Just last night, I was rewatching a portion of the “Walking Dead” first-season episode in which our dwindling band of survivors reach the Centers for Disease Control and Prevention in Atlanta. The news they find there is, to say the least, not good.
And now I see that the real-life CDC has been putting out warnings over the last couple of weeks about the dangerous overuse of antibiotics. And this statement out of the CDC, from the Daily Mail late last month, sounds almost as ominous as what that one surviving researcher on “Walking Dead” had to say:
A high-ranking official with the Centers for Disease Control and Prevention has declared in an interview with PBS that the age of antibiotics has come to an end.
‘For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question mark?”‘ said Dr Arjun Srinivasan. ‘Well, now I would say you can change the title to “The end of antibiotics, period.”’…
Now, there seems to be a sort of contest to see who can raise the alarm in the most, well, alarming manner.
A piece at Bloomberg headlined, “Life Without Antibiotics Would Be Nasty, Brutish and Much Shorter” begins:
Sometimes I imagine how our descendants will look back on our world. Unless something is done about antibiotic resistance, I’m very much afraid that they’ll look upon us the way 19th-century science fiction writers viewed Atlantis: as a lost paradise of magical technology — in this case, one in which you could go to a child coughing her life out with pneumonia, stick a needle in her arm, and watch the disease melt away almost before your eyes. The first doctors who treated patients with antibiotics felt like they were witnessing miracles. Our grandchildren may feel much the same way about the ease with which we cured disease.
But, you say, we’ll just keep developing new antibiotics that microbes are not immune to. Yeah, maybe, but this math, in a piece headlined “Imagining the Post-Antibiotics Future,” is kind of scary:
Every inappropriate prescription and insufficient dose given in medicine would kill weak bacteria but let the strong survive. (As would the micro-dose “growth promoters” given in agriculture, which were invented a few years after Fleming spoke.) Bacteria can produce another generation in as little as twenty minutes; with tens of thousands of generations a year working out survival strategies, the organisms would soon overwhelm the potent new drugs.
Fleming’s prediction was correct. Penicillin-resistant staph emerged in 1940, while the drug was still being given to only a few patients. Tetracycline was introduced in 1950, and tetracycline-resistant Shigellaemerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004.
With antibiotics losing usefulness so quickly — and thus not making back the estimated $1 billion per drug it costs to create them — the pharmaceutical industry lost enthusiasm for making more. In 2004, there were only five new antibiotics in development, compared to more than 500 chronic-disease drugs for which resistance is not an issue — and which, unlike antibiotics, are taken for years, not days. Since then, resistant bugs have grown more numerous and by sharing DNA with each other, have become even tougher to treat with the few drugs that remain. In 2009, and again this year, researchers in Europe and the United States sounded the alarm over an ominous form of resistance known as CRE, for which only one antibiotic still works.
Health authorities have struggled to convince the public that this is a crisis. In September, Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: “If we’re not careful, we will soon be in a post-antibiotic era. For some patients and some microbes, we are already there.” The chief medical officer of the United Kingdom, Dame Sally Davies — who calls antibiotic resistance as serious a threat as terrorism — recentlypublished a book in which she imagines what might come next. She sketches a world where infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. It is a dark vision, meant to disturb. But it may actually underplay what the loss of antibiotics would mean.
Is there a cure? Not really; more of a delaying tactic — it’s to slow down unnecessary use of antibiotics, and develop new antibiotics faster. But there are psychological and cultural barriers to the former, and market forces working against the latter:
In countries such as as Denmark, Norway, and the Netherlands, government regulation of medical and agricultural antibiotic use has helped curb bacteria’s rapid evolution toward untreatability. But the U.S. has never been willing to institute such controls, and the free-market alternative of asking physicians and consumers to use antibiotics conservatively has been tried for decades without much success. As has the long effort to reduce farm antibiotic use; the FDA will soon issue new rules for agriculture, but they will be contained in a voluntary “guidance to industry,” not a regulation with the force of law.
What might hold off the apocalypse, for a while, is more antibiotics—but first pharmaceutical companies will have to be lured back into a marketplace they already deemed unrewarding. The need for new compounds could force the federal government to create drug-development incentives: patent extensions, for instance, or changes in the requirements for clinical trials. But whenever drug research revives, achieving a new compound takes at least 10 years from concept to drugstore shelf. There will be no new drug to solve the problem soon—and given the relentlessness of bacterial evolution, none that can solve the problem forever. In the meantime, the medical industry is reviving the old-fashioned solution of rigorous hospital cleaning, and also trying new ideas: building automatic scrutiny of prescriptions into computerized medical records, and developing rapid tests to ensure the drugs aren’t prescribed when they are not needed….
Anyway, have a happy Monday.