TalkBack Live

Could Too Much Cleanliness Make People Sick?

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

BOBBIE BATTISTA, HOST: Are you too clean? Do you keep your family germ-proof with anti-bacterial soaps, sprays and detergents?

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UNIDENTIFIED MALE: I guess it's a phobia thing.

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BATTISTA: You could be wasting your money.

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UNIDENTIFIED MALE: We concluded that plain soap and water, and very careful washing of your hands is probably the first line of defense, and that the addition of these substances does not add anything that has been demonstrated.

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BATTISTA: And the American Medical Association says you might also be helping develop super drug-resistant bugs.

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DR. STUART LEVY, TUFTS UNIVERSITY: It could backfire by changing the kind of bacteria in our houses to those that may actually be harmful or resistant to antibiotics that we may want to use to treat.

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BATTISTA: Still warnings about E. coli kitchen contamination, the unknowns of public restrooms, and the mystery of where your kids hands have been have created a multimillion market for anti-bacterial products.

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DR. GERALD MCEWAN, COSMETIC, TOILETRY & FRAGRANCE ASSOCIATION: The AMA is overreacting here, and the issue is the overprescription of therapeutic antibiotics.

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BATTISTA: That, too. But could too much cleanliness make us all sick?

Good afternoon, everyone, and welcome to TALKBACK LIVE. You scrub, you wash, you disinfect your house and everyone in it. But your "oh, so clean" kitchen could be the perfect breeding ground for a mutant super bug. This is the picture painted by scientists alarmed by the growing use of anti-bacterial products. The AMA wants the Food and Drug Administration to take a hard look at whether anti-bacterial products are overkill.

Joining us first today is Dr. Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine. He is the author of the book "The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle."

Dr. Levy, thanks for joining us.

LEVY: Nice to be with you.

BATTISTA: Let's -- let's review here. What exactly are your concerns about these products?

LEVY: Well, I think the products that have been made, the anti- bacterial substances, were designed and developed to protect the sick person in hospitals, and they've been used successfully. I don't see a role for them in the healthy household because in fact they aren't used in the way they should be used, for minutes of time, and instead they're being deposited on counters and places where they serve a wonderful purpose of selecting for the very bacteria which will resist them.

So I think it's a change in the microbiology of the home that we don't need. A healthy household, in my opinion, can do well with soap and water, and the old, more classic forms of disinfectant.

BATTISTA: So are you saying that these products, particularly when used excessively, will kill all the germs, including the good ones, and the ones that survive are going to be so strong that there won't be anything strong enough to take them out?

LEVY: That's exactly true. It's taking a mallet to hit a fly. We hear all these analogies.

I think that what concerns me is where is the benefit and the risk, and to me the anti-bacterials will certainly clear away, as they is it on the counters, all the bacteria: what we call the good and the ones that could potentially be harmful.

On the other hand, if you use soap and water or products that don't leave what I call a residue, you can get rid of the bacteria, but you leave the environment very happily able to be populated with the common household bacteria that we actually need. And we can discuss that some time later on the program.

BATTISTA: Why do we need good germs in our environment?

LEVY: There are studies now coming out of Europe -- at least five, six countries -- that correlate too hygienic a house with children that have much, much greater frequency of allergies, asthma, eczema, hay fever. And when they look at these children, they find that their immune system is different from other children. And from the more sophisticated knowledge we have now, it turns out that these children have not mounted, as we call, or trained their immune system in the way that other children have, like you and I, I think, in the sense that you have to meet certain bacteria as you're growing up, as an infant: the ones that have been around ever since we entered the bacterial world. After all, we're in their world; they're not in ours.

And so if we don't have that opportunity as a child and we meet them later, we're not going to respond in the same way. So I think that the more we change the microbiology, the kinds of bacteria we interact with in the home, the less chance we have of training our immune system in the correct way.

BATTISTA: How many products in the home these days have these anti-bacterial agents, like Triclosan, in them?

LEVY: Well, it's estimated to be about 700. When I was asked to look at this study at Tufts University several years ago, there were, you know, maybe several dozen. So there's been an escalation, an incredible increase, and you find virtually the same products in all sorts -- the same chemicals in all sorts of the same products, including plastics and linens and clothing and shoes and pillows.

I mean, the point is that the microbes in the environment, the good ones, where can they go?

BATTISTA: So you're -- but what you're basically talking about here is a theory right now. So would you go so far as to say that these products are dangerous, that we shouldn't use them at all?

LEVY: You see, when you use the word "dangerous," you absolutely should have the data, and I believe in that. I'm a scientist.

What we have are data which tell us that there is reason for great concern, and it begs for more and more science. Now we have done some of it that proves to me that these agents can select and propagate resistant strains. That to me was a very important finding.

The second is that the same mechanisms for resistance to some of these anti-bacterials are also used to resist antibiotics. So consequently you can have resistance to both drugs by using one or the other. So, that's another important point that I think is critical.

BATTISTA: Let me -- let me...

LEVY: The...

BATTISTA: Go ahead. I'm sorry.

LEVY: Yes. No. And the third point is, do we need them? What's wrong with soap and water? And I think that's the most important point here, is that we're not fighting normal hygiene. What we're asking is if this is excessive in the healthy household.

I'd like to reserve these products for caring for a really sick patient as I send a patient home. But if I know that household has now had months to even years of the same product just used casually in the house, what do I expect, how do I expect that product to work in protecting my sick aunt or mother or grandmother?

BATTISTA: Let me bring in...

LEVY: Antibiotic -- yes, go ahead.

BATTISTA: No, I'm sorry. Let me bring another voice into the conversation here, and we'll continue what you were saying. But Steve Milloy is with us, who is publisher of Junkscience.com and an adjunct scholar at the Cato Institute. He is co-author of "Silencing Science" and "Science Without Sense: The Risky Business of Public Health Research."

Thanks for joining us, Steve.

STEVE MILLOY, JUNKSCIENCE.COM: Thank you, Bobbie.

BATTISTA: You -- you tend to think this is a lot of hooey for the most part, right?

MILLOY: Well, I think this is a lot of alarmest bunk. I think that there is no scientific evidence that shows that any microbials are causing any health impacts currently or in the future. I think the notion that we're killing off good bacteria and somehow that's causing a health problem -- I have seen those reports, too, but those are very preliminary and really amount to just speculation.

The whole issue of bacterial resistance really to the extent that it is a problem is a problem with physicians overprescribing antibiotics, basically handing them out like candy.

I think that as far as whether these products work or not, there's no substitute for scrubbing with soap and water. But for people who want an added measure of safety from the anti-microbial product, there's no reason not to use them right now.

BATTISTA: But...

MILLOY: I think one of the issues -- one of the issues here that's really not explored is, you know, what is the nature of the attack on anti-microbials? Who's behind it? What are their real motivation?

BATTISTA: So what you're saying is you don't see anything negative about these anti-bacterial products, but at the same time, do you see any health benefits in them? I mean, do they do what that they claim to do, and are we wasting our money?

MILLOY: Well, I think they -- there's no question that they work. I think you heard that from Dr. Levy. They use them in hospitals, and the reason they do that is they work. That's indisputable. And there may be consumers who feel that they want an extra margin of safety for whatever reason, and I think that they should have that, the ability to buy those products.

LEVY: I would disagree. I read your piece, Stephen, and I -- it's funny. I think we agree more than we disagree. But I'm concerned about waiting for a problem to come down the road where we may have to wait 10 years, and I also appreciate your point of choice, because right now the consumer has very little choice in choosing a product that doesn't have an anti-bacterial. I think we have to have some rationality in whether we need them or not.

BATTISTA: You know, can I just say that most people -- and can I just say that most people, unless the product is marked anti-bacterial most people don't even know that some of their products have these agents like Triclosan in them, like your toothpaste, it's in small print on the back.

LEVY: Well, I would say this, that most of the products that are at least in the area of disinfectants and cleanings and soap do say anti-bacterial on them. And as I've gone through supermarkets and as people have told me, they are hard-pressed to find something that doesn't have anti-bacterial on it. And I think, Steve...

MILLOY: Yes, but...

LEVY: And the other point that I would make is, you know, unfortunately everybody calls everything anti-bacterial, but when you use these -- the chemicals in hospitals -- we use them -- you know, the scrub is 10 minutes, we use them carefully, we -- if you lay down on surfaces that are there for 15 minutes you've got to have time for these products to act, and you are protecting a sick patient. In a household, do you really think that person is getting an added benefit from that five-second wash?

MILLOY: Well, I think we really...

LEVY: I mean, they work, but they work under conditions that are minutes to hours.

BATTISTA: I have to admit that the few times I've used them I've wondered that.

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LEVY: So I think on two points -- one, I think the consumers should be given a choice and I would like to see some of the industry bring back the old products without any bacterials and let the public say what they want, because I think soap and water and the other ones work fine.

BATTISTA: Let me get -- I have to go to break here in a minute.

LEVY: And, two, if we are going to use these products...

BATTISTA: So let me get...

LEVY: ... then I would like to see them used in the correct way.

BATTISTA: Let me get Stephen here quickly, I -- before I go to break.

MILLOY: OK.

BATTISTA: No, go ahead. I thought you wanted to respond to Dr. Levy.

MILLOY: Well, I -- so far all I have heard is the alarmism. I mean, there's no scientific evidence that these things are causing a problem or will cause a problem. This is just strictly speculation.

LEVY: Now there I disagree.

MILLOY: And I'd like to ask...

LEVY: Will...

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MILLOY: I would like to ask Dr. Levy whether he has disclosed the possible conflicts of interest in promoting...

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LEVY: ... is yet to be seen, and the question is, should we be cautionary, should we just let it happen?

MILLOY: But, Dr. Levy, have you disclosed all your potential conflicts of interest in this matter? I mean, is...

BATTISTA: We'll come back -- you know what? Let me come back and explore that question while we take a break here.

And as we do, we invite you to take part in our TALKBACK LIVE online viewer vote at cnn.com/talkback. Today we want to know, Do you use anti-bacterial soap? We will be back in just a moment.

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BATTISTA: Before we continue here, let me read you a statement from the Soap and Detergent Association in response to Dr. Levy's research: "Our society is increasingly concerned about the very real threat of disease caused by bacteria. anti-bacterial personal-care products such as handwashes provide an extra measure of protection for consumers at home and doctors and nurses in hospitals seeking to prevent the spread of germs. These products, depending upon their formulation and application, can kill or inhibit the growth of bacteria that cause odor, skin infections, intestinal illnesses, or other commonly transmitted diseases.

The importance Dr. Levy assigns to anti-bacterial soaps and washes as factors in causing bacterial resistance is based on an unproven theory and is not supported by sound science. He has oversimplified a very complex scientific debate and, most importantly, is not focusing on the proven reasons for antibiotic resistance."

Let me have you go ahead and respond to that first, Dr. Levy.

LEVY: Well, I -- you know, I appreciate -- I must tell you I appreciate the soap and detergent industry and I think they are trying to look hard at this issue. That's my understanding. But I think it's a -- it's slightly ridiculous to think that Stuart Levy is saying that the anti-bacterial soaps are the problem of antibiotic resistance.

I mean, for 30 years I've been preaching about the proven use of antibiotics because of the fact that, that is what is really the leading cause, misuse of antibiotics for antibiotic-resistant bacteria. That is shown, there's no problem there.

The important feature now is that while we are trying to improve the use of antibiotics, and there's a whole organization, the Alliance for Prudent Use of Antibiotics, that has been dedicated to this in 100 countries, in so many chapters around the world, that's not the issue. The issue is, are we seeing something else coming up now? As we are trying to prudent use antibiotics are we now seeing things that look like antibiotics being spread around the home, and do we need them? So...

BATTISTA: Steve, before we went to the break you had asked a question...

MILLOY: Right.

BATTISTA: ... that insinuated a conflict of interest on Dr. Levy's part.

MILLOY: Yes, now I published Junkscience.com, and for those of the audience who don't know, junk science is faulty science used by those that have an alternative motive. And what I would like to ask Dr. Levy is whether he has disclosed all his conflicts of interest, specifically, is he affiliated with the company Paratec (ph), who is set to market a product to compete with anti-microbial products.

LEVY: No, not at all. I am very proud to say that I -- after 25 to 30 years of work on tetracycline resistance, and we have now begun to look for a new solution to tetracycline resistance, that is in the development of new antibiotics, new tetracyclines for the treatment of resisting infections.

Now, at the same time, I have always spoken for prudent use of antibiotics, so it's fairly clear out there where I stand on this. I mean, I don't care what product you are bringing out, you want it to be used in a rational way for an appropriate treatment, so I don't think that should be a problem, Stephen.

BATTISTA: Let me...

MILLOY: But there is no evidence that any of this is being misused or causing any problems. This is just alarmism, and I'm trying to figure out why -- I know why the AMA is being alarmist, because they want to point the finger away from doctors. I question...

BATTISTA: OK, well, hold on. Let me bring the AMA into this, since you bring that up.

Dr. Randolph Smoak is with us, president of the American Medical Association board of trustees.

Dr. Smoak, first of all, what do you think of these concerns about anti-bacterial products and about Steve's allegation?

DR. RANDOLPH SMOAK JR., PRESIDENT, AMERICAN MEDICAL ASSOCIATION: Well, first of all, I think there's a lot of unfounded knowledge about this that we have to find out about it. We have our scientific report that was produced just recently which indicated that No. 1, there's a lot that's not known, and we need to find out about that. We need to do studies to determine the accuracy of these. We also are concerned about the long-term effects of how we could use these antibiotic-type agents in our everyday home lives that really would give no benefit and yet would set us up for arrangements decades from now that could be very serious in terms of being able to use effectively the antibiotics that we have come to know are so useful for infections.

BATTISTA: But at the same time, are you also trying to shift focus off the fact that the medical community has overprescribed antibiotics in the last 50 years?

SMOAK: That's not the issue. That's just a sidetracking mechanism.

(LAUGHTER)

Actually, this came about...

MILLOY: How can you say that?

SMOAK: Well, I'll tell you, because this whole thing came about from a medical student resolution to the (UNINTELLIGIBLE) August. That's how it was begun, and it was then sent on to the Council of Scientific Affairs to investigate, to look and to see what data was available, and to render an opinion. And they did render an opinion based on information available, which shows we do not have sufficient evidence to show that there's great value in using these products in everyday household products, such as hand washes, mouth washes, et cetera.

MILLOY: They're used in hospitals. How can you say they don't work?

SMOAK: Yes, indeed. That's quite different, and as a surgeon, I would tell you that I have used those many times to prepare the skin through which one makes an incision. That's quite different from just using it every day when you wash your hands.

MILLOY: A recent study in "The Journal of the American Medical Association" reported that in 1992 doctors wrote 12 million prescriptions for antibiotics. The same study also said that 90 percent of those prescriptions were totally useless. Now, instead of the AMA involving itself with the FDA and asking the FDA to take regulatory action against an industry where there's no scientific evidence against it, why doesn't the AMA stick to its own turf and tell its doctors to prescribe antibiotics more carefully? Because that's the real threat, if there is a threat, from bacterial resistance.

SMOAK: Well, obviously, we will acknowledge the fact that demand from patients many times is such that physicians perhaps do overprescribe. We're also looking at that issue to inform physicians that they shouldn't overprescribe at the demands of patients. And we've been doing that and we'll continue to do that.

MILLOY: But in the meantime...

SMOAK: But that is just displacing the whole issue.

MILLOY: But in the meantime...

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BATTISTA: I've got to -- I've got to take a break here, gentlemen, quickly. I've got to take a break first. And Kim, I'll get your comment and these e-mails when we come back.

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BATTISTA: In 1954, 2 million pounds of antibiotics were produced in the United States. Today, that figure exceeds 50 million pounds. Humans consume 235 million doses of antibiotics annually. The CDC estimates that 20-50 percent of that use is unnecessary.

Let me go to Kim in the audience here quickly.

KIM: I do not use the anti-bacterial soap. I don't think that they are necessary. I think they're a money-making scheme. It's like taking an antibiotic every day. What happens when real bacteria invades your body and you have to take an antibiotic? It will no longer be effective.

BATTISTA: We have another e-mail here that says basically the same thing, that these anti-bacterial agents are a way for drug and chemical companies to profit from fear and ignorance. Steve, is that -- I mean...

(LAUGHTER)

I think that a lot of people are not convinced that these agents do anything, really.

MILLOY: You know, I understand, you know, but we know that they work in hospitals. That's why they use them, and in doctors' offices.

The only alarmism I've heard here is promoted by the AMA and Dr. Levy. I don't see the companies trying to scare anybody. It's just a product out there. You know, they don't advertise saying that germs are going to kill you or going to destroy...

BATTISTA: No, but I guess -- I guess what a lot of people are saying is we've certainly gotten along a long time without these anti- bacterial products. Which came first? Was it the development of these products or was there consumer demand for them?

MILLOY: That's a good question, but I'll tell you what: Consumers don't have to buy anti-bacterial products. They have a choice. And for consumers that want an extra margin of safety, why can't they buy it? Why shouldn't they be allowed? I mean, so far all I've heard is unfounded, unsubstantiated alarmism.

BATTISTA: Dr. Levy...

LEVY: I -- I -- yes, I think that we have to take stock on why this has all happened. All right. The anti-bacterial craze, as I see it, appeared about the mid-'90s at the same time as we were hearing in the newspapers about these super bugs, about ebola virus, about all these microbes that were newly emerging. And while some of us were out there trying to get people to calm down, use antibiotics only for designated purposes, some marketing found that people were approaching and taking and buying those substances that said anti-bacterial. I'm talking about a couple dozen products at the time.

And what happened is the companies are not necessarily out there having to tout it. It's what's out there in the news, although I would say, Stephen, that right now, if you read some of the ads, I'd be hard put for you to tell me that they aren't saying to the consumer, "I'm taking care of you better than the old stuff."

And while I...

MILLOY: Well, I'll tell you what...

LEVY: ... will certainly substantiate that -- let me just finish, please. I substantiate and I said before, these anti- bacterials have a place, and when they're used effectively in a hospital, it's not a four-second wash. It has to be done under the circumstances where they work, and they're not fast-acting.

And the other point is when we talk about anti-bacterials, we should look at the differences between those that leave chemical residues, and those like alcohols, peroxides and bleaches which do not. There's what I call an appropriate anti-bacterial.

MILLOY: OK. Now let me...

LEVY: (UNINTELLIGIBLE) it cleans off the space there.

MILLOY: Let me respond.

BATTISTA: OK, let me let Steve respond.

MILLOY: I'm not here to defend, you know, an industry or its products. And Dr. Levy, if you have a problem with the claims made in the advertising, then you ought to take that up with the Federal Trade Commission.

What I'm here about is the alarmism about these products. You know, there's no evidence substantiating the alarmism, and I must then go to, why are we being so alarmist? Why are you being alarmist? Why is the AMA being alarmist? And I don't see any science behind any of the reasoning, and that's why I asked the other questions about your motivation and the AMA's motivation.

LEVY: Are you a scientist?

BATTISTA: Let me ask you this, let me interject this...

LEVY: Are you a scientist? Are you a scientist?

MILLOY: I'm a biostatistician.

LEVY: I don't know what you're background is.

BATTISTA: Let me jump in here, gentlemen, if I could, because I think what you just asked rhetorically there, Steve, was there an awful lot of hypothesis out there, and just in some of the research I was going through today and in an article in "The New Orleans Times" on this very subject, there was this statement: "Some researchers hypothesize that reduced exposure to some bugs or germs, bacteria, may have something to do with the rise of reflux disease, allergies and autoimmune disease.

MILLOY: Yes, I've heard all of this before, and this is all great.

BATTISTA: You're saying that's part of the whole alarmist environment here.

MILLOY: Right. Well, I understand that there are hypothesis, and I think that they are hypothesis that need to be fleshed out, but being a hypothesis is a far cry from being the basis for alarmism. I mean, we are so far away from proving that being too clean is a health problem, you know, it's -- the gap is incredible. And I think that right now, Dr. Levy and AMA are just being alarmist for no reason about these products.

SMOAK: No, nobody is trying to be alarmist about this.

(CROSSTALK)

BATTISTA: Hold on just a second..

SMOAK: Where is the that shows these things are...

BATTISTA: Let me get Dr. Smoak in here quickly 00 go ahead.

SMOAK: Where is the data that shows that this is effective in everyday use. That's what's lacking, so you can't say that this is being an alarmist, we are raising the question, and it should be appropriately answered. Give us the data, and then we'll be able to say yes, you're right, or you're wrong. I will believe at the present time, we don't know, Let's find out, let's do the investigations and come down with what's the best scientifically-based evidence.

MILLOY: OK, now, if that's a legitimate question, then that should be explored, whether they work or not, are consumers wasting their money.

SMOAK: That's exactly the question that's been asked.

MILLOY: I don't know. But what I hear is the alarmism, how, you know, we're going to cause all sorts of health problems by using...

(CROSSTALK)

BATTISTA: We've got two questions here. I've got to take a break. We've got two questions here, you know, whether or not you're wasting your money, or whether or not that has negative effects on you. And we'll talk to a researcher who is getting ready to embark on a project, right after this.

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BATTISTA: Let me go to a couple of comments from the audience quickly.

Gwynn, go ahead.

GWYNN: Yes, I think that the superantibiotics and things that are detrimental to us is part of a natural evolution of things, and I think that anything that we can purchase to combat that is helpful, because we have examples like AIDS, and they say that AIDS flourishes in places where extra antibiotics would be helpful, as far as bleach and things like that.

BATTISTA: And over here to Darryl?

DARRYL: Well my concern was, if the contention is that if the house is too clean, it's going to create increased healths risk, therefore we should be more exposed to more germs, and then perhaps the enemies is a sedentary lifestyle, when we're not out being active in the environment where those bacteria and germs exist.

BATTISTA: Spoken like a true lawyer out there.

Let me bring in another voice into this conversation. Elaine Larson is a professor of pharmaceutical and therapeutic research at Columbia University School of Nursing, and she has just received an NIH grant to study of the effects of the antibacterial products. Are we to believe that the effects have not been studied already, first of all?

ELAINE LARSON, COLUMBIA UNIVERSITY SCHOOL OF MEDICINE: Sure. Before I talk about the grant, what I'd like to do is clarify three points that have been made by some of your other guests today that might be helpful to the audience. First of all, it's not automatic that if one use an antiseptic that it will result in antibiotic resistance. Antiseptics and antibiotics work very differently, and it's important, I think, for the public to understand the difference. Antiseptics are only used on the skin, and antibiotics are actually systemic, so they are -- they can become -- they're in your system.

So and the other point is, that not all antiseptics are created equal. Dr. Levy mentioned that some of them have residual effect on the skin, like Triclosan. That is the kind of antiseptic that is a major theoretical concern right now. On the other hand, products such as the alcohols and bleach, other things like that. So far as I know, there is no known theoretical mechanism for the development of resistance to those. So if you put alcohol on your skin, you're not having the potential, even the potential risk, like a Triclosan product, in terms of resistance.

And then the last thing before I talk about my study is that we really don't know what the risks and the benefits are. We simply don't know. So it's very easy to make a cogent argument on any side of the issue. And it's not surprising that there is sort of conflict and disagreement.

BATTISTA: I guess the question is, why don't we know? If this product is in so many consumer products -- or if this agent is in so many consumer products, why don't we know?

LARSON; Sure. Well, I mean, think about what it would take to study the effect of use of antiseptics in the home when there are so many other factors that have to do with whether or not we get infections. So to sort all of those factors out is pretty complicated, and frankly, we've never done clinical trials or studies to look over a period of time at whether people who use anti-bacterial products habitually have different kinds of skin florae than those who don't. So that is what you...

BATTISTA: Yes, that's what you are going to do in your grant, then, and how will you do that in your study?

LARSON: Right.

BATTISTA: How will you do that?

LARSON: Well, first of all, the grant doesn't start until September. So I won't have any results for a while -- or we won't have any results. But, basically, we are going to be doing a clinical trial using products that are on the market. These are not experimental. They are, you know, soaps that are on the market: laundry detergent that is on the market.

And we are going to assign half of families in New York -- about 240 families all together -- half of them to use the anti-bacterial soaps and laundry detergent and half to use the identical kinds of products, only not containing the anti-microbial ingredients. Of course, all of the people who are involved in the study will be fully informed. And they have to give permission to be in the study. They have to be volunteers.

Then, we will follow them -- four at a time -- for a year, and look at what happens to their skin bacteria -- the germs growing on their skin -- over that period of time. And we will also look at -- we are going to contact them every single week to see how many members in their household have symptoms of infection. We will verify those symptoms with a visit from a nurse practitioner. And we'll then be able to say, do those who have used anti-bacterial products over the year have less of a risk of infectious diseases than those who don't?

And also, do those who use an anti-bacterial product on their skin, versus those who don't, have the emergence of more resistance to something like a Triclosan?

BATTISTA: All right.

LARSON: That is basically what we are doing.

BATTISTA: All right, I have got to take another break here. And we will talk about whether the results of that study will put some minds at ease, right after this.

(COMMERCIAL BREAK)

BATTISTA: An FDA-funded study used cameras in the homes of 100 families in Logan, Utah to study kitchen cleanliness. For $50 and free groceries, families agreed to be filmed preparing a meal. Only 45 percent of the cooks washed their hands before cooking; 42 percent undercooked the chicken. And three-quarters of the subjects did not store raw meat and seafood properly.

Let me take some quick comments and questions -- Mark.

MARK: Yes, I think, really, basically, all of this falls down into just moderation. I know when you look in the back of a bottle of antibiotics, you see, if symptoms persist for so long, basically, that they ask you to consult a doctor about it. And perhaps, you know, you can go to that extreme when it comes to soap and anti-bacterial products. But every time you get something on you, it's not run to the bathroom and get your anti-bacterial special soap out and clean yourself with it. It's just a matter of moderation with it.

BATTISTA: And a question from David.

DAVID: Do we know what kind of levels of these anti-bacterial compounds are in this? Is there any regulation or do they just, say, put some in and market it to make it more attractive to the people?

BATTISTA: Dr. Smoak, is the AMA asking for that sort of regulation from the FDA?

SMOAK: We would like to have that type of study done by the FDA, because we believe that's knowledge that we all need to know. First of all, you know, our premise is: Do no harm. And so, if we are sure that products are not harming people, then we have to also know if a certain level of these agents in those products would make a difference. So, that's another study. The study that was mentioned by the participant just a few minutes ago will answer some problems.

But there are many other studies that need to be known and carried out to get some good answers. You know, you don't want to kill a bullfrog with a bulldozer if you don't have to. And I don't we've been alarmist. All that we have asked for is say: Look, there is no data out there that really supports the use of these anti- microbials in everyday products. Go ahead and let's find out and know. At the moment, our information would suggest that there's a potential for some resistance to develop, which creates a huge public problem for us as physicians and as a nation.

That is not something we need to wait until it's already occurred to find out. We need to find out about it right now.

BATTISTA: Sure.

SMOAK: And we believe that the FDA is the appropriate vehicle to start investigating that, to put into regulation, those places where we know that the resistance is beginning to emerge. And those that we don't know, for goodness' sakes, go ahead and study, and let's find out.

BATTISTA: Short segment here. Bear with us. We will be back in just a minute.

(COMMERCIAL BREAK)

BATTISTA: Elaine, let me ask you quickly here in the time we have left, do you personally use these products or do you have some concerns about them going into the study?

LARSON: Personally, if I need to -- if I'm in a situation where I want to de-germ my skin, like during flu season or if I'm taking care of babies or in oncology or whatever, I would tend myself to pick an alcohol-based product, because there's no risk of the development of resistance.

But you know, we know that there are great benefits from hygiene and cleanliness. We also need to know if there are any risks. I think doing otherwise is putting our heads in the sand.

BATTISTA: All right. Elaine Larson, thank you very much for being with us.

LARSON: Sure.

BATTISTA: Dr. Stuart Levy, we appreciate your time.

LEVY: Thank you.

BATTISTA: Steve Milloy, and Dr. Randolph Smoak, thank you very much, sir, for your time.

SMOAK: Thank you very much.

BATTISTA: And we'll see you again tomorrow for more TALKBACK LIVE.

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