TIME Heart Disease

Who Really Needs To Take a Statin?

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Rosemary Calvert—Getty Images

Changes in the way doctors can prescribe the cholesterol-lowering drugs means millions of healthy people should now be taking the pills. But that may not be such a good idea

Since the first statin hit pharmacy shelves in 1987, the cholesterol-pills have quickly become a best-selling class of medications. So why is there such a pitched battle over making the potentially life-saving drugs available to more people?

There’s no question that statins can help prevent recurrent heart problems in people who already have heart disease, by lowering the risk of heart attack and stroke by up to 40%. That’s not in dispute, and heart experts routinely prescribe the drugs for anyone who has had a heart attack, angina or bypass surgery.

MORE: Statins Have Few Side Effects, But Should More People Be Taking Them?

With the medications’ success in this group, however, doctors are wondering whether more people—healthy people who are at high risk of heart disease—should be taking advantage of the drugs. So in 2013, the American Heart Association and the American College of Cardiology took the unprecedented move of expanding the population who should consider a statin. Their recommendation extended the prescriptions to people with no history of a heart attack or other heart problems, but who had troubling signs that they might in the future – being older, carrying around extra pounds, smoking, having high blood pressure, high cholesterol or diabetes. Under those criteria, millions more people were now eligible for a statin.

But as with all drugs, statins have side effects. And more heart experts are voicing concern that the benefits of statins in preventing the first signs of heart problems don’t outweigh the risks, which include everything from muscle weakness to possible memory issues and even an increased risk of diabetes. Even so, not all doctors agree on how to interpret the studies, as a recent controversy over an analysis that questioned the use of statins in this way and was published in the BMJ showed.

Here is that data, along with the latest studies from leading experts, about the side effects in question—which you should weigh if you haven’t had a heart event but are considering (or are already on) a statin:

1. Statins do not prevent early death or a first heart event.

In a review of statin data published in BMJ, lead author John Abramson of Harvard Medical School says that people who take statins to prevent a first heart event don’t lower their risk of dying from any cause, or from heart disease over 10 years.

Not only do statins not lower the risk of dying early, but they also don’t lower the chances of being hospitalized for a heart problem or other serious heart-related illness. The medication can lower—very slightly—the risk of having a heart attack or stroke. But that benefit is offset by the drugs’ side effects. “For people with a less than 20% risk of having a heart event in 10 years, which is the vast majority for whom the statins would be prescribed under the new guidelines, we are not seeing a net benefit,” Abramson says. The paper, however, included a misinterpretation of data from another study and estimated that 18% to 20% of statin users experienced side effects; the editors of the journal have since retracted that statement. While the overall conclusions of the review aren’t in question, the journal has asked an independent panel to take another look at the results.

What it means for now: There are better, more proven ways of lowering your risk of having a first heart attack or stroke. A healthy diet and exercise aren’t as easy to pick up as a prescription, but they are more effective

MORE: Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines

2. The Rx drugs may cause muscle weakness.

Statins are known to cause a range of muscle issues, from mild weakness to a rare but serious condition called rhabdomyolysis, in which muscle tissue disintegrates and releases the byproducts into the blood, where they can cause kidney damage. Most of the milder muscle complaints are reversible, and either go away or are reduced with lower doses or by switching to different statins. But, says Dr. Rita Redberg, a cardiologist at University of California San Francisco, “we don’t really know everything about these adverse events.” Some of her patients with muscle weaknesses continue to complain about their symptoms six months after stopping their statin, for example. And many studies that focus just on recording levels of an enzyme linked to muscle breakdown may miss the early signs of muscle problems, since many patients complain of not being able to finish their workouts or complete daily tasks well before their enzymes show signs of deterioration.

What it means for now: There’s still a lot that’s not known about how statins affect the muscles. For now, the risk of muscle problems, even mild ones, aren’t worth the small benefit for the heart.

3. Statins may increase diabetes risk in some people.

In a trial involving more than 17,000 people who were randomly assigned to take a statin or a placebo to prevent a first heart event, people without any risk factors for diabetes who took statins did not see an increased risk of developing diabetes compared to those taking placebo, but those at higher risk of diabetes did show a 28% higher risk of developing diabetes on the drug. The Women’s Health Initiative trial, which included more than 153,000 post-menopausal women, also found that the medications increased the risk of diabetes by 48%. Those results and other evidence were strong enough for the Food and Drug Administration (FDA) to add a warning on statin labels about increased blood sugar and diabetes risk linked to the cholesterol-lowering medications.

What it means for now: Because diabetes can increase heart disease risk, any increase in diabetes associated with statins likely negates the small benefit the drugs may provide in preventing first heart attacks

MORE: FDA Warns Statin Users of Memory Loss and Diabetes Risks

4. The drugs have been linked to cognitive problems.

This is an area that researchers are still investigating, but there are growing reports from statin users that the medications put them in a fog and contribute to memory loss. The FDA has a warning on statin drugs about potential memory loss, but a recent study involving patients followed from one year to 25 years on the drugs found that over the long term, statin-users showed lower levels of dementia. That may have to do with the fact that statins lower the burden of artery-clogging plaques, not just in the heart but in the brain as well.

What it means for now: Stay tuned; more studies are needed to fully understand how statins affect the brain, especially over decades of use.

Taken together, the data suggests that it’s risky to put healthy people on statins. So why did the leading heart experts recommend that these people take them? For one, says Abramson, studies that these groups looked at detailing the side effects of the drugs may be underestimating them; he notes that most doctors don’t ask patients about specific side effects, but rely on patients to report them, and many people don’t, simply because they don’t think a few aches and pains, for example, are related to their heart medication.

MORE: Experimental Cholesterol-Lowering Drug Shows Promise

Second, says Redberg, some of the data on drugs that agencies like the FDA rely on may be skewed to underestimate side effects. Companies often have “run-in’ periods in which they give a candidate group of volunteers their drug for a few weeks and eliminate those with serious side effects. “Of course the event rate [of side effects] is going to be lower because they didn’t allow anyone who complained of adverse effects to stay in the trial,” she says.

That’s not to suggest that lowering cholesterol isn’t an important part of reducing risk of heart disease. It is. It’s just that compared to other strategies that healthy people can take advantage of, popping a pill doesn’t provide that much benefit. “There are much more effective ways—diet, exercise, and not smoking— that can prevent heart disease and help you live longer that are much more worthwhile to focus on,” says Redberg.

TIME Heart Disease

Women Diabetics Have More Heart Problems Than Men

Female diabetics are at higher risk of developing heart disease than males with the disease, and here’s why

Scientists led by Dr. Sanne Peters at the University of Cambridge report that when it comes to how type 2 diabetes affects men and women, the sexes are not created equal. Peters’ colleagues conducted an extensive survey of data going back 50 years, to 1966, that involved more than 858,000 people. While the risk of heart disease among diabetics is well known, the comprehensive study confirms smaller studies that hinted at a difference in risk between the genders.

Even after accounting for the fact that women tend to develop heart disease at different rates than men, the researchers report in Diabetologia that women with diabetes were 44% more likely to develop heart problems than men with the disease. Historically, women aren’t treated for heart risk factors as well as men, partly because their symptoms are different – many women don’t experience the chest pains and shortness of breath that are a hallmark of a heart attack among men, for example. So women may actually have more advanced, untreated heart disease when they are diagnosed with diabetes than men when they are diagnosed.

That suggests that screening for prediabetes in women may help to lower rates of heart disease, and ensuring that their diabetes symptoms are treated may also close the gap between heart disease rates in men and women.

TIME Food & Drink

This Social Media Site Knows What Restaurants Will Make You Sick

New York health officials found cases of food poisoning on Yelp that weren’t reported to the health department

Restaurateurs, beware: People who eat at your joints are brutally honest on Yelp, reporting on bad service, undercooked food, and yes, even diarrhea and vomiting after dining.

So the New York City Department of Health and Mental Hygiene decided to take advantage of those reviews and see if they could find outbreaks of foodborne illness, which are a sign that restaurants aren’t up to sanitation codes. From 294,000 restaurant reviews between 20012 and 2013, 893 were pulled out for containing red flag words like “sick,” “vomit,” “diarrhea” or “food poisoning.” Of these, more than half fit the conditions of a potential foodborne illness, including the fact that more than one patron reported symptoms, the symptoms occurred within 10 hours of the meal, the affected didn’t share any other meals before becoming sick, and so forth.

MORE: Which Will Make You Sicker: Four Star V. Fast Food

Further investigation via phones calls and visits to the restaurants revealed three foodborne illness outbreaks affecting 16 people that were not reported to the health department. (In the study period, only 3% of the potential outbreaks identified by the analysis were actually reported.) In their report, published in the MMWR from the Centers for Disease Control (CDC), investigators found violations in food handling at the three establishments that included workers not washing their hands before handling food, not storing food in the refrigerator, and the presence of mice and roaches.

As tempting as it may be for health departments to start scouring Yelp or other online reviews for health code violations, the investigators say the process isn’t ideal since not all reviewers can be contacted, and having the reports reviewed and coded for further investigation by outbreak specialists is very labor intensive. Still, it shows that online restaurant reviews can be a treasure trove of potentially helpful information, and possibly identify restaurants that may consistently have problems with hygiene. Not to mention those that have terrible service.

TIME

Global Action Needed In Fight Against Antibiotic Resistant Bacteria

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George Mattei—Getty Images/Photo Researchers RM

In a commentary published in the journal Nature, experts called for a stronger global response in tackling antibiotic resistant bacteria. These pathogens, such as methicillin-resistant staphylococcus aureus (MRSA) which cannot be treated with the most powerful drugs on the market, are now in every corner of the world and pose a significant health threat to humans. Experts want to create an independent body to oversee a coordinated international effort to develop new drugs and set targets to reduce antibiotic use.

We reported on the problem, as outlined by another study from the World Health Organization published in April:

In some countries, more than half of people infected with K. pneumonia bacteria won’t respond to carbapenems. A similar percentage of patients with E. coli infections won’t be helped by taking fluoroquinolone antibiotics.

The growth of drug-resistant strains of bacteria means infections are either harder or impossible to control, which could lead to quicker spread of diseases and higher death rates, especially among hospital patients. [...]

The WHO report highlights how individual decisions about prescribing antibiotics can have more widespread, even global consequences. “If I prescribe a heart medicine for a patient, that heart medicine is going to affect that patient,” says Dr. Martin Blaser, director of the human microbiome program at the New York University Langone Medical Center and author of Missing Microbes. “But if I prescribe an antibiotic, that antibiotic will affect the entire community to some degree. And the effect is cumulative.”

 

 

TIME Breast Cancer

70% of Mastectomies Aren’t Necessary. Here’s Why Women Have Them Anyway

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Getty Images

Science says the treatment doesn’t lower risk of recurrence, but here’s why rates of the procedures continue to climb

In a new study published in JAMA Surgery, researchers say that 70% of women with breast cancer in one breast who decide to remove the other breast do so unnecessarily. In fact, only 10% of women diagnosed with breast cancer should consider such prophylactic mastectomy, say experts.

But that hasn’t kept rates of mastectomies from climbing. In the 1990s, about 1% of women diagnosed with breast cancer in one breast opted to have the other one removed; that percentage has jumped to 20% in recent years.

MORE: Angelina Jolie’s Double Mastectomy: It’s Not the Only Option

This increase is despite the fact that studies don’t show that removing an unaffected breast can lower a woman’s risk of recurrence or increase her chances of surviving the disease. That doesn’t change the fact that there are other reasons—perfectly understandable and deeply human ones—that may be guiding women’s choices. We spoke with leading experts and identified these four.

1. A fear of doing nothing

“Fear is absolutely driving the decision,” says Dr. Isabelle Bedrosian of the University of Texas MD Anderson Cancer Center. “I definitely understand that fear; we often hear, ‘I don’t want to deal with this ever again.’” And that’s reasonable, especially for women who go through the rigors of chemotherapy, and who are worried about surviving their disease so they can be there for their children and their families.

That fear, however, can overshadow reason. Bedrosian was not involved in the current study, but published a trial in 2010 in which she and her colleagues found that only a small and specific group of women diagnosed with breast cancer—those under age 50, with early stage disease that was negative for estrogen receptors—may benefit from having both breasts removed. These women enjoyed a nearly 5% improved chance of survival five years after diagnosis than those who did not have the unaffected breast removed. But as the current study found, this represented less than 10% of women with breast cancer.

MORE: The Angelina Effect

Studies also show that the chances of breast cancer recurring in the opposite breast are very, very small. In fact, breast cancer patients are more likely to develop recurrent tumors in other parts of the body—the liver, lungs, or the brain—than they are their other breast. Still, says Hawley, “There are probably other things caught up in the variable of worry, from not wanting to think about [cancer] anymore, to not wanting to regret anything in the future if something did happen.”

VIDEO: MRI: A New Tool to Detect Recurrent Breast Cancer

2. Early detection means too much information

Technology may also play a role in driving up rates of just-in-case surgery. More women are getting an MRI of the breast, both as a way to screen for breast cancer and to give doctors a better picture of the tumors. These images are refined enough to pick up the tiniest of lesions, including those that may not need treatment. But it’s hard for women to do nothing at all after learning they have a growth in their breast, even if they might be benign and not require treatment. In such moments, it’s likely that every instinct tells women to do something. “The feeling is to do everything possible, and doing everything possible means more surgery,” says Hawley.

3. The pink ribbon brigade

Breast cancer advocacy is a model of how to mobilize and educate the public about a disease. Rates of screening have gone up while death rates have come down (although it is still the leading cancer killer among U.S. women). The awareness about the disease and the push for better treatments, however, have magnified the obligation and responsibility behind every choice, from screening to diagnosis and treatment. And that’s especially true about the decision surrounding prophylactic surgery. “There is a hyper awareness surrounding prophylactic mastectomy, and many women are choosing it without a clear understanding of why,” says Bedrosian.

Coverage of celebrities’ decisions to proactively remove their breasts may also heighten the urgency of taking aggressive action for many women. “I don’t know of anyone publicly who has said they were diagnosed with breast cancer recently and chose to have lumpectomy with radiation,” says Hawley. (Good Morning American anchor Amy Robach, who does not carry the BRCA breast cancer genes which put women at higher risk of recurrence, still decided to have a double mastectomy.) “There is a feeling that doing everything you can is a way to take control. And just doing a lumpectomy and radiation may not be taking as much control as choosing a double mastectomy.”

MORE: Study: Double Mastectomy May Not Improve Survival

4. Not enough accurate information about options

Bedrosian admits that part of the reason women are choosing to proactively remove their breasts, even when they may not need to, has to do with the fact that doctors don’t have the best tools for helping patients make this decision. For the 10% of women at high risk of having recurrent breast cancer, the decision isn’t as challenging. But for the remaining 90%, many of whom may not have a genetic risk but have distant relatives with the disease, the decision becomes harder. “Communication is important to make sure that patients are informed about the medical facts,” says Bedrosian. “It’s important to make sure that our patients are making informed choices and not simply fear-driven choices.”

In the end, it’s a very personal—and complicated—decision, in which each of these factors, and many others, may take on varying degrees of importance.

TIME Pregnancy

The New Way to Predict When Pregnant Women Will Deliver

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All images by Bettina Bhandari—Getty Images/Flickr RF

For clues to the due date, doctors may check your bacteria

There’s growing interest in examining things we can’t even see in order to better understand our health. Millions of bacteria make our bodies their home and most of them are not of the disease-causing kind. Instead, they’re helpful—so-called “good bacteria”—and researchers are finding ever new and strange ways that our bacterial makeup may predict our health.

Researchers led by Dr. Kjersti Aagaard at the Baylor College of Medicine and Texas Children’s Hospital found that the placenta contains clues about when a pregnancy will end. Aagaard is not ready to say that the bacteria living there actually decide when moms-to-be will give birth, but the association is strong enough to make it worth studying further.

MORE: The Good Bugs: How the Germs in Your Body Keep You Healthy

She and her team collected 320 placentas from women who delivered pre-term (at 34-37 weeks), or at term, within an hour of delivery. They analyzed the tissues for the microbes inhabiting them, and compared what they found there to samples the women provided from other regions as well, including the mouth, nose, vagina, gut and skin.

They found that the makeup of the placenta microbial community was different between the pre-term and term groups. “We’re not suggesting that the differences in the placental microbiome necessarily cause pre-term birth; we don’t know,” says Aagaard. “All we know is that they are different.” At this point, they can only guess that the varying communities of bacteria have different functions, and these affect both the placenta’s ability to nurture the fetus and the development of the fetus itself.

MORE: The Latest Thing in Pills? Ones Made From Poop

Looking ahead, Aagaard says that even if a specific bacterial composition in the placenta appears to cause early delivery, it’s not practical nor safe to sample the placenta throughout pregnancy to find out. More benign would be sampling the bacterial makeup in the mouth, which are similar to those in the placenta, suggesting that down the line, a mouth swab may provide the same information.

“By focusing on oral health, we may actually be optimizing the health of the pregnancy and limiting the risk of pre-term birth,” says Aagaard. After paying so much attention to the more obvious ways to make a pregnancy healthy, it may be time to consider the less obvious – and less visible ones.

TIME Weight loss

Can the Paleo Diet Help You Lose Weight?

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Modern day version of a paleo diet meal Lauren Barkume—Getty Images/Flickr Open

Scientists tested the hyped diet in a lab. Here's what they found

For weight loss, the paleo diet, which is what our ancestors ate when they had to hunt or gather their food instead of growing it, seems like a good idea. It’s high in protein and fiber—and anyone who’s ever tried to lose weight has been told that the secrets to slimming down are protein and fiber, which take longer to transit down the digestive system making us feel fuller longer. Processed carbohydrates, on the other hand, zip through our system making us hungry seeminly minutes after we’ve put down the fork.

The high-fiber part, paleo diet devotees maintain, is the key. Because fiber is bulkier and harder to digest, it serves as an appetite suppressant by effectively turning off hunger signals. Except that’s not what scientists found when they put the ancient paleo diet to the test—in a test tube.

MORE: The Paleo Diet Craze: What’s Right and Wrong About Eating Like a Caveman

Gary Frost, from Imperial College London, and his colleagues wanted to confirm how our Paleolithic ancestors addressed their energy needs. So they took fecal samples, full of the gut microbes that are known to digest and break down foods, from three grass-grazing baboons (who ate similarly to the way human ancestors did) as well as from three human subjects. They then added digested solutions of either a grass-based diet or a potato-heavy one to each, to see how the composition of the bacteria changed in response to the food.

They expected that the baboon samples with the grass-based diet would produce the highest amounts of appetite-suppressing hormones, thanks to the bulky nature of the grass. Instead, they found that the potato-based diet produced higher levels of these hormones. Frost says that makes sense, since grasses aren’t very high in nutrients or energy, so our ancestors would have had to graze pretty constantly throughout the day in order get enough from the grass. But that’s in a test tube and based on the actual way Paleolithics ate. What about the modern paleo diet? Should you ditch the promise altogether?

MORE: Overcoming Obesity

No. The modern paleo diet likely, however, does do a much better job in keeping appetite in check.

The kind of grasses our ancestors ate contain insoluble fibers that the body doesn’t break down much, so they may not trigger appetite suppressing signals of other kinds of fiber. That doesn’t mean insoluble fiber isn’t good for you; it is. It’s what’s in leafy greens, some fruit, and lots of vegetables. But it doesn’t send your brain the satiety signal the way soluble fiber does. Soluble fiber, however, is metabolized by the body to produce compounds that set off the signal to the brain that the body has had enough.

The bottom line? All fiber is good fiber, but if you’re trying to lose weight or control cravings, make sure you’re getting plenty of the soluble kind, which can be found in a healthy modern paleo diet. Think: lentils and beans, fruit, nuts, flaxseeds, cucumbers, celery, and carrots.

If you want to eat your way to a satisfied (and suppressed) appetite, a protein and soluble-fiber rich diet may be the way to go.

 

TIME

Here’s Why Bacteria Like E-Cigs

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Barbara Rich—Getty Images/Flickr Open

The vapor from e-cigarettes is supposed to be safer than cigarette smoke, but not when it comes to fighting bacteria

There’s quite a bit that we still don’t know about e-cigarettes when it comes to how safe they are — if they cause lung cancer like traditional cigarettes do, whether they are as addictive as cigarettes, and more. That’s reflected by the fact that fewer smokers believe that e-cigs are safer for their health than traditional cigarettes; in 2010, 85% did, but that percentage dropped to 65% in 2013, according to a study published in the American Journal of Preventive Medicine.

But for bacteria, e-cigs may not be so bad. Dr. Laura Crotty Alexander, from the University of California at San Diego and the VA San Diego Healthcare System, found that the vapor from e-cigs prompts bacteria to become more resistant to antibiotics. In the presence of e-cig vapor, for example, methicillin resistant staphylococcus aureus (MRSA) became more resistant to the natural anti-microbial agents that the body makes. Cigarette smoke also produces the same effect, but Crotty Alexander was surprised that the e-cig vapors did as well, given that they were not supposed to contain the health-harming carcinogens that tobacco smoke does.

MORE: The FDA Plans to Ban E-Cigarette Sales to Minors

“I was hoping that maybe e-cigarettes would be safer and that they would not stress the bacteria as much as cigarette smoke,” she says of her findings, which she presented at the American Thoracic Society International Conference. “But we found that the e-cig vapor also made bugs become more resistant to killing by antimicrobial peptides.”

Other studies show that these peptides, known as the body’s natural antibiotics, are structurally similar to antibiotic drugs, so while Crotty Alexander did not test bacteria exposed to e-cig vapor against antibiotics, she expects they would be resistant to the medications as well.

MORE: Study: E-Cigarettes Do Not Help People Quit Smoking

How did the bugs fight back? When stressed by the e-cig vapors to defend themselves, the bacteria produced copious amounts of biofilm, a sticky, slimy polymer that acts as their armor against things like antibiotics.

But the vapors may be doing much more than disturbing the bacteria. Earlier studies showed that traditional cigarette smoke, with its tar and tobacco-burning byproducts, can also weaken the ability of the body’s immune cells to defend against the insult, making it harder to fight off infections. Crotty Alexander is starting to analyze human cells to see if e-cig vapors have the same effect. She’s narrowing down which components of e-cigs contribute to the antibiotic resistance – some e-juices are made with propylene glycol, while others contain a vegetable-based glycol, and not all contain nicotine.

MORE: E-Cigs Still Produce Carcinogens, Study Shows

So far, it looks like the nicotine may be driving the MRSA biofilms, but Crotty Alexander is doing more research to determine how e-cigs are affecting human immune cells. As the survey of smokers shows, however, they may already know the answer.

TIME mrsa

Bacteria Thrive For Days On Airplanes

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You’re not the only one squeezed into that airplane seat – you’ve got lots of invisible company

Every time you take your seat on an airplane flight, you’re traveling with some hidden companions, courtesy of the passengers (or more likely the passengers) who came before you.

No surprise that airline cabins, from the seats to the seat pockets and the tray tables and lavatories, are blanketed with germs. Here’s a scary fact – the average human loses 30,000 to 40,000 skin cells every hour, and our skin is covered in bacteria – some of which are harmful. An estimated 1% to 2% of people in the U.S. may be carriers of methicillin resistant staphylococcus aureus (MRSA), for example, which can produce sores on the skin and be life-threatening if it enters the bloodstream, many without showing any symptoms. So imagine what you leave behind on a transcontinental flight. But can those discarded cells make you sick?

MORE: Antibiotic Resistant Genes Are Everywhere, Even in Arctic Ice

The first step to answering that question is figuring out if the microbes can actually survive long enough in a plane cabin for unwitting passengers to get infected. And researchers at Auburn University confirmed that yes, the bugs are pretty good at making practically every surface in a plane their home. Kiril Vaglenov, a post doctoral fellow in materials engineering, and his colleagues did what most of us wish we could before every flight – in the lab, they sterilized six surfaces normally found in a cabin, from the seats to the toilet handles by irradiating them with gamma radiation. Then they did something none of us would – they intentionally infected these surfaces with some unwelcome bugs – MRSA and E. coli 0157, which causes severe diarrheal disease.

MRSA found the seat pocket material a particularly cozy habitat, surviving for as long as 168 hours there, while E. coli preferred the rubber armrest, where it lived for up to 96 hours. But the most hospitable surfaces for keeping the microbes alive weren’t necessarily the most dangerous ones for picking up the bugs. Vaglenov used pig skin as a proxy for human hosts (who wants to intentionally exposed themselves to MRSA or E. coli?) and used simulated saliva and sweat solutions containing the microbes. He found that the more porous the surface, the longer the bacteria survived, and the lower their ability to infect, since the microbes tended to burrow deep in the threads and pores of the material. So the non-porous metal flush button in the bathroom, for example, was more likely to transmit microbes than the seat pocket, even though bacteria could survive longer in the seat pocket. Here’s the breakdown of the germiest surfaces in the cabin:

  • Seat pocket 8 days
  • Rubber arm rest 7 days
  • Leather seat 7 days
  • Plastic window shade 3 days
  • Plastic tray table 3 days
  • Steel toilet handle 2 days

“The findings are potentially a call to arms for the airline industry who may wish to take a page from the healthcare industry and apply cleaning products or use antimicrobial fabrics in the cabin,” says Michael Schmidt, professor of microbiology and immunology at the Medical University of South Carolina who studies antimicrobial strategies and was not involved in the study.

MORE: Science Confirms Dollar Bills Are Covered in a Bajillion Gross Germs

The lesson? Just as they do in hospitals, where they can live for up to a year, bacteria are quite at home in a plane. Which means that they can easily jump from a tray table to a passenger and cause disease. “If the bacteria do not survive there is no transmission,” says Vaglenov, who presented the results at the annual meeting of the American Society for Microbiology. “And there is no infection if the bacteria are not transmitted in an viable state. We found they survive and they are viable.”

MORE: What You Need to Know About Staph

In this study, he did not test the levels of the bacteria after the disinfection that airlines do, but he plans to do that using less dangerous strains of microbes, and human subjects, in future studies.

In the meantime, he says, it makes sense for the airline industry to consider whether different sanitation strategies are needed to protect passengers. Hospitals use peroxide vapors or ultraviolet light to penetrate fabrics found in furniture to ferret out microbes, for instance. As the cruise industry learned with the norovirus, microbes are quite good at turning confined spaces packed with inviting human hosts into a playground of infection.

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