November 8, 2005
urstin the bubble on antibacterial soa
FDA panel says some soaps may create super germs that are resistant to treatment
By Caitlin N. Murphy U For the Daily
ver wondered if there's a difference between regular
soap and the antibacterial kind? Maybe in smell, but not
in how effectively they clean.
Germ-conscious Americans have taken notice of the find-
ings of a recent Food and Drug Administration panel. While
the variety of antibacterial products that have emerged in the
marketplace in recent years may lead you to believe differently,
the panel revealed last month that antibacterial soaps are no
more likely to control the growth and spread of bacteria than
regular soap and water.
On top of no real benefit, these antibacterial products could
also lead to super germs that are resistant to antibacterial soaps
and antibiotics, said epidemiology Prof. Allison Aiello, who
has studied the concerns of continued use of antibacterial soap
The most common ingredient in most antibacterial soaps is
triclosan, which the FDA approved as an effective agent for
killing bacteria in.the 1960s.
At the time, scientists believed that it
killed germs indiscriminately, &
making it difficult for
develop ways s
to counteract . ....
the chemical ..
set triclosan apartY
typically disrupt a;
specific protein nec-
essary for a bacteria's
But more recent
research has shown that
triclosan acts like an
antibiotic and does, in
fact, eradicate bacteria by
targeting specific mecha-
nisms in bacteria cells.
The problem with this
killing method is that bacte-
ria can gradually adapt to it
One mutation, which takes the form of efflux
pumps, allows "bacteria to take in an antibiotic and then
vomit it out," Aiello said. With the pumps, bacteria can become
impervious to triclosan and antibiotics because the efflux
pumps can expel specific antibiotics that come in contact with
the bacteria. To make matters worse, these pumps can then be
transferred to other bacteria species.
Traditional soaps do not rely on killing bacteria to control
their spreading. Instead, they remove bacteria by separating
them from the skin. Soap molecules are able to bind to water
and germs on the hands, allowing the bacteria to be rinsed down
the drain or transferred onto a towel.
Another popular line of hygiene products are alcohol-based
hand sanitizers. Aiello said that these sanitizers show no signs
of leading to antibiotic resistance. Alcohol products such as
these kill bacteria by drying them out. Plus they also benefit
the skin by causing less water loss than traditional soap
The Soap and Detergent Association,
which represents the manu-
Kystands by its anti-
which have been
.# approved by the
tr FDA for more
° than 30 years.
In a state-
nxnOct. 20, the
v4: :.....#'.'said, "W hile
.. tory stud-
products and bacterial
resistance, there is simply no clini-
cal, real-world evidence of increased resis-
Along with concluding that antibacterial soaps are not
more effective than regular soap, the independent 12-person
FDA advisory panel recommended that the agency look more
closely into the risks and. benefits of antibacterial products.
Another question that has not been addressed, Aiello said, is
that her studies focused on people who are generally healthy.
But she added that such antibacterial products might be helpful
for people who have weaker immune systems.
GRAPHIC BY GERVIS MENZIES
Triclosan attacks the bacteria, but the efflux pump ejects the antibac-
terial agent, making the bacteria impervious to the Triclosan.
One thing that the Soap and Detergent Association and Aiello agree
on is the importance of hygiene.
"Hygiene is the very important in preventing infection in a commu-
nity setting. The primary barrier against the spread of disease is soap
and water," Aiello stated.
Study: cancer survivors need
follow-up care for years
after Pa. trial ends
and social effects of
disease still linger on
with most survivors
WASHINGTON (AP) - The nation's 10
million cancer survivors require customized
follow-up for years that too few now receive,
says a major study that calls for oncologists
to create a "survivorship plan" to guide every
patient's future health care.
Half of all men and one-third of women
in the United States will develop cancer in
their lifetimes. Thanks to advances in early
detection and treatment, the number who sur-
vive has more than tripled over the past three
When active treatment ends, these people's
special needs may be just beginning, said the
study, released yesterday.
The legacy of physical, psychological and
social consequences has largely been ignored
by doctors, researchers, even patient-advocacy
groups, leaving survivors too often unaware
of simmering health risks or struggling to
manage them on their own, said the report by
the Institute of Medicine.
"There is currently no organized system to
link oncology care to primary care," explained
Dr. Sheldon Greenfield of the University of
California, Irvine, who,led the study for the
institute, an arm of the National Academy of
"You fall off a cliff when your treatment
ends," agreed report co-author Ellen Stovall,
president of the National Coalition for Can-
cer Survivorship, who speaks from personal
experience as a two-time survivor.
Busy oncologists' priority is to treat patients
and they may have little time for the survi-
vor, while physicians who don't specialize in
cancer care may not know what special needs
"Nobody can take custody," said Stovall,
who praises her own doctors but said even
they lack information about long-term follow-
up for the Hodgkin's disease that first struck
her 33 years ago.
"The doctor says you're done" with cancer
treatment, she added. "But you're just begin-
ning a whole new phase of your health care.
Nobody's got the roadmap for that."
Survivors are at risk of their initial cancer
returning or a new one forming, and may need
not just screening to detect that but also help
handling the inevitable fear.
Then there are the lingering health effects
that various cancer treatments can cause:
problems with mobility or memory, nerve
damage, sexual dysfunction or infertility and
impaired organ function.
There may be distress over cosmetic
changes. Other hurdles include keeping health
insurance after that costly first cancer bout
and discrimination from employers.
Whether long-lasting effects seem acute or
subtle, start to emerge just as treatment ends
or not until years later, the report is unequivo-
cal: "Importantly, the survivor's health care is
There are ways to avoid or ameliorate can-
cer's late health effects. But survivors, and
their future doctors, have to know they're at,
risk to take those steps, the report stressed.
For instance, it said, certain dosages of the
chemotherapy doxorubicin can damage the
heart, and survivors who know they're at risk
can have their heart checked and early signs
of failure treated.
Some work is beginning to try to provide
that kind of survivor care, sparked by the
pediatric cancer community.
The Children's Oncology Group, a lead-
ing research group, developed long-term fol-
low-up guidelines that say every child cancer
survivor should be given an explicit treatment
record to provide every doctor who treats
them in the future.
And the Lance Armstrong Foundation has
begun funding centers at some leading hospi-
tals to focus on specialized survivor care.
Monday's recommendations by the Institute
of Medicine, chartered by Congress to advise
the government on medical matters, is sure to
add momentum to those still-fledgling efforts.
Among the recommendations:
Every patient completing cancer treat-
ment should be given a customized "survivor-
ship care plan" to guide future health care.
That plan should summarize their cancer
care down to drug and radiation dosages, cite
guidelines for detecting recurrence or new
malignancies, and explain long-term conse-
quences of their cancer treatment.
It also should discuss prevention of future
cancer, and cite the availability of local psy-
chosocial services and legal protections
regarding employment and insurance.
Specialists and primary care providers
should coordinate to ensure survivors' needs
Health insurers should pay for this
Scientists must improve, or in some case
create, guidelines on exactly what screenings
are needed for different cancers and their
Congress should fund research of survi-
vorship care, to assess their needs and provide
evidence for quality care.
M Eight families ask
judge to overturn
public school policy
on "intelligent design"
HARRISBURG, Pa. (AP) - A fed-
eral judge is contemplating whether
the mandatory teaching of "intelligent
design" improperly promotes religion
in schools, after the historic evolution
trial drew to a close.
Federal Judge John E. Jones III said
he wanted to issue a ruling by January,
the latest legal chapter in the decades-
long debate over
the teaching of
evolution in public 11 . 1 l
Charles Darwin's theory.is "not a fact"
and has inexplicable "gaps." It refers
students to an intelligent-design text-
book, "Of Pandas and People," for more
Dover is believed to be the first
school system in the nation to require
students be exposed to the intelligent
design concept, under a policy adopted
by a 6-3 vote in October 2004.
The school district's policy "has the
primary purpose and primary effect of
advancing science education," Gillen
Earlier last Friday, the defense con-
cluded its case with testimony from
University of Idaho microbiology pro-
fessor Scott Min-
nich, who supports
discussing the con-
mnt cept in high school
ec ameMinnich said arti-
cles, on intelligent
fOr design are not found
dIS in the major peer
teach journals because it
is a minority view.
comes with risk
ric Rothschild because it's a posi-
trial in Pennsylva-
nia featured expert
the scientific mer-
its of the intelligent
and clashes over
ism was discussed
in school board
before the curricu-
lum changed in
asked the judge to
overturn the policy
of the Dover Area
Lawyer for the eight families
in a Pennsylvania case
on the mandatory teach-
ing of "intelligent design"
in public schools
tion against the
consensus," he said.
"Science is not a
The history of
tion dates back to
the famous 1925
students hear a statement about intelli-
gent design before ninth-grade biology
lessons on evolution.
Intelligent design holds that the uni-
verse is so complex that it must have
been created by some kind of higher
force. Critics say it's merely creation-
ism - a literal reading of the Bible's
Scopes Monkey Trial, in which Tennes-
see biology teacher John T. Scopes was
fined $100 for violating a state law that
forbade teaching evolution.
The Tennessee Supreme Court
reversed his conviction on the nar-
row ground that only a jury trial could
impose a fine exceeding $50, and the