Go read this piece by Maryn McKenna — who is, in my never humble opinion, one of the handful of very best reporters on matters of infectious disease, global health, and really scary stuff.
I was born in 1958, fifteen years into the era of clinically-available antibiotics. I was my mother’s third child. Had we shifted that timeline back a few years, that would have meant that there would have been a measure of luck in mom simply making it to and not through her third lying in. As Maryn writes, before antiobiotics, five out of 1,000 births ended with the death of the mother. No worries by the time I popped my head out into the maternity floor at Alta Bates.
But this a must read not because of any remembrance of the pre-antibiotic era, but because Maryn plausibly analyzes a post-antibiotic future.
Here’s a sample:
Doctors routinely perform procedures that carry an extraordinary infection risk unless antibiotics are used. Chief among them: any treatment that requires the construction of portals into the bloodstream and gives bacteria a direct route to the heart or brain. That rules out intensive-care medicine, with its ventilators, catheters, and ports—but also something as prosaic as kidney dialysis, which mechanically filters the blood.
Next to go: surgery, especially on sites that harbor large populations of bacteria such as the intestines and the urinary tract. Those bacteria are benign in their regular homes in the body, but introduce them into the blood, as surgery can, and infections are practically guaranteed. And then implantable devices, because bacteria can form sticky films of infection on the devices’ surfaces that can be broken down only by antibiotics
Dr. Donald Fry, a member of the American College of Surgeons who finished medical school in 1972, says: “In my professional life, it has been breathtaking to watch what can be done with synthetic prosthetic materials: joints, vessels, heart valves. But in these operations, infection is a catastrophe.” British health economists with similar concerns recently calculated the costs of antibiotic resistance. To examine how it would affect surgery, they picked hip replacements, a common procedure in once-athletic Baby Boomers. They estimated that without antibiotics, one out of every six recipients of new hip joints would die.
As Maryn reports, the problem is tangled and complex — but there are clear actions that could be taken and aren’t, most obviously ending the reckless use of antibiotics in agriculture, which consumes something like 80% of the total produced. But don’t waste time here: go read the whole thing. Get scared; get mad; call your congressfolk.
Image: Josse Lieferinxe, St. Sebastian prays for plague victims, 1497-99.
Gin & Tonic
I think the odds of the average Congressmember’s understanding a “tangled and complex” problem with a time horizon measured in decades are roughly similar to the odds I’ll be elected the next Pope.
gwangung
As Maryn reports, the problem is tangled and complex — but there are clear actions that could be taken and aren’t, most obviously ending the reckless use of antibiotics in agriculture, which consumes something like 80% of the total produced.
And if we did that, the wingnuts would start screaming about a liberal plot to destroy the fee market….and there aint nothin’ wrong with antibiotics….
Joe Buck
One of the problems is with the structure of the pharmaceutical industry. Antibiotics aren’t particularly profitable. If a new one is developed, it will be rarely used at first (to keep it in reserve for the toughest bugs), and assuming it is effective, it will be prescribed for only a two week period, maybe a bit more. What Big Pharma wants is a very expensive drug that people have to take for the rest of their lives: a drug that doesn’t cure anything, but that only blocks symptoms for as long as the addict/patient takes it.
There’s a similar issue with vaccines: they aren’t profitable, and that market only works because it’s subsided heavily.
Governments will have to step up and do the development of new antibiotics themselves. In the meantime, it’s insane the way we allow Big Ag to dose their cattle with antibiotics. If we deliberately wanted to breed super-bacteria there wouldn’t be a better way to do it.
catclub
@Gin & Tonic: I think gwangung, right below you, gets it right, that the average congressmember will understand the issue in a heartbeat, just as they understand the global warming issue. Now you may not LIKE the understanding they come to on the issue, but they understand it just fine. I would agree that getting them to do something that actually risks their political position is challenging.
catclub
@Joe Buck: “If we deliberately wanted to breed super-bacteria there wouldn’t be a better way to do it. ” I think uncooperative tuberculosis patients are in the running for methods to breed superbugs.
negative 1
I can not imagine a scenario where the government would propose ending the use of antibiotics in farming without a meltdown of discourse in this country. It would make the ACA look mild. There would not be a single chance that it would be able to pass, there is no way it could garnish support from the public as it would require people to think about what they eat, and there is no group out there that would back its support.
As such, we are well on f&*ked when (not if) bacteria figure a way to get around our antibiotics.
Tom Levenson
@negative 1:
They already have. Not many yet have gotten past every last drug. But there are cases of untreatable infections now. This isn’t the future, folks. This is right now.
scav
@catclub: Well, antibiotics do cause problems when they get into that series of tubes, don’t they?! Don’t want to put too much stuff in there, might get clogged or sumpin.
Woodrow/asim Jarvis Hill
Based upon my anecdotal experiences, I can say a wee bit of this is permeating to General Practitioners; of the last 3 I’ve been to in 5 years, 2 have not given me antibiotics for fairly mild situations — I used to get very nasty sinus infections, and antibiotics as a results. Not so much in the last few years.
Obviously the big change is with farming, but I’m hoping the warnings are disseminating in the medical fields, at least.
Roger Moore
@negative 1:
Exaggerate much? There is already a decent sized group of people who pay extra for meat from animals not treated with routine antibiotics, so there’s at least somebody who would back a general antibiotic ban. And I think that points in the direction to take if you want to push for an end to routine antibiotic use in farms: publicize just how bad modern factory farms are. People may not want to think about it, but once they see something about how animals are treated in modern farming and that they might be eating that stuff, they’ll have a hard time stopping thinking about it. So you need a concerted media campaign to push the issue in people’s faces. Once you reach a critical mass of interested people, the issue will take off under its own power.
Cassidy
Awesome. We haven’t had one of the posts for a while. Everyone should be able to get their fill of “I’m awesome because I only eat local meat and vegetables” today. Bonus points for shaming the poor for not eating the right way!
catclub
@Woodrow/asim Jarvis Hill: Did you see the chart someone did
(can’t remember who) of antibiotic prescription density in the US? It matched up with obesity (I am NOT suggesting any causality either way) and poverty, and I guess, the scotch-irish appalachians, for fans of the nine nations of america.
Villago Delenda Est
Exqueeze me, but Monsanto’s short term profit is far more important than the survival of the human race in the long run.
Tommy
This might not be popular to post. And I get that I have good genes and my family members usually live into their 90s.
But I don’t have any aspirin in my house. I say that cause when I feel sick I assume it is something I did wrong in my life. Like it was cold outside and I didn’t wear enough layers. Or if my stomach is upset I didn’t eat before pounding a few cups of coffee. Or a flu, maybe I should have washed my hands more and had a better diet.
Now I know that is an oversimplification.
We need drugs for many things.
But I feel we hand them out like candy. Antibiotics at the top of the list.
I fear one day I might need them and they won’t work, cause well folks use them 24/7 cause they are handed out 24/7 (by doctors, not the user) and the one time I need them they won’t work.
Again I know this might not be popular, but how I feel.
NotMax
But can the livestock even access the website to get a better and cheaper deal on antibiotics?
Keith P
I’ve had a grand total of 4 dialysis catheters (the go in under the skin in the chest, through the jugular, and into the heart), the last one being in for 8 months, coming out about 2 months ago. They do suck. They tell you to wrap it in plastic for *every* shower (no baths or other submersion in water allowed), although the cath still gets wet with wrapping, so I quit after 4-5 months. Every week, the covering has to come off, and the skin gets wiped down with bleach (yes, bleach, not alcohol). The hospital wants you on a different dialysis mechanism ASAP (in my case, a fistula…I’m on my second after 3 surgeries for those), as an infection will make its way to your heart.
And on my 2nd to last cath, it was blocking my jugular flow, so it was replaced, and during the hospitalization, the doc neglected to include one of my blood pressure meds, leading to a rebound that put me in the ICU on a VERY strong heart med that made me feel like I was dying (Cardene; in spite of the name, it doesn’t choke you but makes you have zero energy). Nasty, nasty stuff.
Tommy
@NotMax: Question. Do you want to eat meat from an animal that needs to get antibiotics to stay healthy? I saw somebody here say I’d be elitist to say this. No, not so much. I can afford good food. I want my fellow citizens that can’t are then not sold shitty food.
That isn’t OK with me. That I can buy local produced food doesn’t make me turn away from others that can’t and not demand they have better food.
NotMax
@Tommy
(channeling Foghorn Leghorn)
That was a joke, son.
liberal
@Tommy:
I thought the main reason antibiotics are fed to animals is not “factory farmed animals need them to stay healthy,” but rather “antibiotics, for some reason, increase growth rates in farm animals.” Higher growth rate = higher profit.
raven
@NotMax: Boy, ah say boy. . .
Dead Ernest
@NotMax:
:-)
Thanks NotMax.
Tommy
@liberal: Well kind of. Both health and growth as I understand it.Storids.
JPL
My son who is pretty healthy has been prescribed Cipro because other antibiotics were not working for his infection. He only eats natural meats and organic foods. My representative, Dr. Tom Price introduced a bill several years ago to allow agri-corps the option of using it, since animals are becoming resistant to other drugs also. Did I mention that my representative was a doctor? Anyway I wrote a lengthy letter and got a thank you for your interest. Did I mention that my representative is an uninformed jerk?
Dead Ernest
@Cassidy:
Hmm. Somehow I get the idea that you would not be delicious Cassidy.
“Waiter! More NotMax please. And, more of that J.S. Fuckhead, Mmmn’ MM!
Is it true you’re out of Cornerstone? Yes, I agree, that is an acquired taste. Please do let me know when you get more of that.”
Cassidy
@Dead Ernest: I’ve been told otherwise. ;)
StringOnAStick
I’m a dental hygienist (one of many careers I’ve had), and anyone who has had a joint replacement or a history of infective endocarditis has to take a single large dose of an antibiotic prior to me working on them. The ADA decided a few years ago that this needs to happen only for 1 year after the joint replacement, so that’s an improvement.
I had a DDS tell me that “in the old days” it was 10 days of antibiotics before the appointment, and until the most recent guideline change, it was the single dose before an appointment for life. But, we let the patient’s treating MD decide if ‘1 year and done’ is what they want; I am shocked at how many MD’s still want their patients on prophylactic antibiotics forever, even patients that have no other (admitted to us anyway) medical problems other than an old joint replacement surgery and who are otherwise apparently healthy.
The use of antibiotics in animal feed to make up for overcrowded, illness-inducing living conditions needs to stop, NOW. If it makes protein cost more, then so be it since the results of not dealing with this is much, much worse that a quarterpounder costing a buck more.
pseudonymous in nc
It’d be nice to point to squeamish Americans who, post-1950, seem to have developed a collective OCD with their antibiotic ointments and antibiotic prescriptions and antibiotic shopping cart handles and antibiotic toilet seat cleaners and so on.
But it’s agriculture that does it. Factory feedlot agriculture.
@liberal:
In addition, the feed is often corn mash that’s a byproduct of ethanol production, and that mash is already laced with antibiotics to prevent bacterial spoilage during fermentation.
Pongo
@Joe Buck: The other problem is that we keep looking to pharma to solve the problem. Even in this article the notion of providing incentives like extended patent protections and reduced burden of clinical trial evidence for approval are suggested as ways to encourage pharma to develop better drugs. We’ve done this already for rare disease drug development, and while it did encourage some development, the outrage now is that the drugs developed using these incentives are so obscenely expensive (many $300,000 + annually and we are on our way to having the first $1 mil a year drug by 2015) when they hit the market that insurance companies (probably justifiably) balk at paying for them, which severely restricts access to the drugs for many of the people who actually need them. The FDA and NIH explicitly stay out of pricing decisions and Congress is adamant that they do so, so we as taxpayers provide up front incentives for pharma without requiring any concessions on pricing and with no control over access to the drug we helped bring to market. This is a known pattern which suggests that using the incentive model to foster antibiotic development could end up being counterproductive and/or downright disastrous.
I’m really not bashing pharma here. Making money and keeping shareholders happy is what they have to do (questionable business practices in pursuit of profit is a separate issue). The point is that they are not charitable orgs engaged in altruistic pursuits and never have claimed to be. So why do we keep treating them like they are? No one would expect McDonalds to come up with solutions to feed all the nation’s hungry because that is not in their corporate purview and they are not equipped physically, practically or morally to do so. The notion that a private corp should be responsible to fix a major public/societal issue like hunger would strike most people as ludicrous. Yet this is exactly the position we put pharma in when we continually turn to them for solutions to public health crises.
It seems very clear that leadership in assessing needs, prioritizing research, and providing necessary resources needs to come from a neutral source with regulatory authority–not the boardrooms of GSK, Pfizer and Merck.
JPL
Tom, I already sent McKenna’s article on to family and friends and I want to thank you for linking to it. As I mentioned at comment 23, I have a son who can take only a few antibiotics. When he was in seventh grade there was a discussion on whether or not to treat him with hospital only iv’s. Fortunately, we were able to clear up his infection another way. He’s lucky because he seldom gets sick. Just like global warming, this subject will be ignored until it’s too late.
SiubhanDuinne
@Gin & Tonic:
You have my vote.
/Siubhan Cardinal Duinne
Calming influence
My wife just came back from a trip to Georgia with a case of whooping cough. She had actually been re-vaccinated for a trip to Turkey 6 years ago, but that wasn’t sufficient.
So not only are we on the brink of having nothing to battle infectious diseases, we’ve decided to roll on our backs and spread our arms and legs, welcoming the final blow by not immunizing our kids anymore.
It’s not the government survivalists should be worried about. It’s all their idiot friends and neighbors.
Uncle Cosmo
@Woodrow/asim Jarvis Hill: That jibes with my experience. For years I would get viral infections in the early spring that would knock me out for a month–after 2 weeks the virus would be gone but an opportunistic bacterial infection would sneak into my sinuses & raise holy hell until I got a course of antibiotics. And I never got those until I was turning kleenexes yellow with pus.
One year in the midst of this I asked my GP to prescribe me antibiotics. She refused. When I came back 2 weeks later, turning kleenexes yellow, & she finally relented, I asked her to put a note in my records about the follow-on infections so that MDs unfamiliar with my situation would be aware of them. She refused even to do that too, on the grounds that it might lead to “overprescrption of antibiotics.” Jeebus cripes, I understand the problem, but do I have to be on death’s door every March before these people relent??
liberal
@pseudonymous in nc:
Somewhat agree, though note (a) a lot of derm antibiotic use is the result of physicians thinking it’s a great idea (“acne? just take tetracycline forever and a day!”), (b) the shopping cart handles/toilet seat cleaners etc are usually disinfectants not antibiotics. I suppose it’s possible resistance can develop to those, too, but it seems less likely/probably much slower than that to antibiotics.
liberal
@Calming influence:
I hate the antivaxers as much as anyone else, but my impression is that it might be more due to the newer vaccines needing more frequent boosters in the adult years.
liberal
@StringOnAStick:
I’ve never really understood the dental “if you’ve had a heart murmur, you have to take antibiotics” thing. My impression is that oral bacteria get into the bloodstream when I floss, so what’s the point?
Yog-Sothoth
Antibiotic resistance is not just a US problem. In India, for example, most antibiotics are over the counter, so many of the new forms of resistance are coming from there. You could say that selling antibiotics over the counter is silly, which it really is, but in India there are lots of people who barely have enough money to buy the pills, much less see a doctor.
Of course, filling all our livestock with antibiotics to save $4.50 per pig is pretty silly, even worse really. Unfortunately, I don’t see any way of fixing that problem with the current Congress.
If I had my way we would put out bounties for new antibiotics, with the provision that the resultant drugs be priced reasonably. Again, I don’t see any way of that passing Congress. Maybe if we replaced the ‘priced reasonably’ with ‘no more than 100K per dose’ the pharmo lobby would help.
There needs to be an international response to the problem, though, lest any new antibiotics we do develop rapidly fade away. I’m sure Congress will find that to be just another U.N. power ploy along with Agenda 21 and put the kibosh on that.
I guess the cynical side of my brain got fired up or something…
Debbie(aussie)
@JPL: and each is going to need the same sort of resolve from our governments! The ‘free market’ ain’t gonna do nuthin.
Cermet
@Joe Buck: What world do you live in? Most new meds ARE developed in Government labs – big pharm just get’s them for small fee’s and “develop'” them claiming the cost is billions (rarely more than 10 million) and then sell’s them to us at jacked up prices.
Yes, the over use is criminal – there are a few bright spots – using virus’s to fight bacteria will work on many illness (of, course, far from all) so there are some alternatives besides antibiotics … some.
Cermet
@Uncle Cosmo: Have you tried taking vitamin D (5000 – 15000 IU) every day? In four or so months your immune system will be vastly better at preventing colds, and somewhat better at fighting bacteria. Also, get the flu shot every year!
Cermet
@Pongo: Those companies rob us blind. They spend far, far less than they claim to develop new drugs and many are developed at tax payer expense in government labs. Go troll somewhere else. Big pharm are thieves and liars, all; just as are their trolls.
Profits? Yes, but stealing the average amerikan and the US taxpayer blind by charging outrageous prices (which are far above any justifiable costs) and obtaining obscene profits at the cost of amerikan lives is what they do. That is why most drugs are far, far cheaper anywhere but the US of A.