Life Without Antibiotics Would Be Nasty, Brutish and Short(er)
Two million antibiotic-resistant infections a year: In a new report, that’s how many the Centers for Disease Control and Prevention say we have. At least 23,000 Americans die of antibiotic-resistant infections every year, and the pace of antibiotic discovery has slowed dramatically from the immediate postwar era. More than one big drug company has pulled out of the area entirely; it’s too hard to find drug candidates, and there’s not enough money in it to make it worth the risk.
It’s hard to overstate the beneficial effects that antibiotics have had in our lives. I was just reading a sort of biography of Nancy Drew (and the people who created her -- fascinating story). One of the things that struck me, late in the book, is that for all the revisions, they’ve kept the fact that her mother is dead. In 1930, when she was created, this was a sadly common condition. In 1914, when the original Nancy Drew would have been “born,” you had a 0.6 percent chance of dying every time you gave birth. Then there were all the conditions we can now cure through antibiotics -- or surgery, which is now vastly less risky because we have drugs to control post-surgical infection. In 1930, the average “nice” family would not have known any children who were born and raised out of wedlock. But they would have known several who had lost at least one parent by the age of 16, because we were powerless in the face of infectious disease.
Antibiotics changed all that; a few shots or a few pills, and vicious killers such as pneumonia, rheumatic fever and even tuberculosis, were conquered. It was always written in the cards that the golden era of abundant antibiotics would someday end. Bacteria, like every other life form, evolve. When there’s something killing them, this selects for the ability to evade the killer. The same forces that made deer fast, and easily startled, make bacteria that don’t die when you bombard them with methicillin.
But our practices make it worse. You know the litany: doctors who overprescribe antibiotics, and patients who demand them. Hospital staff who spread infection because they don’t hew to infection-control standards. People who stop taking their pills before finishing the full course of treatment. We’re all to blame, and we all need to act.
Things are starting to change -- you’ll find your doctor isn’t as willing to dispense antibiotics as she used to be, for example. But the other side of the equation, the pipeline of drugs, is still quite broken. And it’s not just our own practices that need editing. Antibiotics resistance is a global challenge, one often exacerbated by government regulations aimed at other problems. For example, some countries mandate that hospital and doctor bills must stay low -- so doctors and hospitals make up the income by dispensing lots and lots of drugs, which aren’t so ruthlessly price controlled. This requires a global effort aimed at fixing the market for drugs, and also the dispensing of them. Adjusting practices here helps, of course, but it won’t keep totally-drug-resistant tuberculosis from migrating out of India.
Okay, don’t panic: We’re not going back to the 19th century. Tuberculosis used to kill a substantial fraction of the population of Europe, it’s true. But the bacteria were aided by living conditions: crowded rooms, poor ventilation and low-grade malnutrition. So, too, with many other diseases that have been conquered by better living conditions, and the great public health works, such as the treatment of water.
That said “don’t panic” doesn’t mean “don’t worry.” This is one of the biggest public health crises of our time; the number of people who have been saved by antibiotics dwarfs any reasonable estimates of the number of people who will be, say, saved by Obamacare. Much of the time that we spend lamenting obesity or tinkering with the government health care system would be much better spent on figuring out how to prolong our fading golden age of antibiotics for as long as possible.