Be Afraid. Be Very Afraid
So, I’m on this antibiotic resistance kick these days.
Actually — this is a topic that’s been on my mind for a while. The blunt truth is that it was when I first started reading about Vancomycin, a pretty damn nasty drug, originally discovered in 1953 but largely shelved until it became a drug-of-choice as a last line of defense against largely intractable MRSA (Methycillin-resistant S. aureus infections. That started to happen in the 70s, and I guess I began to notice some press on this at the start of my professional career as a science hack, sometime in the early 80s.
It struck me then and at intervals since that I — and most of you, almost certainly — have lived entirely in this really atypical period in the history of human-microbe relations. Antibiotics first became fairly broadly available in the midst of World War II — 1943 or so. Since the fifties, diseases that routinely killed some large percentage of their victims simply ceased to be meaningful threats. My grandparents grew up in a world in which you could die from a scratch, one in which TB killed half of those (or more) who developed active disease.
Theirs was one in which the dangers of surgery included real, scary risk of dreadful illness and sometimes death from post-op infection. Mine — ours — is not.
That’s changing now, to the point where we may look back on the last half of the 20th century and two, maybe three decades of this one and see it as this almost Eden-like mirage, that brief time in the garden when humans and microbes could co-exist peacefully. Then…Boom!
If antibiotic resistance progresses in the way it’s been going — well let me turn to Maryn McKenna, the journalist who more than any other has made this story current for me, and follow the links from a post she put up last month to these words from a genuinely serious person:
“Antimicrobial resistance poses a catastrophic threat,” said [England’s chief medical officer Dame Sally] Davies. “If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”
That struck a chord because I’d already been thinking about a CDC-published field report from South Africa, documenting 17 cases of what seem to be TDR-TB, tuberculosis that has evolved Total Drug Resistance — which is just as grim as it sounds. That finally prompted me to get off my ass and start reporting and writing, which has now generated a piece over at The New Yorker’s new science and tech web vertical (what we used to call a section, I suppose).
Go over there to read the whole thing, but for what I think of as the heart of the matter, there’s this:
Working against pathogenic microbes is not simple altruism. Keeping the lid on bad diseases in the age of air travel is a matter of self-interest, at least as much as it is a duty to our neighbors. And the invisible hand of the market is not currently taking care of this particular business. We are in the midst of a persistent antibiotic-development drought—only two new classes of the drugs have been identified in the last thirty years or so. Drug companies have been withdrawing from antimicrobial research for several reasons…For…perfectly rational economic reasons, the pharmaceutical industry is unlikely to keep pace with the need for a social good whose benefits don’t translate into profits that can be readily captured. That makes this a political matter: some other institutions will have to do the work.
Friends and readers here can guess at where the political theme leads…
In this context, I also was eager to have my second on-the-air/web conversation with McKenna about TB and much else this last Wednesday. I posted about that in advance (barely) of the broadcast — and now the podcast is available.
This is serious sh*t folks. We’re facing more and more resistant diseases — here’s a piece about completely resistant gonorrhea that should make the adventurous among us check the sell-by dates on their condoms — and we are devoting less and less social attention to the problem. I really don’t want to be 80, and in need of a hip replacement, and have to weigh a 1/n (where n is a small number) chance of dying from a bug against my ability to walk into senescence. Or to die coughing in my bed.
I’ll probably be beating on this drum some more, you know. It has (perhaps literally) gotten under my skin.
Cheers everyone. Happy Friday.
Images: Cristobal Rojas, La Miseria, 1866
Michaelangelo, Expulsion from Eden from The Sistine Ceiling, 1509-10
WPA poster created between 1936 and 1941.