Physicians and scientists have been warning about the dangers of antibiotic resistance for years, but the problem has grown acute in recent years. Unfortunately, I don’t think the general public gives it the attention it deserves, because we are too far removed from life before antibiotics. We’ve always had them, and because of that we have seen life expectancy soar and death rates plummet as people stopped dying from post-injury infections which killed their ancestors in generations past. But we are coming disturbingly close to returning to that time.
Maryn McKenna gave an excellent TED Talk on this very topic titled What do we do when antibiotics don’t work anymore? in March 2015. I strongly encourage everyone, especially those who work in healthcare, to give it a watch. She begins the talk by telling the story of the death of her great uncle, who died from blood poisoning (sepsis) following an injury he sustained cleaning brass at the local firehouse. She then warned that we are entering a post-antibiotic world, a time when “…simple infections, like the one that killed my great uncle, will kill again.” Those deaths are already occurring, and with increasing frequency.
Antibiotic resistance, the technical term for the mechanism that is bringing this post-antibiotic world about, occurs as a natural outgrowth of evolution. As Maryn explains, bacteria compete for resources within the body, and this competition includes the release of chemicals meant to destroy competing bacteria. Antibiotics are basically a lab-created version of these chemicals. But, as with all creatures, the bacteria that survive this onslaught develop defenses against them, allowing them to survive and thrive even when these chemicals are present. Bacteria are now developing resistance so quickly to new antibiotics that it is impossible to keep up. As a result, drug companies have decided that it is not profitable for them to invest all of the money into a new antibiotic that may only be valuable for a few years, or even less.
But antibiotic resistance isn’t necessarily a problem of antibiotic shortages…Maryn notes that there are approximately 100 different types of antibiotics on the market. But there are now bacteria which are resistant to nearly all of them. Her TED talk features KPC, a bacteria first diagnosed in one person in North Carolina in 2000 which is only treatable by two available antibiotics. This bacteria has now been transmitted to 47 of the 50 US states and to the South American and European continents. This is bad enough, but another infection called NDM diagnosed in Sweden in 2008 is resistant to only one antibiotic, and has already spread too all of the continents on the globe. Lest you think these are rare cases, 50,000 people in the US and Europe die every year from infections that no antibiotic can treat.
Maryn then goes on to list all of the things we would lose without antibiotics, and how many people who die from lack of treatment. People with weakened immune systems would feel the first effects, so people with cancer, AIDS or premie infants would suffer. Surgery would be impossible, as the risk of post-surgical infections would be too high. “That means no more heart surgeries. No more prostate biopsies. No more C-Sections” she pointed out. It’s sobering to think about how many people would die because of heart conditions, prostate cancer or in childbirth without these treatment options. Then she asked the provocative question, “If you knew every injury could kill you, would you ride a motorcycle? Climb a ladder to hang your Christmas lights? Would you let your kid slide into home plate?”
And who bears responsibility for this? We do. Maryn goes on to document the stunning over-use of antibiotics, pointing out that 50% of antibiotics prescribed in hospitals are prescribed for no documented medical reason and 45% of scripts written in doctor’s offices are written for things that antibiotics can’t cure (I’m looking squarely at you, doctors who prescribe antibiotics for viruses like the Flu). That doesn’t even count the antibiotics fed to animals to protect them from conditions they can easily contract in factory-farm conditions…meat that is then butchered and sent to market that we eat, which may be full of antibiotic resistant bacteria.
So how do we get ourselves out of this mess? Maryn points out that companies are indeed working on novel antibiotics, but that they need to be supported with funding, grants, extended patents and awards to help spur their work. But she acknowledges that this will not be enough, because, “Evolution always wins.” She places more emphasis in things like gate-keeping programs build within a CDSS to flag any prescription for an antibiotic as something that would require a second approval, thus reducing unnecessary prescriptions which give more bacteria a chance to develop resistance to the drug and passing legislation which would ban the use of antibiotics in farming and agriculture. But she notes that even will all of these options in place, we as a society need to help.
Changing social norms, she argues, is something that we have done in the past, and can do again. And it’s not just as simple as making sure your hand soap or dish washing detergent doesn’t contain antibiotics (although that wouldn’t hurt…I know I avoid using both of those particular products that have been treated unnecessarily with antibiotics). She suggests not accepting antibiotic prescriptions for things like ear infections unless we are sure that the cause is bacterial in nature, or challenging our restaurants and stores to sell only meat and fruit prepared without routine antibiotic treatment. Needless to say, these are huge sacrifices to make, especially if you are the parent or caretaker of a child with an ear infection. But I think it could be helped through expanded healthcare literacy and patient education. Patients need to understand the difference between bacteria-caused illnesses and virus-caused illnesses, and stop insisting for antibiotics for things that are caused by viruses.
Maryn warns us, quite rightly, that it took 70 years for us to go from penicillin’s discovery to the edge of the post-antibiotic world, and we won’t get another 70 years to walk ourselves back from the edge. To quote Sir Alexander Fleming, the man who gave the world penicillin:
The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with penicillin-resistant organism. I hope this evil can be averted.