Monday, April 04, 2011

The bugs are winning

Antibiotics are one of the truly remarkable discoveries of the modern era.* By suppressing or eliminating infections, the widespread availability of relative cheap antibacterial drugs has contributed to significant reductions in the mortality rate and consequent increases in life spans. Antibiotics have thus serves as an enabling cause for the unprecedented global population boom of the last century or so.

However, microbes may now have us at checkmate, developing resistances and immunities to our antibiotics faster than we are producing new ones. Despite five decades of warnings from public health authorities, global response has been slow and poorly communicated. Resistant strands are spreading and some are immune to all contemporary drugs.

And it is largely our fault. The overuse and misuse of antibacterial drugs have enabled and encouraged these strains to gain a foothold and spread. Whenever their use is either unnecessary or discontinued prior to a complete course, the surviving bugs (who will be the ones least susceptible to the drug) are left to breed. Just as we have "helped" evolution in our animal husbandry for centuries, selecting the most productive livestock to preserve their genes, so we are helping the evolution of superbugs, selecting those who don't fall down at the first sight of an antimicrobial drug. We are killing off the weaklings and leaving the heroes to breed. And they are fearsome warriors, being perhaps the most effective and feared killers throughout the history of civilisation.

Being the son of a physician, important health lessons like avoiding the abuse of antibiotics were inculcated early. We used them only for bacterial problems that lacked other solutions and always finished our course of drugs. Yet personal responsibility is only effective when widespread. My vigilance seems wasted when others take a few pills as a precaution every time they feel under the weather.

This issue seems to suffer from some remarkable similarities with climate change: a dangerous by-product of a highly desirable human activity with an insidious effect over long periods of time requiring global regulative co-ordination and a personal culture of restraint. It is hard to see in either case how a response adequate to the scale of the problem can be mobilised in the timeframe required amidst the various competing interests and under the ponderous influence of cultural inertia.

Like many of our battles, we go into this one ill-prepared, with failing equipment and not always even sure who the real enemy is. What does it look like to lose well?
*More specifically, I am referring to antibacterial drugs, since there are other microbes than bacteria and other agents that suppress them than antibacterial drugs. However, in common usage, most people mean the latter when using the term antibiotics.

16 comments:

stef said...

This is an enormous problem in the developing world where antibiotic use is far less regulated than in more developed countries, medical and other health practitioers are far less judicious in their prescriptions, and populations have far less health literacy to comprehend when to use such medicines. So many other competing interest too (and not only from big pharma) as doctors here often sell medications as well as prescribe them (which although against the law is hardly ever enforced) and so more medicines means more profits. Plus in a culture where technological solutions seem preferable to less intensive prevention its hard to persuade people they don't need more medicines.

I'm not at all sure how we can get this cat back in its bag.

byron smith said...

Yes, again, another parallel with climate change. The problem (at least its primary manifestation) is seen in the developing world, but really the blame is shared because it lies in the appropriation of "developed" aspirations and technologies as social panacea (that is, in the spread of hypercapitalism into the structures and consciousness of the developing world).

As members of the developed world, I believe one of our chief responsibilities (at a personal level) is to discover the joy that lies in embracing less, realising the possibility of flourishing without being consumed by our consumption. Of course, there are also critical political responsibilities that we share, perhaps most notably reforming or replacing the hypercapitalism (with its nexus of individualism and fiscalism) that is the cause of so many of these ills in the first place. Finding and attempting alternative models of political and economic life (as well as rediscovering spiritual life in relationships and hope for the kingdom rather than material goods) is of critical importance.

Thanks for sharing your experience.

Sarah said...

Hey Byron,

I agree with you wholeheartedly on this one. Even scarier is the fact that bacteria can easily engage in inter-species DNA swaps, thus "passing on" the antibiotic resistance to others! The Post-Antibiotic Apocalypse, as I've heard it called, is indeed a sobering prediction. I'm glad to hear you talk about it; I've rarely heard anybody else mention it. I fully expect this to become the biggest cause of human death in the oncoming decades...or century...or whenever it is exactly that our antibiotics stop working.

The only glimmer of hope I see here is that resistance to bacteriostatic and/or bacteriocidal chemicals does render the organism less "fit" overall. It's not actually that the bacteria have evolved a new feature; it's that the bacteria now have deformed chemistry (due to a mutation often), which happens to make them less susceptible to the drugs involved. But being resistant to quinolone is only advantageous if quinolone is around; under more normal circumstances that deformed chemistry is actually a hindrance for the bacteria. Quinolone-resistant bacteria reproduce a LOT slower than their more normal brethren. It's all still quite terrifying, of course, but at least it's not unmitigated terror. :-)

Sarah said...

(this is Bradley Belschner, btw, from Bradford's blog)

byron smith said...

Mother Jones: What the USDA doesn't want you to know about factory farms and antibiotics.

Sarah said...

Regarding that Mother Jones article you linked to, Byron: "The industry claims that even though antibiotic-resistant bacteria have been found both in confined animals and supermarket meat, there's simply no evidence that livestock strains are jumping to the human population."

What a load of rubbish! Most significant diseases that have afflicted humanity originally jumped to us from livestock! Smallpox, tuberculosis, measles, cholera, flu, malaria, etc. And most of those diseases I just listed are caused by viruses, which are much more species-specific and therefore much more difficult to jump to humans. How much more then are we to expect simple bacteria to jump to us from livestock? It's a cinch...an observable, documented cinch.

byron smith said...

I generally trust the industrial ag industry about as far as I can throw a cow.

byron smith said...

SMH: To publish or not to publish? The ethics of super-viruses. Not directly related to antibiotic abuse, but falls into the category of superbugs.

byron smith said...

CD: US FDA does U-turn on antibiotics fed to animals.

byron smith said...

SMH: Why antibiotics can be a health risk.

"The study of more than 1000 people found half of them didn't know stopping taking antibiotics before the course was finished contributed to antibiotic resistance. Only about 40 per cent knew antibiotics do not work on viruses, and even fewer knew that if antibiotics were taken for viruses they could help create drug-resistant bugs."

byron smith said...

SMH: Superbugs leave hospital.

byron smith said...

Grist: Superbugs are not just a problem in human health.

byron smith said...

Guardian: Meet the weeds Monsanto can't beat.

byron smith said...

Cary Institute: Anti-bacteria soap driving resistant bacteria in waterways.

byron smith said...

Wired: CDC Threat Report: ‘We Will Soon Be in a Post-Antibiotic Era’.

byron smith said...

Global Mail: TB and me. The rise of resistant strains of TB.