Son of Superbug
The combined edition (Aug. 11 and 18) of The New Yorker features a meticulously researched, seven-page article written by Jerome Groopman titled “Superbugs.”
In the year since I last wrote about antibiotic resistant bacteria in general and MRSA, the bacterium prevalent in hospital ICUs, in particular, apparently little has changed except that new strains of resistant microbes are gaining an even larger foothold outside of hospital settings.
Some of this is not new. In the 1980s, a class of drugs called carbapenems was developed to combat gram-negative organisms like Klebsiella, Pseudomonas and Acinetobacter. At the time, they were considered drugs of last resort so many hospitals put them “on reserve.” Some physicians, however, couldn’t resist using the “cure-all” and inevitably mutant resistant microbes flourished.
Though recognized by public health experts, little is being done to retard the proliferation of these pathogens. In fact, the National Institutes of Health budget is still woefully inadequate to accomplish much on this front, with pressure from advocates for research on malaria, TB and HIV using up its meager resources and Congress pushing for research on agents that could be used in bioweapons.
At the same time, pharmaceutical companies are opting out of the development of desperately needed new antibiotics because the big money is in blockbuster drugs that must be taken daily for decades to control chronic conditions (high cholesterol, hypertension, psychiatric and sleep disorders) and can be sold to millions of people. Antibiotics, on the other hand, are prescribed for infections in limited courses, usually without refills. No amount of advertising would likely improve the net profit on these drugs.
Eli Lilly and Co., which developed the first cephalosporins, broad-spectrum antibiotics like Keflex, has withdrawn completely from the field; Squibb merged with Bristol-Myers and closed their antibacterial program; Abbott, which developed key agents used in treatment of gram-negative bacteria, has followed suit.
FDA approval of new antibacterial agents has decreased drastically. Only six of the 506 drugs currently being developed are new antibacterial agents. The agency offers only non-binding guidelines for antibiotic use, but has rarely withdrawn approval for their application in agriculture and other cases widely recognized by scientists as detrimental or contributing to resistance.
After decades of unbridled use of antibiotics, doctors and HMOs are finally cautioning against the use of antibiotics for common viral infections (flu and children’s ear aches, for example) and as remedies for self-limiting infections. This is a step in the right direction but comes too late to save many of the most effective antimicrobial agents.
And industry hasn’t helped much. In an effort to “improve” cleaning and hygiene products, and market share thereof, everything from liquid soap to bathroom and kitchen cleansers now sports the “antibacterial” label. Never mind that these products do not protect as well, much less better, than old-fashioned bar soap, hydrogen peroxide and chlorine bleach.
But the real culprit is U.S. agricultural policy, driven by lobbyists for agribusiness conglomerates and the huge chemical companies that keep them afloat after factory farming and monoculture deplete natural resources in soil. Instead of using biology to treat biology, like parasitic wasps to control plant-eating insects, the answer seems to be “better living through chemistry.”
Seventy percent of the antibiotics administered in this country end up in agriculture. The ramifications of this are severe and yet not well understood by consumers. Two bestsellers written by Michael Pollan: “The Omnivore’s Dilemma” and “In Defense of Food” tell the story in ways that are easy to understand. Pollan, a professor of journalism at Berkeley, told The New Yorker, “The drugs are not used to cure sick animals but to prevent them from getting sick because we crowd them together under filthy circumstances . . . perfect environments for disease.” Also, “Administering low levels of antibiotics to animals speeds their growth.
“We’ve created a Petri dish in our factory farms for the evolution of dangerous pathogens,” Pollan says.
So what, if anything, is being done? The Infectious Diseases Society is lobbying Congress to pass the Strategies to Address Antimicrobial Resistance Act, which would earmark funding for research and set clinical trials on how to limit infection and antibiotic resistance.
And Stuart Levy’s Boston laboratory has received NIH funding to study a soil-based bacterium that may protect plants from microbial infection. He plans to develop it as a biocontrol agent to wean farmers off potent antibiotics and chemicals used to treat their fields.
So what can consumers do to speed these efforts?
First: Read Groopman’s New Yorker article, Pollan’s two books and, if you can find a copy, Laurie Garrett’s “The Coming Plague” (Published in 1996 by Penguin Books).
Second: Support organic agriculture. Buy organic produce, meat, poultry, dairy, eggs and wild-caught fish. Don’t buy cleaners labeled “antibiotic.” Disinfect the old fashioned way.
Third: Write, phone or e-mail your senators and representatives. Ask them to increase federal funding for research on antibiotic resistant microbes. Let them know you care about agribusiness abuse of chemicals, hormones and antibiotics. Tell them to vote for subsidies to organic farmers instead of to huge factory farms.
Finally: Frequent markets that sell grass-fed beef, eggs and dairy raised without antibiotics. Don’t buy the argument that organic products are too expensive. With soaring gas prices, buying locally will be cheaper. Also cleaner, more nutritious and tastier.
A votre sante!