What is really in our food products and is FDA keeping an eye on it?

The FDA was established as a regulatory overseer to ensure implementation of the 1906 Pure Food and Drugs Act, a law a quarter-century in the making that prohibited interstate commerce in adulterated and misbranded food and drugs. Its official title 'Food and Drug Administration' was given in 1930.

Since then FDA has been entrusted with the task of " protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation" ( as defined on the FDA website)

But it is starting to become apparent that some food product manufacturers have found ways around the regulations that ensure public safety, most commonly used is a legal loophole, introduced in 1958, that allows use of additives in food products if deemed by them as 'generally recognized as safe' (GRAS). The most well known example of GRAS is partially hydrogenated fats.

As defined on the FDA site: "Under sections 201(s) and 409 of the Federal Food, Drug, and Cosmetic Act (the Act), any substance that is intentionally added to food is a food additive, that is subject to premarket review and approval by FDA, unless the substance is generally recognized, among qualified experts, as having been adequately shown to be safe under the conditions of its intended use, or unless the use of the substance is otherwise excluded from the definition of a food additive."

Thus these additives may not require FDA approval or oversight if declared as safe by industry experts. It is at the food companies' discretion whether to ask for FDA for approval or declare them harmless using the GRAS loophole. Such an evaluation by the food company is not required to be reviewed by the FDA, yet again the decision lies with the food companies.

What is worrisome is that in recent years several safety of such GRAS ingredients has been disputed by scientists and consumer groups. There have been documented cases where some GRAS additives have led to serious allergic reactions or other health issues.

The fact is that American consumers are ingesting food products with ingredients that have not be scrutinized and approved by the FDA. The long term effects of such ingredients on general health are not known or understood.

As pointed out in the NPR news article "Why The FDA Has Never Looked At Some Of The Additives In Our Food "
This is true of one of the most known — and vilified — GRAS additives: partially hydrogenated oil, a form of trans fat. Widely used in food products including fried foods and cake mixes, trans fats have been named by public health experts as a contributor to heart disease, stroke and Type 2 diabetes. Despite strong pushback from industry, the FDA in November 2013 made a tentative determination that artificial trans fats should not have GRAS status, and the agency is likely to make that determination final this summer.

The general assumption that these GRAS ingredients are safe is no longer being accepted by major consumer groups. These are now pushing for higher standards of review and scrutiny by FDA.
 
Researchers for the Pew Charitable Trusts and the Natural Resources Defense Council say that allowing companies to make safety determinations without telling the FDA makes it nearly impossible to identify whether there are health effects caused by long-term exposure to certain ingredients.
Their concerns are heightened because safety decisions often rest in the hands of a small group of scientific experts selected by companies or consulting firms with a financial incentive to get new ingredients on the market. Several of these scientists, a Center for Public Integrity investigation found, previously served as scientific consultants for tobacco companies during the 1980s and 1990s, when the tobacco industry fought vigorously to defend its products.

Unfortunately the steps being taken to control the increasing number of GRAS ingredients being used by food companies are lagging behind, as mentioned in the article;
In the past five decades, the number of food additives has skyrocketed — from about 800 to more than 10,000. They are added to everything from baked goods and breakfast cereals to energy bars and carbonated drinks.
Meanwhile, the FDA's food additive approval system has slowed to a crawl — the average review takes two years, but some drag on for decades.

Many industry experts feel these concerns are exaggerated, but as a consumer we need to take time to read food labels and try to make informed decisions of our own. After all the consequence of what we put in our bodies will primarily effects us and our families.

 


 
 

How much benefit do we really get from Organic food?

Most people myself included tend to think of organic foods as healthier and safer. But that may not always be the case, points out Tamar Haspel in her recent article in The Washington Post's Health and food section. To make it simple she simply gives the evidence on the nutrition and contamination of both organic and conventional foods such as milk, meat, eggs, produce and fish. Here is a short excerpt of the article;

Is organic better for your health? A look at milk, meat, eggs, produce and fish.

Organic or conventional? It’s a choice many grocery shoppers are faced with, over and over. The price difference is easy to see; it’s right there on the product. The quality difference is much harder. Is the organic milk better for your kids? Is the conventional lettuce more likely to carry pathogens?

Leave aside for the moment whether organic agriculture is better for the planet and whether organic livestock have better lives, although there’s a strong case for both of those arguments. Leave aside flavor, too, because it’s subjective and variable. What motivates many organic buyers, particularly the parents of small children, is health benefits, and there are two questions: Do organics do us more good (in the form of better nutrition), and do they do us less harm (in the form of fewer contaminants and pathogens)? 

Milk 
 
Nutrition: Compared with conventional milk, organic milk has higher levels of omega-3 fats, which protect against heart disease and may decrease the risk of depression, stroke, cancer and other diseases, but the quantities are too small to be very meaningful. (It takes 11 quarts of organic milk to equal the omega-3s in four ounces of salmon.) Milk’s omega-3 content is a function of the cow’s diet, and higher levels reflect more grass. (A few other nutritional differences between organic and conventional milk have been studied, but there isn’t enough research to draw conclusions.)
Contamination: Neither organic nor conventional milk contains antibiotics. By law, every truckload of milk, organic and conventional, is tested for veterinary drugs, including antibiotics, by trained dairy workers. Any load that tests positive is pulled out of the food supply.
Hormones: The issue with milk is that many conventionally raised dairy cows, unlike organic ones, are injected with bovine growth hormone (BGH, the synthetic version of which is called either recombinant bovine growth hormone, rBGH, or recombinant bovine somatotropin, rBST) to increase their milk production.Both organic and conventional cows have IGF-I in their milk, but cows that get hormone treatment may have more of it.
The use of rBGH has fueled concerns among some parents about giving milk to children, but the FDA report concluded that “consumption by infants and children of milk and edible products from rBGH-treated cows is safe.”
Bottom line: Organic milk has higher omega-3 fat levels, but probably not enough to make a difference. Exposure to pesticides, contaminants or hormones is not a significant risk in either organic or conventional milk.
 
Produce

Nutrition: Many studies have compared the vitamins, minerals, macronutrients and other compounds in organic and conventional produce, and a 2012 review concluded that the results were all over the map. The one exception was that the phosphorus content of organic produce is higher, although the review, done by Stanford University scientists, calls that finding “not clinically significant.”
Contamination: There are two issues for foods that grow in the ground: pesticides and pathogens. There is widespread agreement that organic produce, while not pesticide-free, has lower residue levels and fewer pesticides.
Carl Winter, a toxicologist at the University of California at Davis, says that the Environmental Protection Agency, working from animal research and factoring in the special sensitivities of human subgroups such as babies and children, has found that lifetime risk of adverse health effects due to low-level exposure to pesticide residue through consumption of produce is “far below even minimal health concerns, even over a lifetime.” 
As for pathogens, the 2012 Stanford review found that E. coli contamination is slightly more likely in organic than conventional produce.
The best strategy to reduce risk from produce isn’t to buy either organic or conventional. Rather, it’s to cook your food.
Bottom line: While there may be no significant nutritional difference between organic and conventional produce, organic does have lower levels of pesticide residue. However, there isn’t universal agreement on the risk those residues pose.
 
Meat
 
Nutrition: As with milk, the main issue here is omega-3 fats. Some organic meat and poultry have more of them than conventional products do. The reason is diet: Animals that eat more grass have lower fat levels overall and higher omega-3 levels than animals fed more grain.
Although measurements of omega-3 fats in beef vary, the numbers are low and substantially below what can be found in a serving of salmon.
Contaminants: The USDA randomly tests carcasses for residues of pesticides, contaminants and veterinary drugs including antibiotics. In 2011, it screened for 128 chemicals, and 99 percent of the tested carcasses were free of all of them.
It found a few with residue violations and a similar small number with residue within legal limits (mostly of arsenic and antibiotics). Although the USDA doesn’t report organic and conventional separately, contaminant risk overall is extremely low.
The bigger concern is pathogens. Studies of bacterial contamination levels of organic and conventional meat show widely varying results. These findings suggest that organic meat may be slightly more likely to be contaminated, possibly because no antibiotics are used. But conventional meat is more likely to be contaminated with antibiotic-resistant bacteria. But the risk in meat overall was essentially the same. And whether meat is conventional or organic, the solution is adequate cooking.
Bottom line: Grass-fed beef has a slight edge over grain-fed because of higher omega-3 levels, but the amounts are probably too small to affect human health.

Eggs
 
Nutrition: As with milk and meat, the omega-3 levels of eggs are affected by the hens’ diet and can be increased by pasturing or diet supplementation for either organic or conventional hens. Eggs high in omega-3s are generally labeled.
Contaminants: There’s very little research on contaminants in eggs. The 2012 Stanford review concluded that there is “no difference” in contamination risk between conventional and organic eggs.
Bottom line: There are no significant differences affecting health between organic and conventional eggs.  

Fish
 
The USDA has not issued any organic standards for farmed fish or shellfish, but several overseas organizations have. (Because there’s no way to control the diet of wild fish, “organic” doesn’t apply.) Canadian standards prohibit antibiotics and hormones, restrict pesticides and set criteria for acceptable feed. There’s not enough research comparing organic and conventional fish to draw any conclusions about their health benefits.


Reference:
Is organic better for your health? A look at milk, meat, eggs, produce and fish.


(The Washington Post- Health, Science and Environment 07/04/14)

Millions living with leprosy in spite of being curable

On January 26th The World Day of Leprosy, I saw a video on The Guardian global development news page by Maria Zupello  titled Leprosy in Brazil: Uncovering a hidden disease. Realizing that leprosy is still around was rather disturbing, especially because this is a curable disease and therefore there should be no such thing as living with leprosy in these times, but after doing some research it became apparent that is not the case.

WHO: Leprosy Statistics:

According to the World Health Organization's latest stats on leprosy in the world, there are still around 200,000 reported new cases of leprosy every year in the world. Also known as Hansen's Disease, leprosy is endemic in 91 countries around the world. The highest concentration of reported new cases (at the start of 2012) being in South East Asia (117,147). The majority of which are in India. The second highest incidence is in the Americas (34,801),  of these reported new cases the majority are from Brazil. But because of its long incubation period and the lack of tools to allow early detection leading to late diagnosis, the exact prevalence of Hansen's disease is not clear.

India:
Although the Indian Government declared it has eliminated leprosy in 2005. It has since then become clear that the claim was premature. Of the total leprosy cases in the world 55% are in India, and about 127,000 new cases were reported between 2010-2011. Besides lack of access to basic healthcare services, leprosy patients also suffer socioeconomic isolation as a result of the stigma and discrimination that still exists in India.

Brazil: 
Leprosy is more prevalent in Brazil than in any other country except India. More than 30,000 new cases are diagnosed each year. Despite economic development, expansion of public healthcare, and efforts of the leprosy control program in the past 30 years, this disease has not been eliminated, and new cases are still being detected. The leprosy control program in Brazil distributes free drugs as part of the World Health Organization multidrug regimen for treatment of leprosy. Unfortunately health care services are not available in rural parts of the country. The amazon region of Brazil where leprosy has been endemic for more than a century is almost deprived of such health services.

Leprosy is particularly prevalent among the poorest and most marginalised communities due to their lack of access to healthcare, poor sanitation and congested living spaces. - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

Government statistics under estimate the extent of leprosy according to research organisations, NGOs and some medical personnel who argue that leprosy cases are on the rise - See more at: http://www.tlmindia.org/index.php/about-leprosy/facts#sthash.zlOMnaBW.dpuf

To understand why the stigmatization, socioeconomic isolation, discrimination leading to leprosy communities in countries like India and Brazil is so wrong, here are some basic facts about Leprosy( Hansen's Disease);

What is Leprosy?

Leprosy is a chronic bacterial disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. This infection primarily affects the skin, peripheral nerves and upper airway. It is well known that leprosy is not spread through casual contact. 

About 95% of human beings are naturally immune making leprosy the 'least contagious communicable disease'. The World Health Organization suggests that it is transmitted through moisture from the nose and mouth during frequent and close contact with an untreated leprosy-affected person. It might also happen if you are exposed to other nasal fluids (also known as secretions). Droplets and other secretions can contain the bacteria that cause Hansen’s disease. If you breathe these in, you can become sick with the disease.

According to the CDC,  as incubation period of the bacteria is long , it may take up to 2-10 years for signs and symptoms to appear. The disease mainly affects the skin, nerves and the mucous membranes. Common signs and symptoms include; disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored. Nerve damage can lead to loss of feeling in arms and legs and muscle weakness. Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.

Treatment of Leprosy

Leprosy can be cured. In the last two decades, more than 14 million people with leprosy have been cured. The World Health Organization provides free treatment for all people with leprosy.

Treatment depends on the type of leprosy that you have. It is treated with a combination of antibiotics. The treatment may last anywhere from 6 months to 2 years. People with severe leprosy may need to take antibiotics longer. Antibiotics cannot treat the nerve damage.

Anti-inflammatory drugs are used to control swelling related to leprosy. This may include steroids, such as prednisone.

Patients with leprosy may also be given thalidomide, a potent medication that suppresses the body's immune system. It helps treat leprosy skin nodules. Thalidomide is known to cause severe, life-threatening birth defects and should never be taken by pregnant women.

According to the WHO 'Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 population. Only a couple of endemic countries have still to achieve this goal at the national level; most are now applying the same elimination strategy at regional, district and sub-district levels. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.

Most countries that were previously highly endemic for leprosy have achieved elimination at the national level and are intensifying their efforts at regional and district levels.'

Information campaigns about leprosy in high risk areas are crucial so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment. The most effective way of preventing disabilities in leprosy, as well as preventing further transmission of the disease, lies in early diagnosis and treatment with MDT. (WHO)

P.S: 
The Leprosy Mission India 
The Leprosy Mission Canada  
Hansen's Disease (CDC) 
Leprosy (WebMD)
Leprosy Today (WHO) 
National Hansen's Disease Program (HRSA) 
Watch Video: Leprosy in Brazil: Uncovering a hidden disease (The Guardian)

Watch Video: Battling leprosy in Brazil(BBC World)

Watch Video: Leprosy: India's Hidden Disease (The Guardian)

Photo Gallery: Colonia Antonio Alexio - Leprosy community in Manaus, Brazil (Photojournalist: Sharon Steinmann)

High Incidence of Diseases Endemic to the Amazon Region of Brazil, 2001–2006 (CDC)

 

The rise of the drug-resistant infections

For many decades after the discovery of the first antibiotic, we have been able to root out and beat bacterial infections after bacterial infections. But when the medical professionals celebrated this invincibility with the widespread use of antibiotics, most of them forgot the fact that bacteria like any other life form know how to evolve. And thus after being victorious against even the most aggressive and deadly infections for almost a century, we are now facing a new breed of bacteria that have learned to survive even the strongest drugs in our antibiotic arsenal.

According to the CDC Antibiotic Resistant Threats 2013 Report;
Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.
In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. difficile) infections.In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented.
The most aggressive and lethal drug resistant infections are caused by gram-negative bacteria, which are mostly seen in healthcare settings, but other forms of bacteria are also showing presence of drug-resistant strains. As to who is more likely to be at high risk, according to the report, it is often individuals with suppressed, weak or damaged immunity. But many innovative treatments require effective treatment of any infection, as a result it is becoming very difficult to offer such options to individuals with other pre-existing conditions, such as diabetes, rheumatoid arthritis, and asthma.
Some of the common medical situations in which doctors are faced with this dilemma are;

1. Cancer Chemotherapy
2. Complex Surgeries (eg. Joint replacement, Cardiac Bypass)
3. Rheumatoid Arthritis
4. Dialysis for End-Stage Renal Disease
5. Organ and Bone Marrow Transplants

What makes these new infections worrisome it the fact these can happen anywhere. Data has shown that majority of these happen in the general population but the antibiotic resistance mostly develops in a healthcare setting such as a hospital or nursing home.


The CDC also classifies these drug-resistant superbugs by threat levels: 
Urgent:

These are high-consequence antibiotic-resistant threats because of significant risks identified across several criteria. These threats may not be currently widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission.

Serious:

These are significant antibiotic-resistant threats. For varying reasons (eg.,low or declining domestic incidence or reasonable availability of therapeutic agents), they are not considered urgent, but these threats will worsen and may become urgent without ongoing public health monitoring and prevention activities.

Concerning: 

These are bacteria for which the threat of antibiotic resistance is low, and/ or there are multiple therapeutic options for resistant infections. These bacterial pathogens cause severe illness. Threats in this category require monitoring and in some cases rapid incident or outbreak response.

The report in the end points to the lack of certain measures that might help, as a result, these are some of the suggested steps, that might allow healthcare professionals everywhere, better understand and cope with this serious growing medical problem, include;

 An efficient capacity to detect and respond to urgent and emerging antibiotic resistance threats at national, state and federal levels.
-A collaborative systematic international surveillance of antibiotic resistance threats.
-Systematically collect data on antibiotic use in human healthcare and agriculture.
-More widely use programs to improve antibiotic prescribing practices in the United States.
-Promote the use of advanced technologies that can identify threats much faster then current practices.

P.S: 
CDC Antibiotic Resistant Threats 2013 Report
CDC sets threat levels for drug-resistant 'superbugs' (CNN News)

Heart Attacks, Strokes and Apples

We all heard our parents encouraging us to eat fresh fruit and vegetable, specially apples, and all of them used the old Victorian saying " An Apple a Day Keeps the Doctor Away" to further motivate us. Well, more then a century later it still holds true, especially for the above 50 population.
According to an article published in the christmas edition of the British Medical Journal, a research study led by Dr Adam Briggs of the BHF Health Promotion Research Group at Oxford University came to the conclusion that about 8500 deaths from heart attacks and strokes could be averted if all adults of 50 years and above were prescribed an a apple a day. The significance of this outcome is more apparent when compared to another recent study that showed that if adults 50 and above not already on it, were prescribed statins, it could prevent about 9400 deaths from heart diseases. 
Dr. Adam Briggs says 'It just shows how effective small changes in diet can be, and that both drugs and healthier living can make a real difference in preventing heart disease and stroke.' But the researchers stress that this does not encourage individuals already on statins to stop taking them, just try adding apples to your daily diet.
Although apples appear to be exceptionally good for maintaining a healthy heart, it is clearly essential to eat a variety of fresh fruits and vegetable on a daily basis to stay healthy.





P.S:
An Apple A Day Keeps The Heart Doctor Away (University of Oxford)
Apple Nutrition and Composition Facts(USDA Database)

What are the real benefits of antibacterial soaps, if any?

Probably because of my medical background I have always worried about the indiscriminate use of antibiotics, which can consequently create antibiotic-resistant bacteria called 'Super Bacteria'. Treating the infections caused by these super bacteria can be a nightmare, often leading to disastrous outcomes, even death.

It is in the same vein, I have always been a bit skeptical of the antibacterial soaps sold to consumers. Since antibacterial soaps are supposed to be killing everyday bacteria we end up collecting on our hands, they are also indirectly creating super bacteria. And besides that these antibacterial soaps are also killing off the normal bacterial flora on our hands. 

What is normal bacterial flora on our hands?

According to the 'WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care.' and Medical Microbiology. 4th edition :
The bacteria found on our hands can be divided into two types; namely resident and transient. The resident bacteria being the ones normally residing on our hands, these predominantly include Gram-positive organisms (e.g., staphylococci, micrococci, diphtheroids). The resident flora primarily plays a protective role by providing microbial antagonism and the competition for nutrients in the ecosystem. Hence the resident flora rarely causes infections.
The transient bacteria are the one we acquire through contact with infected individuals or surfaces. These can lead to infections and spread from person to person. This transfer of bacteria through direct contact is highest in health care workers. In fact their hands may constantly become colonized by some pathogenic flora such as Staphylococcus Aureus and Gram-negative bacilli.

The main bacteria killing ingredient in majority antibacterial soaps is Triclosan. Although Triclosan is meant to rid our hands of the transient kind of bacteria, over time it indiscriminately also kills the resident kind. 

What is Triclosan?

According to the FDA Consumer Update on Triclosan:

'Triclosan is an ingredient added to many consumer products to reduce or prevent bacterial contamination. It may be found in products such as clothing, kitchenware, furniture, and toys. It also may be added to antibacterial soaps and body washes, toothpastes, and some cosmetics—products regulated by the U.S. Food and Drug Administration (FDA).'

'Triclosan is not currently known to be hazardous to humans. But several scientific studies have come out since the last time FDA reviewed this ingredient that merit further review.

Concerns about Triclosan:

According to the FDA Consumer Update on Triclosan:

'Animal studies have shown that triclosan alters hormone regulation. However, data showing effects in animals don’t always predict effects in humans. Other studies in bacteria have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics.

In light of these studies, FDA is engaged in an ongoing scientific and regulatory review of this ingredient. FDA does not have sufficient safety evidence to recommend changing consumer use of products that contain triclosan at this time.

For some consumer products, there is clear evidence that triclosan provides a benefit. In 1997, FDA reviewed extensive effectiveness data on triclosan in Colgate Total toothpaste. The evidence showed that triclosan in this product was effective in preventing gingivitis. 

For other consumer products, FDA has not received evidence that the triclosan provides an extra benefit to health. At this time, the agency does not have evidence that triclosan in antibacterial soaps and body washes provides any benefit over washing with regular soap and water.

We are engaged in a comprehensive scientific and regulatory review of all the available safety and effectiveness data. This includes data relevant to the emerging safety issues of bacterial resistance and endocrine disruption due to triclosan in FDA-regulated products.'

On December 16  2013, FDA finally came out with the verdict FDA Taking Closer Look at 'Antibacterial' Soap.  Colleen Rogers, Ph.D., a lead microbiologist at FDA stated that "there currently is no evidence that over-the-counter (OTC) antibacterial soap products are any more effective at preventing illness than washing with plain soap and water." She goes on to say "New data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits."

The update states "In light of these data, the agency issued a proposed rule on Dec. 16, 2013 that would require manufacturers to provide more substantial data to demonstrate the safety and effectiveness of antibacterial soaps. The proposed rule covers only those consumer antibacterial soaps and body washes that are used with water. It does not apply to hand sanitizers, hand wipes or antibacterial soaps that are used in health care settings such as hospitals.

According to Rogers, the laboratory tests that have historically been used to evaluate the effectiveness of antibacterial soaps do not directly test the effect of a product on infection rates. That would change with FDA's current proposal, which would require studies that directly test the ability of an antibacterial soap to provide a clinical benefit over washing with non-antibacterial soap, Rogers says."

In the end, it seems to be wise to continue washing our hands with just plain ol' soap and water, and postpone the use of these fancy antibacterial soaps till further notice. 



References:
Dangers of Antibiotic Resistance
WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care.
Medical Microbiology. 4th edition 
FDA Consumer Update on Triclosan
FDA Taking Closer Look at 'Antibacterial' Soap.