A pillar of medical treatment is under threat

November 28, 2015

Sources: Centers for Disease Control and Prevention; Keeve E. Nachman, PhD, MHS, Johns Hopkins Center for a Livable Future

When you’re sick, you expect the medicine a doctor gives you to work. But the effectiveness of one of the most important types of drugs — antibiotics — is under threat.

In the United States alone, there are 2 million antibiotic resistant infections causing 23,000 deaths each year. You say that you never get sick, so this isn’t your problem. But what if I told you that antibiotics make modern medicine possible, including surgery, cancer treatment and organ transplants? Half of men and a third of women will get cancer in their lifetimes. Many treatments for cancer weaken the immune system, putting you at risk for infection.

We have an epidemic of obesity, high blood pressure and diabetes in this country; many of those affected will eventually need dialysis and kidney transplants. When you get an organ transplant, you need to take medications that weaken your immune system so your body doesn’t reject the organ. And this puts you at increased risk of infection.

Over 50 million people have surgery in the hospital in the U. S. every year. And more get outpatient surgery. Without antibiotics, people would die of surgery-related infections. Watching “The Knick,” I wonder how anyone survived surgery back in the day. The first sulfa-based antibiotics didn’t come into use until the 1930s, and penicillin not until the 1940s.

RTR46C0R1Unfortunately, those germs that mutate to survive even in the presence of antibiotics are the ones that win out. Take a Staph skin infection, something you could pick up from shared equipment at the gym: what before could have been treated with a cheap oral antibiotic might now require IV antibiotics and a trip to the hospital.

Most people think they know when they need antibiotics. We think we need them when we feel really sick, whatever may be ailing us. If a doctor gives us antibiotics, we feel our illness has been acknowledged. But we don’t always know the difference between bacterial and viral infections or that antibiotics don’t cure viral infections. In fact, viruses cause many of the most common illnesses, like colds. Antibiotics can’t do anything to help.

Doctors are a big part of the problem. We’re prescribing broader and broader big gun antibiotics, and this creates stronger evolutionary pressure on bugs to mutate and become resistant, mostly because we aren’t sure what we’re treating. We figure that if we cover all our bases, we won’t go wrong. Better diagnostic tests that were quick, easy and work well would make us feel more confident we haven’t missed something.

Many doctors didn’t learn microbiology very well in medical school. And unless they specialize in infectious diseases, that knowledge tends to deteriorate over time. When I ask my medical residents at the hospital what bugs cause what infections, they give me blank looks.

Worldwide, antibiotic use is going up with rising incomes. And much of this is a good thing. Lack of access to or delays in getting antibiotics still kills more people worldwide than antibiotic resistance. But in many poor countries, antibiotics substitute for real public health, where better nutrition, safe water, hygiene, sanitation and vaccination could dramatically reduce the burden of infectious diseases. And when resistance develops, it spreads.

Increasing incomes have also driven a massive increase in food production. More antibiotics are used in animal husbandry and aquaculture than in people. It’s projected that by 2030, antibiotic use in livestock will increase by two-thirds. Antibiotics are used to mask unhygienic conditions as well as to promote growth. And, as in people, indiscriminate antibiotic use drives resistance. We’ve seen antibiotic resistant bacteria then spread from live animals or animal food products to humans.

The European Union banned use of antibiotics for growth promotion in 2006. In the United States, we only have non-binding guidance. We’re trusting Big Agriculture, which has vociferously fought regulation of antibiotic use in the United States, to police itself. Only California has banned routine use of antibiotics in agriculture. In the absence of regulation, consumer demand for antibiotic-free food may be our most powerful tool.

Still, you might say that the risk of antibiotic resistance seems very abstract and far off. It may seem fair to assume that scientists will come up with new antibiotics to replace the old before this becomes a serious problem. But medical experts aren’t in the business of producing and selling drugs, pharmaceutical companies are.

Pharmaceutical companies develop drugs that will have a large market so they can recoup their investments in research and development and make a profit. The problem with antibiotics is that they’re used them for a short time to treat an infection. Antibiotics aren’t like Lipitor, which you might take for the rest of your life. And when new antibiotics are developed, their use is restricted so that resistance doesn’t develop, which guarantees sales will be slow.

Unless we decouple the financing of antibiotic research and development from drug sales, few new antibiotics will come to market. And there are already shortages of common generic antibiotics due to the same market forces.

The good news is there are a few things everyone can do to help fight against antibiotic resistance. For instance, it may not seem like getting a flu shot — which helps us fight off a virus — would help, but people who become sick with the flu are at risk for complications like a subsequent bacterial pneumonia. Make sure kids are fully vaccinated. Pneumonia vaccination helped reduce the rate of penicillin-resistant strains of bacteria by 59 percent in this country over just a five-year period. Wash your hands and do so often. When you’re sick, work from home if you can or take a sick day. And demand antibiotic-free food.

Antibiotics can be life saving, but they can also do a lot of harm.

One comment

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Too many constant-dose anti-biotics in hand soaps. These are put into public spaces as regular hand soap, and they are basically a widespread training program for super-bugs.

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