In the Summer of 2011 my 92 year old father was faced with a diagnosis of terminal heart failure – maybe 3 months to live, unless he underwent heart valve replacement surgery. For someone of his age this is a rarity, but he was judged healthy enough otherwise to withstand the surgery. He came through the surgery beautifully, a miracle, no? With the new valves he could now reasonably expect to make it to 95, 100, who knows? But then while spending a month in a rehab facility to get his strength back he caught Clostridium difficile (commonly called C.diff), a nasty and very communicative intestinal infection that causes extreme diarreah and weakness, can lead to colitis, and is very, very difficult to beat. It is one of the many superbugs plaguing medical science today.
For his advanced heart failure there was a miraculous answer. For the superbug he caught during his hospital/rehab experience, no miracles. In fact, the quality of life promised by the heart surgery was negated by the infection. Like a cruel joke, the surgery gave him hope, the infection gave him despair. The infection ended his independent life and nearly killed him outright.
The doomsday preppers, the negativity about the economy, the plethora of entertainment (books, movies, video games) about Earth (or just America) being turned into an apocalyptic hellscape by zombies, vampires or alien invasions, all seem to indicate something in the zeitgeist (if not the water) that is inspiring the fear of complete breakdowns of society (i.e. “libertarian utopias” ha! I kid Rand Paul) – the worst possible scenario – that has never happened on a world wide basis. But in fact, we have had actual pandemics that have caused the deaths of millions of people. The Bubonic Plague, small pox, cholera, deadly influenzas – imagine millions dying! Hundreds of millions! It’s happened in the last century, and it can happen again.
The irony would be if it happened not because our technology and medicine was too backward to handle it, but because it had advanced to the point that it was taken for granted and the unintended and unforeseen consequences (which are never actually unforeseen) of its cavalier overuse become horrifically tragic.
Infectious disease doctors are reporting an explosion of what they term superbugs – bacteria that have evolved strains that are resistant to existing antibiotics. Let that sink in. The idea that you could get a bug that you could go to your doctor to treat and they will have nothing for you. The U.S. Centers for Disease Control and Prevention calls antibiotic resistance one of its “top concerns” and “one of the world’s most pressing health problems.”
How do the bacteria evolve in such a way? “Resistance occurs when bacteria genetics change in response to a drug, especially in non-lethal concentrations where the antibiotic is “tickling the bacteria, rather than killing it,” said Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta.
Today millions of pounds of antibiotics, Alexander Fleming’s wonder drug that changed medicine and saved millions of lives, are handed out like candy to humans with viral infections and used as a prophylactic on healthy farm animals to improve the bottom lines of CAFOs (concentrated animal feeding operation). The Union of Concerned Scientists estimates that 70% of all antibiotics are used as additives in feed given to healthy pigs, poultry and cattle raised in extremely unhealthy conditions to promote health and growth.
The Ontario Medical Association is calling for a ban on the prophylactic use of antibiotics in agriculture in Canada.
The European Union has already banned prophylactic use of antibiotics in agriculture, while the U.S. government has curbed some of it.
“Patients are now dying from infections that physicians have been successfully treating for decades.”
“The problem of bacteria impervious to antibiotics has moved beyond the oft-reported super bugs like MRSA (methicillin-resistantStaphylococcus aureus) and C. difficile, and affects a “multitude” of common infections from strep throat to salmonella, the Ontario Medical Association (OMA) warns.”
The FDA issued new rules on animal use of antibiotics last year as they have tried to curb the overuse for 35 years. It is estimated that at least 2 million people develop hospital-acquired infections every year, and 99,000 die. So that’s 33 9/11s every year! That’s about as many Americans die each year of gun related deaths.
Antibiotics were the wonder drugs of the 20th century, and their initial uses in humans and animals were indiscriminate, experts say. Farmers were impressed that antibiotics led to rapid animal growth and began to add the drugs to feed and water, with no prescriptions or sign of sickness in the animals.
By the 1970s, public health officials had become worried that overuse was leading to the development of infections resistant to treatment in humans. In 1977, the F.D.A. announced that it would begin banning some agricultural uses. But the House and Senate appropriations committees — dominated by agricultural interests — passed resolutions against the ban, and the agency retreated. In the years since, the issue of antibiotic overuse in animals and drug resistance has become one of the leading public health concerns worldwide. Those concerns have over recent years even convinced some in the agricultural community that action was needed.
The new rules generated mixed reactions from both public health advocates and agricultural trade associations. Laura Rogers of the Pew Campaign on Human Health and Industrial Farming called the new rules “the most sweeping action the agency has undertaken in this area,” while Caroline Smith DeWaal of the Center for Science in the Public Interest criticized them as “tragically flawed” because they relied too much on voluntary industry efforts.
Clearly, the voluntary nature of this rule means the huge meat packing industry will continue to have their bought and paid for veterinarians write prescriptions based on the health of their bottom line. Stronger action needs to be taken
For humans, the overuse and misuse is so widespread that the CDC says more than 10 million courses of antibiotics a year are prescribed for viral conditions that will not benefit from them. It may seem harmless to proscribe them to people and animals, but all those antibiotics work their way through our digestive systems and into the waste water, the water supply, and into the food chain. The low levels that are constantly in our systems then “tickle” the bacteria and the bacteria evolve resistance.
The list of new superbugs plaguing the medical community and threatening the public keeps growing.
A new superbug is on the rise in U.S. hospitals, according to the U.S. Centers for Disease Control and Prevention. The family of germs, dubbed CRE for carbapenem-resistant Enterobacteriaceae, evades some the strongest antibiotics, making infections almost untreatable.
“Right now, these infections are limited to hospitals, but we know from history that bacteria that start in hospitals often find a way out into the community,” said ABC News chief health and medical editor Dr. Richard Besser, who for seven years ran a CDC program aimed at promoting proper antibiotic use to curb antibiotic resistance. “That would be a nightmare scenario.”
What can be done to keep antibiotic resistance under control?
In the wider world, there is now concern that antibiotic resistance could continue to develop to the point where some bacteria are resistant to all antibiotics. To stop this from happening, the medical profession has taken a number of steps:
1. Reducing its levels of antibiotic prescribing by no longer prescribing antibiotics for viral infections. For example, many coughs and colds are caused by viruses and antibiotics will have no effect whatsoever. In the past, antibiotics were prescribed to help prevent co-infection with bacteria, however this only served to increase antibiotic resistance and has been stopped.
2. Encouraging patients to finish their whole course of antibiotics, regardless of whether they feel better earlier or not. This measure is particularly important in preventing resistant bacteria from surviving and multiplying.
3. Using infection control measures in hospitals, including handwashing between patients, to minimise the chances of bacteria being passed from one patient to another.
So what can we do? In Part II the thoughts of a frustrated doctor.