carpe decorum

Antibiotics on the Op-Ed Page

Revenge of the Bacteria, the outcome of our carelessness with antibiotics is the subject of this op-ed:

Every day in the United States, 100 men, women and children—40,000 or more every year—die from infections caused by bacteria that are resistant to antibiotics. The number, which is larger than the number who die from AIDS, may actually be higher, because many deaths, particularly those of elderly patients suffering myriad problems, may in reality stem from these “superbugs.”

Antibiotics have become the foundation of modern medicine. They are an essential ingredient not only in combating disease but also in transplanting organs—heart, kidney, liver and others—as well as surgery of all kinds. Without antibiotics, few surgeries would be “routine” because of the constant threat of death from infection.

The bacteria that were neutralized by antibiotics, however, did not disappear. Like other living organisms, they have responded to the challenge and adapted. Now medicine is encountering deadly new strains of bacteria that resist powerful antibiotics. Some strains already have appeared that are immune to all existing antibiotics.

Why are our miracle drugs failing us? One reason—well documented—is that we have used them too often, to treat infections and conditions that more often than not could be defeated by the body's immune system without medical intervention. Another reason is that antibiotics have become omnipresent, in our food and water supply, as farmers feed them to cattle and poultry and spray them on crops. As we ingest them in low doses, bacteria become familiar with them and mutate to protect themselves.

Although they advocate the obvious, reducing the use of antibiotics to only needed situations and cleaning up hospitals—including hand-washing among healthcare workers between seeing patients— the authors argue that the problem lies with the market for developing new antibiotics:

These are positive steps, but they alone are insufficient. We are in desperate need of new antibiotics and other drugs to treat infections. Few drug companies are developing new antibiotics, and most of these are closely related to existing drugs. Hence, they are theoretically less likely to baffle bacteria very long.

What we need and what we are not getting—and under present circumstances will not get—are entirely new types of antibiotics with characteristics unknown to the new strains of bacteria lying in wait.

The authors argue drug companies want to make broad-spectrum antibiotics, the opposite of what interests the medical field, which exemplifies the problem of ignoring how actual incentives in a system can distort the marketplace. Are there ways to align the need for more, selective antibiotics with drug companies' imperative to make money?

Posted at November 4, 2003 10:14 AM