by futurist Kit Arrow
What would a world without antibiotics be like? Unfortunately, we know all too well from history. Here’s what our future could look like without them:
Marjorie was working at her favorite pastime, woodworking, planing a piece of wood for a cabinet she was making, when the wood plane slipped, and she cut herself on the left wrist. Thinking nothing of it, she put a bandage over it and carried on with her work. The next day, her wrist throbbed, and, when she removed the bandage, she saw there was pus oozing around the wound. She washed the wound, put some antiseptic cream on it, and bandaged it again. By the next morning, her wrist was really sore, and pus was oozing out from beneath the bandage, so she went to the doctor, who gave her some antibiotics for the infection. The antibiotics did nothing to help, and her wrist got progressively worse. Three days later, sores started breaking out all over her body, so she went to the local ER. They took one look at her, and admitted her immediately, where the doctor, shocked, diagnosed sepsis, and put Marjorie in the intensive care ward.
Kevin came home from school with a nasty, hacking cough. It was worse the next day, so his mother kept him home. Over the course of the day, the cough got worse, with uncontrollable coughing fits lasting several minutes at a time. Alarmed, Kevin’s mother took him to their family doctor. After Kevin started coughing uncontrollably in the waiting room, the receptionist went to get the doctor, who immediately took Kevin into an examination room. After examining Kevin, and witnessing a coughing fit, the doctor concluded Kevin had whopping cough. Relieved, Kevin’s mother asked what Kevin should take. The doctor replied that while he would give Kevin a prescription for the latest antibiotic, this was probably an antibiotic-resistant strain that was going around, and it might do nothing to help Kevin. Kevin’s mother became angry, and asked if this was serious. The doctor looked at her and said, ‘It might be fatal. I think we’d better admit him to the hospital.’ Now Kevin’s mother was shouting, ‘Well, DO something!’. The doctor looked at her and answered, ‘Like what?
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In the 1800’s, there were several wars fought on or near American soil, which were the first wars for which we have good medical records, and to which there was easy access. In both the Mexican war from 1845 to 1848, and the Spanish-American war in 1898, seven times more deaths occurred due to disease than were caused by war wounds. Most of the so-called ‘war pestilence’ diseases are things we barely think about in 2014, like cholera and typhoid. We give them little thought because they are caused by bacteria, and we have antibiotics that take care of these diseases so easily that they barely even register as dangerous with most people. But 150 years ago, you could (and many people did) die from a scratch from a nail, or a cut, or any type of infection. Prior to the 1940s, we had almost no defense against these diseases, until Alexander Fleming discovered penicillin in 1928, and Howard Florey, Ernst Chain, and Norman Heatley subsequently harnessed it as a medical treatment for bacterial diseases.
Antibiotic-resistant bacteria are scary. They get lots of press time, with headlines screaming about super-bugs, and saying that resistant strains of TB, E.coli, MRSA, and gonorrhea are out there, and can’t be cured. This scares me as well, since I’m no more immune than anyone else. But then I take a step back, and think through some critical questions.
Question 1: How do super-bugs develop? That’s a multi-factorial question, but the primary reason is antibiotic misuse, specifically that we humans chronically and criminally misuse them. Antibiotics are overused and over-prescribed, particularly for things that don’t require them. Many people take antibiotics for the flu, not realizing that influenza is caused by a virus, and treating it with antibiotics is as effective as knocking down a brick wall with pillows, or trying to make a phone call with a pizza. It’s just the wrong tool for the job. Another problem is people don’t follow their doctor’s orders when it comes to taking antibiotics. Many people stop taking antibiotics when they start to feel better. This gives any surviving bacteria a chance to recover, and to develop the resistance to antibiotics that makes them so dangerous.
And then there’s overuse. There are antibiotics in feedstock for cows, pigs, and sheep to make them larger and healthier. Indeed, almost 80% of all antibiotics used are given to livestock, and most of that is not for treating illness, but to help livestock stay healthy, which is an enormous misuse of a precious weapon. This is like beating your sword against a rock before a duel.
Then there’s antibiotic soap. You know the stuff that claims to kill 99.99% of bacteria? Well, the 0.01% that survives is now resistant to those antibiotics, and multiplies and spreads rapidly as you’ve conveniently wiped out all of its competition. Our society seems to be determined to create tougher bacteria to infect us.
Question 2: Where are the medicines to cure these super-bugs? Simple: they don’t exist. There hasn’t been a significant antibiotic produced in the last 25 years.
Question 2a: OK, so why haven’t we produced any new antibiotics? There are two answers to this. The first is that all the easy ones were found by the late 70’s, and the research is much harder now. The second is that there’s no money in it.
The pharmacy industry would have to devote hundreds of millions or up to a billion dollars to create a new antibiotic to fight super-bugs. Given the speed with which bacteria mutate and develop resistance, the drug companies would be unlikely to earn back their investment. So, while consumers see Big Pharma as being greedy profiteers, the pharmaceutical industry sees a new generation of antibiotics as a fast road to bankruptcy.
Question 3: Is there anything out there that can help? Yes, as a matter of fact, there are several things. We, as a species, study bacteria an awful lot. They’re a useful model organism for many different tests because they are everywhere on this planet, and we can see multi-generational effects in them quite quickly because of the speed with which they reproduce. When the time it takes to get to Starbucks and back with your coffee can produce a new generation, seeing the effects of a drug or chemical twenty generations down the line is something you can do overnight.
So, what are the brightest prospects on the horizon for treating super-bugs? I’ve mentioned silver nanoparticles in earlier blogs, and they definitely have a place in fighting bacteria. Silver nanoparticles, when combined with existing antibiotics, reduce bacterial resistance to antibiotics dramatically, some studies say by over 60%. This is the bacterial equivalent of arming your soldiers with assault rifles rather than pointy sticks.
The University of East Anglia has a chemical that they believe can destroy the bacterial cell wall of a certain class of bacteria, which include E.coli, gonorrhea, and salmonella. Researchers at Monash University are working on disarming bacterial, rather than killing them, so they won’t harm us, and hopefully won’t be able to develop resistance, either. Finally (for this article, at least), a group from McMaster University have echoed Sir Alexander Fleming’s discovery of penicillin by discovering that a compound produced in a soil fungus is effective at reversing antibiotic resistance. So there are things we can do – and we are doing them. All is not lost, no matter how serious the situation seems right now.
Question 4: So we have the methods to beat them, how do we make use of these methods on a large scale? First off, we need to focus on not making the situation worse. This means we need to educate people about antibiotics. Remove antibiotic soaps from the marketplace. Take ALL of your pills, even if you are feeling better. Stop feeding antibiotics to farm animals unless they have an infection. Only take antibiotics when your doctor tells you to. Don’t ask for antibiotics for colds and other non-bacterial diseases.
Second, we need to change the financial incentives for lifesaving drugs. This is not my area of expertise, but if the drug companies aren’t searching for cures because it’s not worth the cost, this strikes me a something that should be changed. Suppose, for instance, that governments guaranteed a certain level of profit for a new antibiotic, subject to certain pre-agreed performance measures, on a take-or-pay basis. Hence, if the drug sold well, and bacteria didn’t quickly develop resistance, the market would pay for the drug development, the companies would make sufficient profits to encourage further research, and it would cost governments nothing. But if demand for a new antibiotic was low, or the drug was rendered useless too quickly, the drug company would still be guaranteed at least an acceptable profit. I suspect that would be enough to kick-start serious research. It would limit a drug company’s risk, and thus increase their willingness to do the development necessary on new antibiotics.
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