Foodborne diseases: The case of the innocent-looking berries

'Berries' by Jeremy Cherfas
under a CC license

It's been about two-and-a-half years now that cases of hepatitis A have been appearing in Europe. Further analysis, as quoted by the European Food Safety Authority, has shown similarities in the viral genome across the majority of those cases. That is an indication for a common source of infection, which - currently - is believed to be frozen berries. So far, 11 countries in Europe are known to have been affected. (A similar-sounding story that appeared in the US seemed to be coincidental and it was attributed to imported pomegranate seeds.)

Technically, the term "berries" covers a wide variety of fruits although it is normally used to describe small, juicy, bright-coloured fruits, such as blueberries, strawberries, blackberries, blackcurrant, etc. They can be eaten raw but they are also extensively used as ingredients either raw or as preserves in other foodstuffs, such as creamy desserts, parties, flavoured ice-creams, various alcoholic beverages, etc.

In some of those products the berries find themselves in having had minimal - and sometimes non-thermal - treatment. That provides ground for pathogens and, in the case of hepatitis A, the hepatitis virus that may lie on the surface to survive.

Locations of the hepatitis A outbreaks attributed
to a common, continuous source in the EU/EEA,
possibly frozen berries; Compiled from Source:
European Centre for Disease Prevention and
Control and the European Food Safety
Authority,  2014; Outbreak of hepatitis A in
EU/EEA countries - Second update. EFSA
supporting publication 2014:EN-581. 14 pp.

Hepatitis A is a disease usually transmitted via the consumption of food or water contaminated by infected fecal matter. It has a very long incubation period that can reach up to 50 days and, in some cases, it is asymptomatic, i.e., the people infected do not display any symptoms of illness (but they can transmit the virus).

While the food law in Europe requires food businesses to keep traceability records when receiving or providing food products or ingredients to other food business operators, including retailers, linking the hepatitis A outbreaks to a particular contaminated ingredient and tracing it back to a single source has proven to be very challenging.

The main reasons for that are the long incubation period of the disease and the complexity of the food chain, especially when dealing with multi-ingredients food products. Thus, when a case of hepatitis A is confirmed, pinpointing the source of the infection would require the patient to identify foodstuffs he/ she had consumed over a very long time (up to 50 days before the onset of symptoms), an exercise that is nearly impossible to execute in a fully accurate way. Then the ingredients and the processing of the individual foods needs to be considered in order to select the ones likely to have been vehicles for the virus. Then those should be traced back the food chain. With luck, superimposing the trace-back routes of different cases infected by the same virus strain could, at some point, help identify the starting point of the contamination.

Although hepatitis A is not normally a deadly disease (for reasonably healthy adults), it can be a rather "unpleasant" experience. Thankfully, consumers can minimise the risk by boiling frozen berries for about one minute; this will destroy the virus if present on the berries. Simply rinsing the berries with tap water may not be enough; depending on the type of the berries, they may have a large total surface with lots of niches where water cannot really reach (not to mention that fruits tend to have a hydrophobic surface... which reminds me of an older - yet irrelevant - post).

Moral line of the story - if there needs to be one: Risk communication, i.e., telling consumers (and businesses) what the hazard, the risk and the reasonable mitigation measures are, preferably in plain language, can be very effective when everything else fails.

Bugs: Coming soon in an ice-cream near you!

'Nanners and Rummy Raisin
Ice Cream"' by ulterior epicure
under a CC license

Within a few days after our birth our intestines get populated by numerous bacteria. Such bacteria will, normally, keep us company until the end of our lives. With them, we are connected by a bit more than a mere co-existence. Current knowledge describes our relationship with plenty of the gut flora microorganisms as "symbiotic": we feed them, provide warmth and shelter to them and in return the keep our guts safe from pathogens, train our immune systems and release metabolites of theirs, some of which are necessary for us. Well, that relationship does go pear-shaped occasionally, but life is full of messy stuff, isn't it?

The interesting thing is that the more we look into our intestinal population the more links we find between their existence and our lives. Yesterday, the New Scientist was highlighting research findings on rats, which suggest that the composition of the gut flora has an effect on appetite, initially, and, later on, changes in the body weight: Changing the gut flora of obesity-resistant rats to that of the obesity-inclined one increased the appetite, firstly, and the weight, secondly, of the former.

Weight changes and the composition of the gut flora is nothing new. In 2006, the New Scientist featured a corresponding article. It was based again on research carried out on mice. That time they compared normal μmice with ones that had been living in sterile conditions and, thus, had no microorganisms within their digestive track. Those mice tended to stay slim. Having their gut populated by the flora of the normal mice lead to a body weight increase of about 25%. If the flora used was similar to that of obese mice, the weight gain was much higher. That observation was attributed to the effect of the gut flora on the food that passes via the intestines; the microorganisms living there help metabolize it more efficiently, thus producing more energy the mass unit than without their intervention. The more efficient the microorganisms are, the higher the weight gain for mice.

Combining the two observations there are several questions that come to mind:

• Let's assume that gut flora that is more efficient in processing the food we normally eat leads to us getting more calories out the food. Temporarily, that will lead to weight increase unless we either reduce our food intake or increase our physical activity. However, it is suggested in the 2012 article that the appetite (of rats) is enhanced. Does this mean that the flora microorganisms mess with the energy intake - appetite mechanism of the host? And if yes, is that a temporary effect? What pathway does it messes up with?
• Since the gut flora lives on what food we consume and on the metabolites secreted by our cells, locally, do they have any mechanism to "encourage" us to eat the food that is most nutritious to them? I don't necessarily refer to "mind-control" but to any pleasant or unpleasant symptom that may encourage or discourage us from eating stuff that "tastes" nice or not-so nice, respectively, to our intestinal guests.
• Is it possible to sustainably change one's gut flora in such a way that it will lead to better weight control? Can this be done in a safe way? What will be the catches (because, surely, there will be at least one downside!)?

The last point carries particular weight for the food industry. Foodstuffs with probiotic content have been consumed practically since the beginning of civilisation; fermented dairy products being a common example. Recently, the trend has expanded and, for some time, probiotics (and prebiotics) became central to what is typically referred to as "functional food".

'Strawberry Panna Cotta'
by Matthew S. Cain under
a CC license

If probiotic microorganisms can indeed help maintain a healthy body weight, without negative side effects, they could become particularly interesting for foods that tend to be tempting and are often responsible for making a weight-loss diet feel particularly punishing.

Ice-cream is a good example. The idea has been explored a few years ago and there seems to be little concern for technological limitations. Household-oriented recipes have also been available for - say - yoghurt ice-cream or more exotic stuff, such as kefir-based chocolate ice-cream.

Having said that, I find the path of "slimming" foods to be a potentially slippery one. Regardless of how pleasant the thought is of devouring tons of yummy ice-cream and, still, lose weight, the wise thing to do is seek for a healthy, balanced diet and live a life with plenty of physical activity. And then, why not, enjoy the occasional scoop or two of our favourite dairy vice....

To eat or not to eat (it): The never ending quest for safe food

'Crystal ball take #1'
by Isobel T under
a CC license

Food safety has always been high on the agenda of state authorities, the industry and - of course - the consumers. Asking for the food we have access to to be safe is a reasonable expectation. One that sounds much easier that it actually is!

The more ingredients are employed in food production, the longer the route they follow before ending in a product, the more complex the food supply chain becomes, the higher the number of potential hazards. But, relax, that doesn't mean that the end-product will be unsafe. Practices are in place (and the EU those practices are dictated by law and enforced) to ensure that at any stage hazards are identified and controlled so that the final product is safe. Further to that, the Food Authorities operate sampling programmes and perform inspections so the overall risk is kept at very, very low levels. In fact, I suspect that the risk of consuming spoiled food due to improper storage or handling at home (or in mass catering establishments) may be an equally or more important factor to have in mind when discussing food safety!

Regardless of how things are at present, it is valid to say that a chain is a strong as its weakest link. With new players joining the food production and distribution 'arena', with an increasing globalisation that does have an impact on food production and on consumer trends, with the climate change very much in progress, with incidents of contamination of scale sufficient to affect the food chain, with the evolution of bacteria and other life forms that can affect food safety and quality and - altogether - with the emergence of new hazards, the quest for food safety is really still ongoing.

Still though, as every new food crisis proves, the system is not perfect. Could it ever be? I would say, plainly, no. Pardon my cynicism, but I feel it is impossible to check all food reaching the consumer for all potential hazards. And I mean really all potential hazards, regardless of whether they are considered to be reasonably expected, rather-not-expected or completely unpredictable. Oh yes, the last two are also seen for time to time. The sunflower oil crisis was something like that.

Performing an analysis on a foodstuff is normally restricted to a single hazard factor or - at best - at a limited group of hazards. The analysis for salmonella, for instance, will not highlight the presence of other pathogens, unless a specific analysis for them is also carried out, nor will it reveal high heavy metal concentration, even if that were the case. Currently, a long list of analytical methods is at hand to reliably identify the presence (and quantity) of numerous contaminants in food. But while for each used method attention has been put in ensuring specificity, accuracy, reproducibility, etc. there is no easy way in testing food samples for their safety altogether.

Is that critical? Well, maybe not yet. But it may well make sense in times of tight budgets. It may also prove useful as a line of defense against emerging hazards, including bio-terrorism. The latter sounds a bit exotic, true (although it's not entirely a new story). But it remains a concern and it's always better to be ready and alert! Going slightly off-topic, it seems that DARPA has been identifying a number of dark possibilities (some of which could also be deployed via the food supply channels) and tries to identify viable counter-measures....

Today, to my knowledge, there are no methodologies practically applied to indicate food safety altogether.

Sensory analysis can give hints on the state of foodstuffs but it would only detect hazards that would affect the sensory profile of the tested sample; the simple presence of many of the common food pathogens, the existence of chemical contaminants, etc., would normally go unnoticed.

Intelligent packaging advances have taken steps towards that direction (e.g., microbial growth indicators, time-temperature indicators, shock indicators, etc.) but their deployment has been limited, mostly because of cost issues.

A number of spectroscopy and imaging (e.g., hyperspectral imaging) techniques have been developed but they are indented for the measuring of quality parameters for specific foodstuffs, mostly where there is the necessary monetary driving force (e.g., meat quality estimation).

The combination of new-generation, biotechnology-produced sensors, employing cell membranes or living cells or enzyme-containing membranes also seem promising as analytical tools. They tend to exhibit specificity but, given their low cost, they could be assembled into kits suitable for a pool of tests on a single sample.

I believe that we should go much beyond that. We should keep existing analytical methods and work on improving specificity, sensitivity, etc. but we should also develop tools that would allow a first yes/no assessment of the safety of foodstuffs. I wouldn't be surprised if that would come together with a generous error margin, initially (false positive and false negative results).

Maybe we could get some inspiration from the IT world. Take spam filters applied to e-mails, for instance. They have been employing a number of technologies. Initially, they were looking for specific words in the subject line or in the e-mail text. Others were trying to evaluate the 'reputation' of the originating e-mail server, checking against public blacklisting databases. Nowadays, however, spam filters are much cleverer and more adaptable. They evaluate e-mails against a set of rules and the have the capacity to 'learn' as you (the user) re-classify false-positive messages that were incorrectly flagged as 'spam and false-negatives that ended up together with the normal e-mail.

Would it be possible to define a set of criteria that would allow a machine-learning system to be used for evaluating the overall safety of a food sample? For sure, deploying such a system at a world-wide level would give it a lot of data to use for refining its model (the 'learning' process). Would that make a good first line of defense? Could we devise cheap and effective methods to fill in any gaps that such a system would have?

The IT world has also been using other methods that may be of interest here. Computer viruses, for instance, have been sought for using a signature-search approach, initially. That has considerably evolved - as computer viruses became more complicated and the systems that they targeted also changed. Process emulation is one of the alternatives employed.

For the record, the spaceships of the Star Trek series were lucky enough to have 'biofilters' that could identify and remove 'anomalies' in the matter they were processing, including pathogenic agents.

Thinking aloud, I assume that the ultimate test would be systematic consumption and observation but - obviously - that is not an acceptable approach! Could we, perhaps, have an ecosystem of bacteria that could do that for us? Their survival, flourishing or decline, in other words the change in the balance of the ecosystem could give clues on the hazard factors present in the sample... Just a thought I feel it might be worth looking into....

Thirsty?

'Water walker' by Navdeep Raj
under a CC license

What do you ask for when you feel thirsty?
Water, maybe?

It doesn't take much thought to reply to that, does it?

A couple of days ago (on 18/11, to be precise), The Telegraph featured an article titled "EU bans claim that water can prevent dehydration". The article comments negatively on legislation that follows an EFSA opinion, which rejects a health claim on the potential of water consumption against dehydration. The EFSA opinion is not a very new story but it seems to have resurfaced. The said article was also in slashdot yesterday, so I assume that it has received plenty of attention world-wide by now.

Interesting article, with negative bias, regardless of the fact that both quotes and facts are provided. The article suggests that EFSA's opinion and the subsequent legislative act are really against common knowledge and are, thus, wrong. Apart from that, according to the article, the whole process has been rather expensive (for the taxpayer). Only at the very end of the text does a supportive (for EFSA) opinion appears, with no further comments given.

Well, let's see where this case stands. The claim that was submitted to EFSA for their opinion was "regular consumption of significant amounts of water can reduce the risk of development of dehydration and of concomitant decrease of performance". It was submitted by two German professors (some internet sources say they are consultants for the bottled water industry) under Art. 14 of Regulation EC/1924/2006, which covers claims for the reduction of disease risk.

EFSA said (and repeated) that the submitted claim did not meet the requirements of Art. 14 for the reduction of disease risk. The European Federation of Bottled Water seems to agree. Dehydration is a state of the body and - itself - is not a disease, although it can be a side-effect/ symptom of various diseases. I admit, however, that EFSA's opinion has been written in a rather complicated way, where they seem to somehow accept dehydration as a disease before concluding that the requirements of the Regulation are not met!!! Strange....

To make things interesting, the responsible EFSA's panel had given favourable opinions on the role of water for "maintenance of normal thermoregulation" and for it being a "basic requirement of all living things" - both claims falling under Art. 13 of Regulation EC/1924/2006, which includes claims on "the role of a nutrient or other substance in growth, development and the functions of the body". In order words, it seems plausible that the claim was filed under the wrong classification. If that was really the case, EFSA should not be the one to blame for that.

It is clear that all nutrition and health claims submitted for consideration should be rigorously processed. That 's what the law foresees and that 's what is needed in order to protect the consumer and maintain a competitive - but fair - market. Submitting obvious (or stupid) claims doesn't mean that they won't go down the processing pipeline. And although that this comes with a price-tag, there's no safe way to go around that; there is no "obviousness" clause that would allow the EC (or EFSA) to accept or reject a proposed claim.

Going a bit beyond, I really wonder, what is the reason of having a health claim supporting that water can help against dehydration? If it is common knowledge (which it is), why apply for it? In any case, the EU law would prevent such a claim phrased in a way that it would benefit a particular product, since the beneficial function is performed by any drinkable water (yes, including tap water :-)

Was it an effort to prove that the system is broken? If that was it, then point taken. And then immediately, point put aside. Every system that is open to all and is committed to dealing with all has similar weaknesses. I've got nothing against improving a system, if that is needed, but passing the obvious through formal channels so as to see what happens is a questionable practice...

Food choice - a reading game

Nutritious food; gourmet food; fast food; healthy food; baby food; convenience food; organic food... Food constitutes a human need tightly integrated to most sides of our social existence. In several places around the globe (but not everywhere), people have access to a considerable variety of foodstuffs, while new products pop up on a daily basis, often dynamically co-existing with traditional ones at nearby supermarket shelves.

There, consumers have the chance to choose. A number of factors are known to get in the middle, including biological, economic and social factors. Understanding the process of making a food choice, is certainly a hot desire for the corresponding sector these days. And it's not only the marketing pressure, as you may think. Surely, the food industry would love to make products that are (or can become) more appealing to consumers. But since food is closely associated with other things like health, it would be really useful if the choices people would go for, would also be "healthy" ones.

But there is a thin line somewhere there! Yes, food does affect the functions of the human body. Although research is still ongoing, there is clear evidence that food and the function of the nervous system, of the immune system and of the metabolism - to name a few of the systems/ processes of the human body - are related. But to what extent can food, on its own, prevent or cure diseases? If a food-health link is substantiated for a specific foodstuff, could food producers go ahead and inform the consumer on the health benefit of that food?

In Europe, nutrition and health claims are governed by Regulation (EC) 1924/2006. That Regulation places restrictions on what can be claimed of a food label and provides templates for a number of claims. Any health claim made on food labels must be true, not misleading and clearly understood by the average consumer; the claimed benefit should be achieved by reasonable consumption (specified by the producer); it must not imply that the by not consuming the food in question the consumer's health will be negatively affected; it should be accompanied with notes on the importance of a healthy, varied diet and a healthy lifestyle, and warn consumers on potential hazards associated with excessive consumption.

Regarding health claims, the Regulation discriminates across several categories:

• Health claims that have to do with the general function of the organism
• Health claims that refer to psychological or behavioural function
• Health claims regarding slimming, satiety control, etc.
• Health claims on the reduction of the risk of a disease or the health or development of children

The authorisation of each new claim depends on the category it falls under. However, in any case, claims examined by the European Food Safety Authority (EFSA) need to be sufficiently substantiated by scientific evidence, strong enough to demonstrate a cause and effect relationship between the nutrient or food that carries the claim and the claimed benefit. Don't be mistaken on that; that is no trivial task (e.g., check out the EFSA panel's recent opinion on an application for a health claim of a product containing cranberry extract, or for the function of phospholipids).

Clearly, the law offers - in a controllable way - opportunities for food producers to advertise to the consumers health benefits that foodstuffs may help towards. Critics do exist in both opposing camps: pro-health claims and contra-health claims. However, few can ignore the fact that consumers today can have access to increasingly more information on what they eat. All one needs to do, is take the time to read a label. Although - as some fear - we may be having increasingly longer food labels within the years to come!

(Photo by http://www.flickr.com/photos/swamibu/ / CC BY-NC 2.0)

The knowledge in the closet

14/01 was a big day for the agro-, food- and bio- people around the world going after European research grants (it was the deadline for the 2010 KBBE call of FP7 - a public research funding instrument in Europe, giving about 53 billion euros to research in the period from 2007 to 2013).

The persistently pending question, however, is: what happens to the results of all that research? Understandably, not all research efforts are successful; and even when they are successful, they don't necessarily lead to tangible results. There 's really nothing wrong with that; research is a venture into the unknown (well, actually it is a venture in the not fully known, but let's not stick onto that for the time being), thus has associated risks, mostly of financial nature. It is also understandable that some of the research carried out will end up calling for further research in order to reach a ready-to-exploit stage.

But what is the amount of that ready-to-exploit scientific knowledge? The last few years (or decades) the need from knowledge exploitation has become a policy priority. I can't judge if that has led to substantial results (I have no means to measure in an objective way) but at least I feel that a higher number of people in universities and companies are rather aware that there are ways to protect, trade and - in general - exploit new knowledge.

The current system for intellectual property protection has been widely promoted as a helpful tool for the quest of knowledge utilisation. While I can see the pluses, I can't help but wonder what could other players do, that have limited access to the resources needed for such a game. And what about knowledge that is already available in an "unprotected" form, that is, either published or unpublished - being kept in a closet full of paper, data CDs and other archiving means.

Surely, even more of that knowledge could be exploited; if not at a big scale, at least at a micro-scale, through a cooperation of scientists will small companies under short-term projects of low, affordable budget; something like the sales that shops have, only for science :-)

As an example, think about the valorisation of the waste from the fish processing factories. The large production plants often produce fishmeal or fish oil out of that, using available equipment suitable for their volumes of production. At low production volumes, however, although the principles remain the same, it is likely that no optimised processes are commercially available, which would be a relatively easy task for an engineer to design. Interestingly, the original research on that must have worked on laboratory-scale volumes and, thus, is likely to be closer to the desired application.

The same applies for most of the waste outputs of farming, where biotechnology could provide solutions, sometimes with no further research being necessary. One could argue that the driving force of additional income from such as effort is simply non-existent in those cases; the value of the products derived from those exploitation processes is only achievable if one has a distribution and sales network reaching the right market. And then, there is the risk of producing surpluses of secondary products, thus leading to a drop of their market value. True and true. The right answer depends on the actual case but, in general, it takes an "unbalanced" action to break a vicious circle.

Cooperation frameworks around that idea have been tried in a number of countries with encouraging results (e.g. the innovation vouchers scheme that has been tried in many places, including Ireland, the UK, the Netherlands, Greece, etc.). However, with big grants around asking for ambitious research, the priorities of most researchers are not shaped towards "low-tech" cooperation with small enterprises. While I admit it would be stupid to suggest throttling the funding for innovative research, I believe that a stronger mandate for exploitation through small companies should begin to form.

Yes, there will be implementation problems (e.g., how many small food companies would put innovation as a priority instead of growing production volumes or sales figures? how many of those companies would be willing to participate in such schemes?). And yes, the existing legal framework may not be very flexible around food innovation (e.g., putting a health-related claim on a foodstuff is not a trivial process - and that has a pretty good reason behind that - I might add). But the potential benefits are many-fold:

• "Older" knowledge or published knowledge could find application in a way that could further benefit the original researcher or research group
• "Older" knowledge or published knowledge could be transformed to practical innovation at a higher pace than entirely new, breakthrough knowledge
  
• Small companies will get exposed to working together with scientists and vice-versa; possibly a beneficial exercise for both groups
• The public profile of food research will improve
• The mobilisation of private funds for research could be encouraged (many small sums of money instead of a few larger ones)
• The competition between food producers would benefit - even at the regional level

It might be worth considering it in a more thorough way, especially now that the global financial crisis has reminded to us that "big" doesn't necessarily mean "stable".

(Photo by http://www.flickr.com/photos/wiccked/ / CC BY-NC-ND 2.0)

Superbugs

A few days ago, just before the entry of 2010, I came across an article on the BBC News website on the undesirable effect that disinfectants may have on bacteria. The article was supporting the the incorrect use of disinfectants (e.g., incorrect dilution) could allow bacteria to develop resistance to antibiotics.

I am by no means an expert in microbiology, or even plain-vanilla biology, however, I was aware that overuse or misuse of antibiotics could lead to increased resistance to those antibiotics; a trait which, once acquired by a group of bacteria, can be passed onto others, under certain conditions. In the hospital world, where people (patients) often have a weakened immune system, MRSA is a considerable threat, while an increasing number of other pathogens (or potential pathogens) begin to exhibit threatening tolerance to the available antibiotics, turning from simple "bugs" to "superbugs".

To my understanding, the antibiotics-induced antibiotic resistance can be mitigated by a tight antibiotic-use regime. Sweden has had considerable success in tackling the MRSA problem by forcing the health care system to resort to antibiotics only when absolutely necessary. The transition period might have taken considerable time but the gain sounds considerable: they can still make good use of antibiotics that on many place of this world are now considered to be ineffective.

The article of the BBC I spoke of earlier, however, is alarming in the sense that not only antibiotics but also disinfectants (and possibly other bacteria control means???) can somehow lead to antibiotic resistance. Clearly, improper use of disinfectants, which allows for a select portion of the microbial population to survive, favours that surviving population in the sense that it eliminates the competition. I would assume that this process effectively ensures that the descending bacteria will have those gene combinations that allowed their ancestors to survive the disinfectant. It seems, if my understanding of the article is correct, that those "disinfectant-survival" gene combinations can also be effective against antibiotics.

The alarming bit is that the use of disinfectants is much, much wider than the use of antibiotics. There not only used by hospitals but by a very high number of businesses, including the food industry, and they are also at hand in the typical household. I admit it would be inconsiderate to extrapolate that all disinfectants, if misused, could lead to superbugs. The fact that the number of known supebugs is still rather a small one, while the use of disinfectants has been more-or-less systematic over the last decades would rather support that the risk is minor.

I mentioned the food industry before. Interestingly, the agro-food industry was alarmed, in the past, by the antibiotic resistance problem but managed to sort it out by adopting good livestock practices and by considerably limiting the use of antibiotics. In Europe, there is legislation in place to ensure that things stay this way. But what about the use of disinfectants? The manufacturers of such products do include instructions for use, which normally are followed. I wonder though, with the modern foodstuffs enjoying increasingly longer shelf-lives, are there any significant chances that microorganisms which find their way into foods can turn into threatening superbugs?

In "live" foodstuffs (i.e., foods that contain a flora consisting of living microorganisms, such as yogurt, fermented sausages, various cheeses, tea, etc.), which contain a small eco-system, it is likely to be much easier to keep things under control. An undesirable contamination would be worse in the case of previously sterilised (or poorly sterilised) products under packaging conditions that lack bacteria growth barriers.

In any case, and for any of the existing reasons (ranging from health and safety concerns to competitiveness and sustainability issues), it may be worth revisiting some of the practices in our every day "war" with bacteria.

The use of good practices when it comes to cleaning surfaces or when actually using antibiotics has been proven to be an effective one. The use of phages to fight off antibiotic resistant bacteria has also been tested - successfully I believe; although, I'm not sure if it can find wide scale application beyond the health sector. The manipulation of the microbial ecology could be another promising sector, which has recently re-attracted research interest; after all, it may be time to remember that microorganisms are our valuable friends far more often than otherwise (not only when it comes to the function of the human body).

(Photo "big bug", CC by G J Hutton)