Volume 19, Number 1 .... January 1997

Health and Safety

Chris Stavroudis, Column Editor

Good News, Funny News and Scary News

The good news first.

Art Hazards News is back. The Center for Safety in the Arts (CSA) has resumed publication of Art Hazards News which will now be published quarterly as an eight page newsletter. Implicit in this is that CSA is also back, albeit with a reduced presence. Their website has moved to: http://artswire.org:70/1/csa.

Because of the budget cuts they have sustained, CSA does not accept or return telephone calls (they don't even publish a phone number). If you are not in a hurry, they will answer arts related health and safety questions of general interest in a new column in Art Hazards News. Questions may be submitted to Letters to the Editor in Art Hazards News by sending them to the address below.

Subscriptions to Art Hazards News cost $24.00 per year. If you have an interest in the health and safety of our profession, you should support CSA. They have done much good work for conservators over the years and we owe it to Michael McCann and Angela Babin to support CSA during these difficult times. Send your $24 to: Art Hazards News; 2124 Broadway, P.O. Box 310; New York, NY 10023.

Funny, or perhaps very odd: According to an article in the December ACTS FACTS, two companies and their top executives are being prosecuted on assault and battery charges. The charges have been filed by the state of Massachusetts for exposing employees to lead, cadmium and dangerous solvents. The action is being taken against a scrap smelter and a pewter maker who have ignored environmental and occupational health rules. If the courts agree with this interpretation of assault and battery, it opens a whole new realm for redress or a whole new excuse for paranoia, depending on which side of the exposer/exposee fence you reside.

To find out how the case gets sorted out, send $15.00 to Arts, Crafts and Theater Safety (ACTS) for a 1 year subscription to Monona Rossol's monthly ACTS FACTS newsletter. ACTS, 181 Thompson St., #23; New York, NY 10012-2586

The scary news isn't that new, but it is very frightening. I've been slowly working my way through The Coming Plague for the last year.

It is a fascinating, well written, well researched book. If you have ever watched one of those TV shows on PBS about the creation of life, you walk away amazed that anyone has ever been conceived or born - the odds seem so against it. Well, after reading this book, it is also amazing that any of us have survived the battle with the teaming hoards outside the gate of our immune system!

HIV, the outbreak of Hantavirus in the four corners region of the US, Ebola, the flesh eating bacteria, killer E. coli in Jack-in-the-Box hamburgers (and apple juice last month). Why are many of us alive right now? Antibiotics! Why are we at risk? Bad luck, global poverty, our mobility and the misuse of antibiotics.

Some of the most interesting reading is about the mismanagement of outbreaks. The most well know, HIV, was ignored for years because the perception was that it only affected gays. Then, it was thought to be a gay disease and countries with epidemic hetrosexually transmitted AIDS would not acknowledge its presence because they "do not have gays here."

Tuberculosis, TB, is returning with a vengeance. New strains of multiple drug resistant TB (MDR-TB) have mutated their way into our major cities. The Coming Plague argues that some of the mutations developed as a result of cutbacks in public health spending in the US in the 1980s.

Budgets for TB surveillance programs were cut,and, in the US, some hospitals could only show an 11% patient compliance with the treatment regimen. (By comparison, Mozambique, during a civil war, mind you, managed an 80% compliance rate.) The other 89% of patients were started on the drugs used to treat TB and then stopped taking them once the worst of the symptoms abated.

This repeated exposure of the bacterium to partial drug treatments, in classic Darwinian selection, culled the weak and promoted the strong, eventually selecting a mutant form that was drug resistant.

Sadly, this is a common pattern. We are both misusing and overusing drugs. This allows drug resistant forms of common diseases to develop faster than we are finding new antibiotics.

The 1991 killer Jack-in-the-Box hamburgers are but one example. 500 people became ill, 50 developed E. coli hemorrhagic syndrome, and four children died. The killer was a mutant form of Escherichia coli, a bacterium present in all of our guts. The constant dosing of cattle with low doses of antibiotics selected a strain that was drug resistant.

It also seems that the genetic coding for drug resistance in DNA is located near centers for virulence. The result is that drug resistant forms are also often highly virulent.

There aren't many morals to the story. Many of the emergent microbes are just part of the ebb and flow between human and germ. Sometimes we win a round, as was the case with the discovery of antibiotics. Sometimes we lose, as is the case with a new emergent virus like Ebola. However, many of the actions Homo sapiens take cause or contribute to the development of a plague. Examples include disturbances of the microbial ecosystem by movement of groups of people from one area to another, such as when smallpox was brought to the New World. Similarly, poor standards of living was a factor in the bubonic plague in the Middle Ages and in cholera outbreaks of today.

Many of the circumstances that lead to the outbreak of a new disease are outside of the influence of humanity. Those that are within human control are affected at societal levels. Policies like those that allow the administration of antibiotics to overcrowded livestock or the decision to build a new highway through an isolated jungle are made at levels that you or I cannot effect.

There is one action that can be taken by each individual: always, always!, complete an antibiotic course. Don't stop taking the drugs when the symptoms disappear. Don't save some for the next time you have similar symptoms. You don't want to be the factory that produces the next killer mutation of a formerly easily treatable disease. You particularly don't want to be its first victim, the so-called index case.

The book is: The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett, 1994, 750 pages (622 not including the notes), Penguin Books. And, believe it or not, there is a wonderfully human, positive and touching story at the end of the book. (I would never give away an ending.)

Chris Stavroudis is a conservator in private practice.

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