…and scuttle one of the best efforts going to reduce the problem of antibiotic resistance. I discussed before how the antibiotic resistance problem is, in the context of hospital infections, an infection control problem:
One of the hidden stories in the rise in the frequency of antibiotic resistant bacterial strains is that this has also been accompanied by an absolute increase in the number of infections. In other words, it’s not the case that you used to have 90 sensitive infections and 10 resistant infections per year in your hospital, and now, you have 50 sensitive and 50 resistant infections (which would be bad enough). Instead, you have the same 90 sensitive infections and 90 resistant infections (for a frequency of 50% resistance). That’s an 80% increase in infections (180 versus 100). This is a bad thing.
Essentially, rising resistance rates in a given hospital mean that infection control has gone to shit–which given the 33% increase over a three year period in the hospital-acquired MRSA infection rate is a pretty accurate statement.
Michigan, in concert with researchers at John Hopkins, instituted a program to use a simple five-step checklist that over an 18 month period this program saved 1,500 lives in Michigan. Nationally, that means…
[the Mad Biologist takes off shoes to do the countings]
…roughly 30,000 lives per year if implemented nationally. So what does the Office for Human Research Protections do?
It shuts the program down. According to the OHRP, since the hospitals did not notify the patients–in the entire hospital–of the checklist, this effectively was an altered treatment without the patients’ consent:
A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures.
Yes, Intelligent Designer forbid, doctors who are practicing bad medicine and killing their patients should be exposed. Not only is this an awful decision as it relates to this particular program, and the potential to prevent 30,000 people from dying annually, but as construed, almost any public health intervention to reduce contamination that is not disclosed to patients will be shut down. What happens if a patient decides to object to this hospital-wide study? There are a lot of patients out there, and some of them are fucking morons. Is a data collection pilot program subject to this (beyond the usual HIPAA and IRB concerns)?
I swear, during the Bush Administration, we are either governed by crazed ideologues or complete fucking morons.
Related post: ScienceBlogling Revere discusses this far more calmly (but where’s the fun in that?)