Thursday, March 9, 2017

On Being a Cassandra: Antibiotics

Just a quick aside, before I get seriously into today’s unfounded alarmism and moping about the future, I want to thank everyone who has been reading so far. Without all of you, this would be entirely pointless. On this note, if you enjoy the blog, please do share any articles on your social media platform of choice.

Previous Cassandra series posts: A.I.Global Warming

At the risk of cliché, it’s hard to overstate the importance of antibiotics. While it’s unimaginable to us, the children of the golden age, the medical advances we take for granted, such as organ transplants, surgery, and safe childbirth are all possible only because of antibiotics.

I’m not recusing myself from that group, if this NYT article is to be believed, 11% of skin infections were fatal back before antibiotics. Which doesn’t seem realistic to me, but I don’t have the standing to refute the datum. Maybe they just mean serious infections, not my acne and cat scratches, otherwise I’ve really beaten the odds.

At any rate, without antibiotics, many surgeries have a decent chance of being life threatening. Even with sterile conditions, you’re still making a big hole for bacteria to get in, with antibiotics consistently used during surgery to prevent infection. And even that’s not enough, the World Health Organization estimates that “Of every 100 hospitalized patients at any given time, seven in developed and 15 in developing countries will acquire at least one HAI [Health-care Associated Infection].”

I guess I kind of skipped over the major problem on this one, so let me rectify that: we are running out of antibiotics. Not just for the “MSRA” staph infections that occasionally make the news every now and then, but in general. We’ve already seen bacteria that are immune to every antibiotic we have, and the others are continually growing and refining themselves, actively working to develop resistances to treatment. Not only do bacteria acquire resistances through ordinary mutation, but they can also acquire resistances through plasmids. Essentially, a bacterium that develops resistance can spread it to other unrelated species of bacteria, making the development of any resistance a highly undesirable outcome from our perspective.

Like in any evolutionary arms race, bacteria that develop resistances are more successful. It takes constant progress on our end to maintain our superiority. At the moment, this is not happening, and scientists are predicting the practical end of antibiotics within a few decades.
It is difficult to justify investment in new antibiotics when they quickly stop being useful

One of the glaring problems is that the bacteria are developing resistance more quickly. Quicker than we can develop new drugs, at least. The reasons for this are likely due to the overuse and misuse of antibiotics, a topic for which a comprehensive accounting is beyond the scope of this short essay. One salient fact: the vast majority of antibiotics used are given to animals in their food, in order to keep them healthy in the foul conditions of factory farms. Use of antibiotics in this way also raises the percentage of body fat in the animals. Similar results occur when antibiotics are (over)used with children. Additionally, an estimated 50% of all antibiotics administered to people are used unnecessarily, to treat colds and flus. Suffice it to say, we are ever the architects of our own demise.

What will the future look like? The past, likely enough. Diseases once untreatable (Tuberculosis, Gonorrhea, Cholera, E coli, etc.) will be untreatable once again. I want to stress that this is not speculative, it is already occurring around the world. Species of gram negative bacteria have been the first to develop resistance to all known antibiotics, but more will inevitably follow. Our children will die from infections that our parents shrugged off, and, in one more way, the world will be darker and more dangerous.

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