were somewhat premature.

According to the report, researchers at Jefferson Medical College found that a partially purified extract of Chinese red yeast rice, Xuezhikang (XZK), reduced the risk of repeat heart attacks by 45%, revascularization (bypass surgery/angioplasty), cardiovascular mortality and total mortality by one-third and cancer mortality by two-thirds. The multicenter, randomized, double-blind clinical study was conducted on about 5,000 heart attack patients, ranging in age from 18-70 during a five-year period at over 60 hospitals in the People's Republic of China. Study participants were given 300-milligram XZK capsules or a placebo and tracked over a five-year period. The XZK extract used in the study contained a combination of lovastatin, lovastatin hydroxyl acid, ergosterol and several uncharacterized components.

Based on study results, the study’s authors believe that XZK may offer therapeutic benefits to people at risk of heart attack and cardiovascular disease. However, they cautioned that the active pharmacologic ingredient (API) of the red yeast rice is unknown and it isn’t clear how XZK works to fight cardiovascular disease.

Chinese medicine practitioners have long touted the benefits of red yeast rice for heart patients. Nevertheless, this is the first controlled clinical study of red yeast rice that tends to substantiate these claims. According to the study authors it is important to note that “the commercially available over-the-counter supplement found in your average health food store is not what was studied here. Those over-the-counter supplements are not regulated (by the US Food and Drug Administration), so exact amounts of active ingredient are unknown and their efficacy has not been studied yet.”

It is unfortunate that I didn’t know about the benefits of red yeast rice during my recent trip to China. I certainly would have gone out of my way to try some. That said, given the plethora of exotic foods that I tasted in China, maybe I ate some XZK without knowing it!

Until next time

Good Luck and Good Eating (Chinese of course)……

Princeton U Salmonella Outbreak Revisited

I apparently made a few errors in the post about the recent Salmonella food poisoning outbreak at PU (pun intended). I want to thank the anonymous member of the Princeton Graduating Class of ’09 for pointing out the inconsistencies and errors in the post.  First, the so-called “dining clubs” are actually called eating clubs. Second, fraternities and sororities are allowed at PU and I hear that they are alive and well. Finally, I inadvertently noted that the University has severed contracts with several of its produce suppliers which may have been the putative source(s) of the outbreak. In fact, the University didn’t cancel contracts but only temporarily closed a few of the eating stations at the Frist Campus Center. My local newspaper reported that contracts where severed–I guess you truly can’t believe everything that you read!

I was duly chastised for not adequately verifying my information before I hastily crafted the post. I stand corrected and will attempt to be more vigilant in the future. That said, I think that my lack of understanding of the practices and customs at Princeton University is directly related to the fact that I attended Cornell as an undergraduate. Mea Culpa!

Until next time…

Good Luck and Good Job Hunting!!!!!

Salmonella Outbreak at Princeton University--Oh My!!!

Yes, even the Ivy League isn’t immune to food poisoning outbreaks from time-to-time. There are currently 10 confirmed cases of Salmonella food poisoning at Princeton U. Another 50 people or so have also fallen ill with gastrointestinal symptoms consistent with Salmonella food poisoning.  As a precaution, university officials have temporarily discontinued doing business with their produce suppliers. For those of you who don’t know, Princeton is famous (infamous?) for its so-called dining clubs. These clubs take the place of sororities and fraternities which are not allowed at this august institution of higher education. Obviously, there is more than eating that goes on at these “dining clubs.”

The reason I am blogging about the outbreak is two-fold. First, I live about seven miles from Princeton and it has been all over the local news. Second, I did my PhD work on the pathogenesis of Salmonella gastroenteritis. So, Salmonella food poisoning is dear to my heart (thankfully, not my gastrointestinal tract). Many infectious disease experts tend to dismiss the seriousness of Salmonella gastroenteritis. This is likely because it is usually not as devastating as shigellosis or infections caused by enteroinvasive strains of Escherichia coli (which is actually Shigella masquerading as E. coli). As my major professor once put it “You know when you have Salmonella gastroenteritis—if you can’t decide than it is not salmonellosis.”

I am happy to report that I never came down with gastroenteritis while working for over three years with enteroinvasive Salmonella strains (even though I was routinely mouth pipetting and eating lunch in the lab; practices which aren’t acceptable by today’s standards). I like to think that “the bugs” were afraid of me. Alternatively I had either a great immune system or extremely good aseptic techniques. Whatever the reason, it is always embarrassing when card-carrying microbiologists come down with the disease(s) that they are studying. Luckily, I never came down with the disease caused by the bacterium that I was studying during my first postdoctoral fellowship—Neisseria gonorrhoeae. That would have been extremely difficult to explain!

Until next time…

Good Luck and Good Job Hunting (remember to wash your hands)!!!!!!!!

The Real Problem at FDA

I spent the entire morning reading various articles, blog posts and comments about what is wrong with the US Food and Drug Administration (FDA). Not surprisingly, phrases like “drug lag”, the large size and costs of clinical trials, political and corporate influence, reduced numbers of NME approvals etc appeared ad nauseum. These are the same old, tired complaints with the agency that have been bandied about for the past 10 years or so. 

In my opinion, the bottom line is this: the agency is egregiously under staffed and under funded despite the fact that companies pay steep user fees for regulatory reviews. I can understand why corporate America is dissatisfied with the service that it receives from FDA. It is natural to expect good customer service after paying large sums of money to a service provider.  However, it is important to note, that the words “customer service” don’t appear any where in the Food, Drug and Cosmetic Act of 1938 (although it can possibly be implied fromPDUFA in 1992 and FDAMA in 1997).  Nevertheless, what is mentioned in the FD&C is SAFE and EFFICACIOUS pharmaceuticals, biologics and medical devices. Put simply, safe and efficacious products, not customer service, is REAL the mission of FDA.  With this in mind, the agency is legally required to do everything in its power to provide Americans with carefully scrutinized and safe medical devices, pharmaceutical and biotechnology products.

If we Americans want FDA to accomplish its REAL mission, then the agency must be sufficiently funded, adequately staffed and have strong, non-partisan leadership. Unless this occurs, FDA will continue to struggle and remain dysfunctional well into the 21st century.

Until next time…

Good Luck and Good Job Hunting!!!!!

FDA to Expand Scope of Foreign Inspections-Gee, What a Novel Idea!

The US Food and Drug Administration announced late last week that it intends to post inspectors in embassies and consulates throughout the developing world to improve the quality of the food and medicines that flow into the US. FDA Commissioner Andrew C. von Eschenbach (Bush’s latest appointee to head the agency), said that he wants to have “boots-on-the-ground in developing nations like India and China and regions like Central and South America and the Middle East.” At present, less than 1% of the food imported into the US is inspected each year

As many of you know, FDA inspectors are required to visit both domestic and foreign manufacturing facilities that produce food, cosmetics and medicines that are sold in the US. By law, these inspections must take place every 3 years. Unfortunately, due to budget shortfalls and inspector shortages, routine inspections at domestic facilities are now taking place every 4 to 5 years– it is unclear how frequently inspections occur at foreign manufacturing facilities.  Based on von Eschenbach’s call for more foreign-based inspectors, the answer is likely “not frequently enough.”

The obvious solution to this problem is to increase the agency’s budget to hire and train new inspectors. However, despite repeated attempts by lawmakers, the Bush administration has steadfastly refused to endorse or consider budget increases for the agency. Instead, White House officials have urged the agency to uses any means possible to “bolster the aggressiveness and effectiveness of foreign health regulators” to prevent unsafe or tainted products from reaching the US market. I do not want to sound overly cynical but good will can go only so far with financial inducements or incentives.

Despite the obvious need for more inspectors, von Eschenbach admitted that his plan to post inspectors in foreign countries is “only in its infancy”. Also, he hasn’t decided whether he will ask Congress for additional funding for the agency or find money in the current budget for the foreign inspectors. I suspect that “finding money” in the current budget would translate into curbing other regulatory activities at FDA –something that would not bode well for the already-embattled agency. The inability of von Eschenbach to secure funding to train and deploy new inspectors is another reason why I believe that the FDA Commissioner ought not to be a political appointee!

Until next time…

Good Luck and Good Job Hunting!!!!!!!!!