Hope in a Prison of Despair by Evelyn De Morgan
I’ve been following the rise of antibiotic resistant diseases (along with viral outbreaks and world touring parasites) since about 2005.
I don’t know why I do this exactly, other than being insatiably curious about these tiny, adaptively brilliant, nearly invisible little companions that outnumber us by magnitudes of trillions and wield a level of power that takes my breath away.
BTW, it’s a power for both ill AND good as we’ll see in a bit, so don’t panic yet.
You may or may not have noticed some of the headlines lately, but first the director of the U.S. Centers for Disease Control and now the U.K.’s Chief Medical Officer have come out publicly to announce that we’re heading over the predicted cliff where antibiotic resistant diseases are concerned.
Antibiotics are losing their effectiveness against a disconcerting array of infections now. Some of those tiny bacterial companions I mentioned earlier? Well, they’ve been very, very industrious and mutated to the point where antibiotics just aren’t slowing them down like they used to. A couple have actually become bullet proof where no antibiotic can touch them.
The language in these bureaucratic announcements is eyebrow raising. There were unusually dramatic words employed like catastrophic and nightmare which, if you don’t follow these things, is kind of the governmental equivalent of tearing hair and screaming from rooftops.
So what does all this mean? Well, if you’re a bacteria, it means the future’s looking very rosy. But if you’re human? Not quite so much.
Picture the world as it looked before the development of penicillin and you start to get an idea of how much our lives have changed since the terror of infections ceased to rule them. Forget about syphilis, tuberculosis, and pneumonia. Once upon a time a splinter or scraped knee could turn fatal if they became badly infected.
Of course things won’t return to exactly the way they were back then. On the good side, antibiotics will continue working to some extent, and on the bad side, we’ve made some of our little bacterial companions a thousand times stronger. But in any case it’s safe to say that infections are going to be a far bigger issue than they have been for the last seventy years.
Such is the nature of shifts in power.
Naturally, the $64,000,000 question on everyone’s lips is What comes next? What do we do about all this? How are we going to treat infections that have achieved semi or complete immunity to antibiotics?
Well, it’s really going to have to be a multi-pronged approach. Just like there’s no one energy source capable of completely replacing oil, there’s unlikely to be one miracle treatment that can replace antibiotics.
(Although bacteriophages…wonderful little viruses that eat bacteria…may finally get a chance to come into their own. But more on that in a minute.)
First, a couple of other possible prongs off the top of my head:
CIRCLING THE WAGONS
Trying to prolong effectiveness for the antibiotics that do still work.
This seems to be the main focus of our beloved bureaucracies. It’s kind of a close-the-barn-doors-after-the-horses-are-gone approach but still vitally important and necessary to buy time. It involves taking dramatic action to try and slow the spread of antibiotic resistant diseases, curb widespread antibiotic abuses, and encourage new antibiotic research. Of course here in the U.S., any such policy that’s actually been approved hasn’t been funded, (ahem…cough, cough) but I guess we deserve that. Our politicians’ divide simply reflects our own.
In any case, we’re effectively leaderless for the time being which is why We The People need to start harnessing some of our famed independence and creativity. Now would be a good time to energetically explore other alternatives in individual, grassroots, and entrepreneurial ways, the leader of which has to be:
I would like to stick my neck out here and make a few predictions.
1) We’ll see a renewed love affair with stricter hygiene in clinical settings.
Remember when nuns ran the hospitals, how squeaky clean everything was? The metal was shiny, floors were knee-scrubbed, sheets were bleached and ironed, and anyone who didn’t wash their hands had them struck hard and repeatedly with rulers? I predict our tolerance for rulers will return.
2) We’ll all learn the correct way to wash our hands.
Soap will once more be king. We’ll not only start using it every time, we’ll use it liberally and scrub up to the wrists. No more just swiping one’s fingertips under the dribble and then touching every last contaminated surface on our way out the door. (Or worse, not washing one’s hands at all. I predict that people who don’t wash their hands thoroughly will be the future equivalent of 17th century lepers.)
3) We’ll start rethinking just how necessary any surgery or procedure really is.
Without antibiotics to back it up, reluctance to cut ourselves open and stick foreign medical objects inside will skyrocket. I predict fewer boob jobs and face lifts, cesarean sections and knee replacements, as well as a lot more soul searching and research before patients agree to things like stents, bypass surgeries, spinal fusions, etc. It’s estimated that 30% of American healthcare costs are spent on overtreatment. I imagine the risk of fatal bacterial infections could cut into that.
And then there should also come a rising openness to:
OTHER ALTERNATIVE TREATMENT POSSIBILITIES LIKE:
1) Maggot debridement therapy.
Living, disinfected maggots eat mostly dead tissue and, wisely employed, can help clean up a chronic or infected wound in the niftiest of ways. This method fell out of widespread medical use with the advent of penicillin in the 1940’s but it’s recently been making a comeback. It’s currently only used on a limited scale because most people think maggots are gross, but I predict that dying from an infected wound will eventually be viewed as even grosser.
2) Fecal implants. (The use of bacterial white hats against bacterial black hats.)
With success rates reportedly as high as 60-80% against drug resistant C. difficile the use of fecal transplants is already swiftly rising. (The good bacteria in the transplanted healthy feces repopulates the compromised intestinal tract driving out bad bacteria.) There are also early indications that fecal implants may be of benefit for a variety of other serious gastrointestinal complaints and, if so, their value will explode. I predict that Big Pharma will double down on trying to develop and patent some kind of poop pill.
3) Bacteriophage therapy. (The little viruses that could.)
Every bacteria has a hungry little virus or bacteriophage…phage to their friends…that will gobble that specific bacteria right up. (These little guys are viral white hats to be distinguished from viral black hats like flu and cold viruses, etc.)
Bacteriophage therapy is the science of matching the right virus to the right bacterial infection and then turning a bunch of them loose to have their way. Pioneered mostly in Georgia before the fall of the U.S.S.R. the therapy was gaining momentum before the advent of penicillin. (See a trend? Penicillin accidentally killed more than just bacteria.) A handful of dedicated Georgian doctors kept the therapy alive through the decades (a great story btw…these guys are fucking heroes) and currently have the most impressive stockpile of therapeutic viruses around, including a happy little phage for MRSA. As I write this some of our own venture capitalists are working furiously to get the therapy through regulatory hurdles right here in the States.
I predict that professional and public interest will continue to rise in other alternative therapies like these that were previously viewed as too weird or gross or complicated to consider.
And on the individual level there’s already a lot of enthusiasm and interest in possible infection control alternatives coming from:
4) Old home remedies and
5) Traditional medicine from other cultures
But those are a whole other blog post and I’ve already gone on for way too long here.
I guess what I’m mainly trying to say is that, while the dwindling power of antibiotics signals the end of an admittedly halcyon age in medicine, it’s by no means the end of the world. We’ve been battling infections since the dawn of humanity so of course there are other options (a couple of which look like they may be superior to antibiotics for specific infections as in the case of fecal implants for C. diff.) And there are plenty more options still to be explored.
The transition between medical ages won’t be easy of course. We’ve become dependent on antibiotics in a way that makes us pretty vulnerable to their loss. I’m not trying to minimize the real and looming threat to public health that we face.
But neither do I want to climb up on the rooftop to join in screaming and tearing my hair. While grave warnings are absolutely necessary in the current situation, there are other people far better equipped than I am who are already covering that job.
What I’d like to do is try and introduce some hope to the conversation to keep things grounded. I remember my initial response to all this when I first learned about it some years back was that of a deer frozen in the headlight of an approaching train. It took me a while to calm down and figure out that I didn’t have to just stand there and get hit.
That’s when I started my research and, over time, the more I’ve learned the more hope for the future I’ve felt, so I thought I’d share a couple tidbits here in case it might do something like that for you. A little hope can works wonders with a bad case of paralysis.
copyright Dia Osborn 2013
p.s. These are all articles hyperlinked in the above text. Just thought I’m stick them here again for easier reference.
The Rise of Antibiotic-Resistant Infections
‘We Have a Limited Window of Opportunity’: CDC Warns of Resistance ‘Nightmare’
‘Catastrophic Threat’: UK Government Calls Antibiotic Resistance a ‘Ticking Time Bomb’
Are you ready for a world without antibiotics?
How to wash our hands
Phage Biology and Phage Therapy