A new Florida law allows residents to challenge any school textbook that they find inappropriate.

The legislation, which went into effect on July 1, is known as the Instructional Materials Bill. It permits any resident, regardless of whether or not they have a child in school, to challenge what Florida students are learning via an independent hearing. If the hearing officer deems the complaint justified, they can order the school to ban the book. However, school districts will still have the final say.

The Florida Citizens’ Alliance, a conservative group, pushed for the law after examining more than 60 textbooks in 2015. The group’s founder, Keith Flaugh, found more than 80 instances in one government textbook that he believes gives false information.

“We found [the textbooks] to be full of political indoctrination, religious indoctrination, revisionist history and distorting our founding values and principles, even a significant quantity of pornography,” he told NPR.

He goes on to explain the pornography is in literature within the school library or on summer reading lists.

While the bill can apply to any piece of required reading, the FCA’s main concern is with science textbooks. The group does not believe the schools should teach evolution or climate change as facts. One unnamed member claimed that the “vast majority of Americans believe that the world and the beings living on it were created by God as revealed in the Bible,” so the textbooks should only present evolution as a theory.

Similarly, an affidavit from a teacher complains that her school is teaching climate change as “reality.”

Other issues the FCA has with the books include attitudes toward Islam and anti-American portrayals of history.

In response to the bill, the Florida Citizens for Science Group posted a statement on its blog:

We believe that should this bill become law with the governor’s signature, people who crusade against basic, established science concepts such as evolution and climate change will have the green light to bog down the textbook selection process on the local level and bully school boards into compromises that will negatively impact science education.

Glenn Branch, deputy director of the National Center for Science Education, is also concerned. “It’s just the candor with which the backers of the bill have been saying, ‘Yeah, we’re going to go after evolution, we’re going to go after climate change,'” he said.

Delaney Cruickshank

Delaney Cruickshank is a Staff Writer at Law Street Media and a Maryland native. She has a Bachelor’s Degree in History with minors in Creative Writing and British Studies from the College of Charleston. Contact Delaney at DCruickshank@LawStreetMedia.com.

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The science curriculum for Alabama public schools is getting a much needed facelift thanks to state officials deciding that both evolution and climate change should be taught to all students.

The unanimous vote decided last week by the state Board of Education was the first change to Alabama science standards in a decade, according to NPR, and is indicative of the state being behind in the times in more ways than one.

Take the state’s controversial evolution “warning stickers” for example, which have accompanied biology textbooks containing any mentioning of Darwinism since 1996. The stickers act as a glorified disclaimer, referring to evolution as a “controversial theory” and sometimes even mention creationism as an alternative. Even though the board’s decision shows a willingness to make this material more accessible to students, the state hasn’t made any substantial steps to banish the archaic stickers.

Some of the motivation behind the board’s decision could also stem from college educators, who claim that students who lack knowledge about scientific theories such as evolution are ill-prepared for college curriculums and arrive at a disadvantage compared to other students.

According to NPR, dozens of Alabama school teachers welcome the change in curriculum, including science teacher Ryan Reardon, who supports the new standards saying,

You might not accept it, but that doesn’t change the fact. Talking about evolution in a classroom is controversial, but there is no controversy about how all the organisms on the planet are related to each other.

Another controversial theory is that of climate change. Like the theory of evolution, climate change has also been adopted as fact within most circles of the scientific community, with a 97 percent consensus that humans are causing global warming. Despite this, several Republican presidential candidates including Ben Carson, Rick Santorum, Rick Perry, Mike Huckabee, Ted Cruz, and Donald Trump have all publicly denied its existence. The Obama administration, on the other hand, considers climate change to be one of the biggest threats Americans face. Obama also recently took a highly publicized trip to Alaska, where he attempted to rally support for the issue by highlighting melting glaciers and rising sea levels.

Just because Alabama students will now be required to learn about both theories, it doesn’t mean they will be required to believe in them. Instead students will need to be able to show “detailed knowledge” of the subject matter and are encouraged to come to their own conclusions.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

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Like anything with a life, survival is a germ’s end game. When it faces a challenge, it will adapt. Some germs adapt alarmingly well to the challenge of modern medicine. They’re called superbugs because they’ve evolved to survive the challenges we throw at them, including antibiotics.

Do we have a counterattack against these superbugs? Let’s find out.

Superbugs in the News

Superbugs have been making headlines lately. Here’s what’s happening in case you missed it.

CRE Outbreaks

CRE stands for carbapenem-resistant Enterobacteriaceae, a type of bacteria resistant to carbapenem antibiotics. CRE resists nearly all antibiotics and can cause death in about 50 percent of infected patients because most people who become infected are already sick and have weakened immunity. Most recently, CRE killed two people in an outbreak at the Ronald Reagan UCLA Medical Center in Los Angeles and one person in a Charlotte, North Carolina hospital.

A duodenoscope, a device that drains fluids from the pancreatic and biliary ducts, stands out as the main suspect in the UCLA outbreak. Duodenoscopes probe the body, making infection easier for hitchhiking germs, especially superbugs like CRE. The particular duodenoscope implicated in the UCLA outbreak boasts an intricate design that unfortunately makes it difficult to clean properly even through reprocessing, the multi-step sanitation process designed for reusable devices. So this particular model of duodenoscope picked up some potent CRE that withstood reprocessing and infected several patients.

C.difficile Infections on the Rise

C. difficile infections happen when the harmful bacterium Clostridium difficile (C.diff) overpowers the otherwise harmless and helpful bacteria living in the intestines. Antibiotics kill bacteria, including the good kind that help fight off C.diff, so sick people who have taken antibiotics for long periods of time become especially vulnerable to C.diff. Since C.diff resists antibiotics, once good bacteria succumbs, zero defenses stand between it and the multiplication that causes deadly intestinal infections. C.diff preys on the sick and spreads wildly through hospitals. It ranks as one of the three most common infections acquired in hospitals and still cases are growing. Confirmed C. difficile infections doubled from 2000-2009 according the Centers for Disease Control and Prevention.

In Short, Superbugs Threaten Hospitals

As you can see from the cases above, superbugs thrive in hospitals where sick people with weakened immune systems squeeze together in close contact. Our usual sanitation tricks don’t stop them. Even when healthcare workers practice sanitation that could kill the flu virus, these superbugs stick around, hiding out in bathrooms, hospital beds, and on medical equipment. Since superbugs resist antibiotics, once the inevitable infection does occur, it’s extremely hard to fight and could lead to death. For example, CRE kills almost half the people it infects.

Public health officials working on the UCLA outbreak have sprung to action to contain the spread. They’re finding people who might have been exposed to CRE via use of the potentially faulty duodenoscope. They’ve issued warnings about the devices so other hospitals don’t run into similar problems.

But after two deaths in California and one in North Carolina in 2015 so far, many have asked: how can we prevent superbug outbreaks in the first place?

Preventing Superbug Outbreaks

To fight superbugs, experts recommend combating the antibiotic resistance that produced them in the first place, becoming better at monitoring and controlling them, and developing innovative techniques for prevention and control.

Combating Antibiotic Resistance

The CDC’s report Antibiotic Resistance Threats in the United States, 2013, inspired government action that fights the antibiotic resistance that produces threats likes superbugs. Their recommendations include prevention, tracking, changing antibiotic use, and developing new drugs and diagnostics.

In actual practice, the CDC has encouraged hospital antibiotic stewardship programs, which combat overprescribing and incorrect prescribing of antibiotic drugs. The programs push for evidence-based assurance that antibiotics are necessary and effective for the condition in question. For example, in antibiotic “time-outs,” doctors revisit the need for antibiotics after receiving diagnostic lab results. Often antibiotics are prescribed as a precaution while waiting for medical tests, but this practice encourages doctors to reassess the need for the drugs with medical test results in hand. These programs are voluntary, and so far California is the only state that requires antibiotic stewardship programs by law. Experts, including President Obama’s science advisers, are pushing to make stewardship programs a requirement for hospitals and nursing homes that want to receive Medicare payments.

Additionally, President Obama’s FY 2016 budget shoots to double federal spending to fight antibiotic resistance that would help move the National Strategy for Combating Antibiotic Resistant Bacteria along.

Read More: Are We Doing Enough to Prevent Antibiotic Resistance?

Monitoring the Spread of Superbugs

Tracking is crucial to understanding where superbug infections might happen and what efforts might be needed to control them.

One recommended control measure requires all patients admitted to hospitals be screened for CRE. CRE squats in the guts of many people, but only creates problems when they’re weakened by sickness or too many antibiotics. Knowing who carries CRE would help control potential problems before they happen.

In terms of general tracking, there’s no requirement that state health agencies track and monitor antibiotic-resistant bacteria, but luckily, many of them do. According to an Association of State and Territorial Health Officials survey of antibiotic resistance-related state health agency activity, about half of them collect surveillance data about occurring infections. Federal requirements could lead to all states performing valuable surveillance activities.

Implementing Innovative Practices

Superbugs challenge our sanitation practices and antibiotic use. The race is on to develop new techniques to fight them so we can replenish our defenses instead of relying on old practices. Here are a few new interventions considered for fighting superbugs. Warning…don’t read this while eating.

• Fecal transplants: Nope, that’s not a typo. This procedure is exactly what it sounds like. Fecal matter is collected from an ideal donor and placed into the gut of another individual whose population of good bacteria might have been compromised through antibiotic use. In the case of C.diff, a fecal transplant can replace good bacteria that keep infection at bay. It might seem strange, but the procedure has proven 90 percent effective at curing C.diff infections. These unorthodox transplants work better than many other cures.
• Sanitizing robots: A concentrated hydrogen peroxide solution poses a threat to superbugs. It can be toxic to humans, so at Johns Hopkins University Hospital they’ve enlisted impervious robots to help them sanitize hospital rooms. After a human technician seals the room, a bot blasts the air with 35 percent hydrogen peroxide solution that reaches every inch of the room, even cracks and crevices. A second bot dries up the room so no residue remains. This results in a completely pristine hospital room, medical equipment and all.

• New antibiotics and alternative therapies: Superbugs grow accustomed to existing drugs and we haven’t created new ones that shock their systems. This is partly because 99 percent of living species (plants and fungi) that produce promising new antibiotics will not grow in lab conditions. If they can’t grow in a lab, scientists can’t study them to make them into medicine. Recently, scientists tapped into this 99 percent horde of potential antibiotics by tricking the microbes into thinking they were in a natural environment by stuffing dirt in between two membranes. The extracted antibiotic is known as Teixobactin and has proved successful in battling antibiotic resistant MRSA and TB in mice. It hasn’t been tried on humans yet, but the methods scientists used to grow “ungrowable” cultures in laboratory conditions hold promise for the future.

Antibiotics are also overused in agriculture to treat animals raised in conditions that lead to persistent infection. Hyun Lillehoj, an avian immunologist at the Beltsville Agricultural Research Center, has discovered promising new treatments for diseases affecting poultry that would render antibiotics unnecessary. She’s found promise in using food supplements, probiotics, and phytochemicals to enhance a bird’s natural immunity and ward off infection in the first place.

On a sweeter note, Lund University found promise in the lactic acid bacteria hiding in honey bee stomachs. Lactic acid bacteria contains antimicrobial properties and has proven effective in fighting resistant MRSA. Honey processing kills the good bacteria, so store-bought honey has no antibiotic properties. The researchers reintroduced the natural bacteria into honey and used it on horse wounds. All horses were healed when no other antibiotics or steroids had worked.

Legal Challenges of Superbugs

Superbugs involve a liability hotbed because they’re changing the rules. Healthcare professionals adhere to strict rules and protocols proven to prevent the spread of infection. Unfortunately, following those rules doesn’t prevent the spread of infection from superbugs. So when something goes wrong, who is liable? The new proliferation of superbugs presents a legal problem without precedence. Courts will look at whether a hospital has taken reasonable actions to promote safety, unfortunately with a lack of history in the case of antibiotic resistance laws, what actions might be considered reasonable are not yet clear. Upcoming decisions might afford more clarity.

California Congressman Ted W. Lieu requested a hearing from the Committee on Oversight and Government Reform (OGR) to discuss the sterilization issues with duodenoscope that led to the UCLA CRE outbreak. Family members of affected patients are also filing suits against the manufacturer of the duodenoscope that led to their infections, citing grievances like negligence and fraud. Decisions in these cases could influence future arguments.

Are superbugs under control?

As alarming as recent superbug growth might be, so far the situation is under control. However, the outbreak and C.diff growth calls attention to the need to prepare our defenses for the growing threat of superbugs. Antibiotic resistant germs prey on the weak, making hospitals and nursing homes vulnerable targets for devastation.

The government and medical professionals have jumped on the case with their efforts to combat antibiotic resistance, stop the spread of superbugs, and develop new treatments. While antibiotic resistance presents a challenge, consider how antibiotics themselves have been around for less than a hundred years. While their invention was considered a medical miracle, we surely have more miracles up our sleeves to get past this new challenge.

Resources

Primary

CDC: Lethal, Drug-Resistant Bacteria Spreading in U.S. Healthcare Facilities

FDA: Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning

U.S. National Library of Medicine National Institutes of Health: Clostridium Difficile Infection: New Insights Into Management

CDC: Vital Signs: Preventing Clostridium Difficile Infections

California Department of Public Health: The California Antimicrobial Stewardship Program Initiative

CDC: Core Elements of Hospital Antibiotic Stewardship Programs

USDA ARS: Alternatives to Antibiotics in Animal Health

Additional

Network for Public Health Law: Superbug Prevention and Hospital Liability

Kaiser: UCLA Bacteria Outbreak Highlights the Challenges of Curbing Infections

USA Today: Dangerous Infections Now Spreading Outside Hospitals

International Business Times: Drug-Resistant Bacteria A ‘National Security Risk’

US News & World Report: Patients File Lawsuit Against Medical Scope Maker in Hospital Superbug Infection

Washington Post: New Class of Antibiotic Found in Dirt Could Prove Resistant to Resistance

CNN: Superbug Cases Reported in North Carolina; One Dead

Food Safety News: The Search For Alternatives to Antibiotics

Food Safety News: White House Wants to Nearly Double Funding for Antibiotic Resistance Fight

Nature: A New Antibiotic Kills Pathogens Without Detectable Resistance

ASTHO: State Strategies to Address Antimicrobial Resistance

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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