The Post-Antibiotic World Would Have Fewer Miracles

Megan McArdle is a Bloomberg View columnist. She wrote for the Daily Beast, Newsweek, the Atlantic and the Economist and founded the blog Asymmetrical Information. She is the author of “The Up Side of Down: Why Failing Well Is the Key to Success.”
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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.

QuickTake Antibiotic Resistance

At Wired, Maryn McKenna outlines all the medical miracles that antibiotics have made possible:

If we really lost antibiotics to advancing drug resistance -- and trust me, we're not far off -- here's what we would lose. Not just the ability to treat infectious disease; that's obvious.

But also: The ability to treat cancer, and to transplant organs, because doing those successfully relies on suppressing the immune system and willingly making ourselves vulnerable to infection. Any treatment that relies on a permanent port into the bloodstream -- for instance, kidney dialysis. Any major open-cavity surgery, on the heart, the lungs, the abdomen. Any surgery on a part of the body that already harbors a population of bacteria: the guts, the bladder, the genitals. Implantable devices: new hips, new knees, new heart valves. Cosmetic plastic surgery. Liposuction. Tattoos.

We'd lose the ability to treat people after traumatic accidents, as major as crashing your car and as minor as your kid falling out of a tree. We'd lose the safety of modern childbirth: Before the antibiotic era, 5 women died out of every 1,000 who gave birth. One out of every nine skin infections killed. Three out of every 10 people who got pneumonia died from it.

And we'd lose, as well, a good portion of our cheap modern food supply. Most of the meat we eat in the industrialized world is raised with the routine use of antibiotics, to fatten livestock and protect them from the conditions in which the animals are raised. Without the drugs that keep livestock healthy in concentrated agriculture, we'd lose the ability to raise them that way. Either animals would sicken, or farmers would have to change their raising practices, spending more money when their margins are thin. Either way, meat -- and fish and seafood, also raised with abundant antibiotics in the fish farms of Asia -- would become much more expensive.

We are, she writes, on the brink of the "post-antibiotic era." Already, some bacteria are resistant to everything we can throw at them. They're mostly confined to hospitals at the moment, but they're increasingly seen "in the community" - i.e., in all the homes and stores and workplaces where we like to spend our time.

The dependence of the rest of our medical miracles on antibiotics is hard to overstate. We would still do abdominal surgery or put in feeding tubes. But we would do these things only in emergencies, especially if the patients were children or elderly. The risks of elective surgery would mostly be too high to take. The body is a closed system, and it's meant to stay that way. Open up the skin, and you provide a gateway to bacteria that will try to take over your body's delicate ecosystem.

The post-antibiotic world of the future wouldn't be quite like the world of the past, however. Antibiotics are one powerful reason that so many fewer people die of disease. But public-health measures such as better sanitation also matter a lot. So does the much more nutritious diet enjoyed by most modern humans. Even if all the antibiotics went away tomorrow, we'd still be healthier than our ancestors, because we don't live crowded into small, poorly ventilated spaces, breathing smoke, washing irregularly and going to the bathroom in a hole in the ground.

But that's not cheering when you remember that our post-antibiotic grandchildren will be less healthy than we are: more likely to die young or spend their lives crippled by disease. In the face of such a large problem, it's an amazement that our public-health experts have any time to spare on any other problem.

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Megan McArdle at