Monday, November 25, 2013

Concerns over antibiotics

  A report in The Week (November 22, 2013, page 9) outlines problems we face in healthcare because antibiotics are becoming ineffective. At least 23 thousand Americans are dying annually from infections that no longer are curable. Viruses are becoming immune to the antibiotics used over more than five decades.

  In 1945, Nobel Laureate Alexander Fleming, who discovered penicillin, warned, “There is a danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”

  Viruses are infectious particles smaller than any bacteria. A virus can insert its genetic material into its host, literally taking over the cell’s functions and may remain dormant inside cells for long periods. Some of the diseases in humans caused by viruses include smallpox, the common cold, chickenpox, influenza, gastroenteritis, shingles, herpes, polio, rabies, Ebola, hanta fever, and AIDS. (

  Viruses have evolved rapidly. Since the life-cycle of a single organism may be only hours or days, thousands of generations live, infect, and die each year. Mutations cause a few to be resistant to a particular medication. These changes are passed on to future generations. Those with the modification continue to infect even when the medication is given, while those without die. Soon, the resistant viruses dominate.

  Dr. Arjun Srinivasan, an official at the Centers for Disease Control, warns that procedures such as organ transplants, pre-mature-infant care, replacing a catheter, and chemotherapy may be in jeopardy in a “post-antibiotic era.” Margaret Chan, director-general of the World Health Organization worries that problems such as strep throat or a scrapped knee could, once again, become deadly.

  We are making the situation worse. The CDC estimates that half of human antibiotics are misused. Some patients stop using the medication as soon as they start to feel better, leaving many microbes to multiply. Worse negligence comes from overuse for treating diseases not caused by a virus, such as bacterial infection, or to which the virus is immune, such as the common cold, influenza, and gastroenteritis. I know about the latter from personal experience this summer. I received one antibiotic, then another, and finally cefdinir, a medication to which the virus was not immune.

  The worst offense: 80% of antibiotics sold in the US are fed to farm animals, to plump them up and keep them alive in their overcrowded pens. The resulting resistant viruses are in the final product and sold to the consumer. This occurs here in central Michigan at the invasive cow and pig factories that are springing up too frequently in our counties. Lansing refuses to implement any reform to this unhealthy practice.

  Unfortunately the pharmaceutical industry is not interested in developing new antibiotics. There have been no major innovations in the area since 1987. It can require billions of dollars to develop a new drug, but the return can be small. The average new antibiotic loses $50 million. In 2012, Congress passed the GAIN Act to encourage new development. The law extends patents on new antibiotics and fast-tracks those aimed at important new pathogens. The industry wants tax credits to help cover research and development costs.

  Unfortunately, viruses will develop immunity to the new products over time, so the process must continue. Livestock farmers must stop pumping their animals full of these medications, and doctors and patients must use available products only as required.

  We live in a complex world and must insure that the pharmaceutical, medical, and agricultural communities do what is correct for the health and wellbeing of everyone. If Lansing and Congress do not oversee the process properly, we could face a pandemic of immense consequences and the deaths of millions. The Great Plague was caused by Yersinia pestis, a micro bacillus carried by fleas on rats. The next one could be caused by a virus caught from your sick neighbor.

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