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How Great Is the Menace?Awake!—2003 | October 22
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How Great Is the Menace?
IN October 1997, Hollie Mullin, a three-week-old baby, contracted an ear infection. When it failed to clear up in a few days, her doctor prescribed a modern antibiotic. It should have been a routine cure, but it wasn’t. The infection returned and continued to do so after each course of antibiotics.
In her first year, Hollie had 17 courses of various antibiotics. Then, at 21 months of age, she got her worst infection. After 14 days of intravenous administration of an antibiotic of last resort, the infection finally cleared up.
Scenarios like this have become increasingly common and not just among babies and the elderly. People of all ages are getting sick and even dying from infections that were once easily cured with antibiotics. Actually, germs that survive antibiotic assault have been a serious problem in some hospitals since the 1950’s. Then during the 1960’s and 1970’s, germs resistant to antibiotics spread into communities.
In time, medical researchers began to cite overuse of antibiotics in humans and animals as the principal cause of the increase in germs that are resistant to antibiotics. In 1978 one of these medical personnel described antibiotic overuse as “completely out of hand.” So by the 1990’s, headlines like the following were appearing worldwide: “Super-bugs Arrive,” “Superbugs Take Hold,” “Dangerous Drugs—Antibiotic Overuse Is Spawning Superbugs.”
Sensationalism? Not according to respected medical organizations. In a report on infectious diseases in 2000, the director general of the World Health Organization (WHO) stated: “At the dawn of a new millennium, humanity is faced with another crisis. Formerly curable diseases . . . are now arrayed in the increasingly impenetrable armour of antimicrobial resistance.”
How serious is the crisis? “This disturbing development [of drug-resistant germs] is closing the windows of opportunity to treat infectious diseases,” WHO reported. A number of authorities today even speak of humanity’s return to a “pre-antibiotic age,” when there were no antibiotics for curing infections.
How have resistant microorganisms been able, in effect, to colonize the world, outmaneuvering sophisticated scientific advances? Is there anything an individual can do to protect himself or others? And what solutions are in the offing to combat germs that are resistant to antibiotics? The following articles present some answers.
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Those Resilient Germs—How They ReboundAwake!—2003 | October 22
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Those Resilient Germs—How They Rebound
VIRUSES, bacteria, protozoans, fungi, and other microorganisms have evidently been around since life on earth began. The stunning flexibility of these germs, the simplest of all creatures, has allowed them to survive where nothing else can. They are found in scalding vents on the ocean floor as well as in the freezing waters of the Arctic. Now these germs are repelling the most concentrated of all assaults on their existence—antimicrobial drugs.
A hundred years ago, some microbes, or microorganisms, were known to cause illness, but no one then living had heard of antimicrobial medicines. So if a person came down with a serious infectious disease, many doctors had little to offer in the way of treatment except moral support. The person’s immune system had to fight off the infection on its own. If the immune system wasn’t strong enough, the consequence was often tragic. Even a minor scratch infected by a microbe all too often led to death.
Thus, the discovery of the first safe antimicrobial drugs—antibiotics—revolutionized medicine.a The medical use of sulfa drugs in the 1930’s and of such drugs as penicillin and streptomycin in the 1940’s led to a flood of discoveries in succeeding decades. By the 1990’s, the antibiotic armory had come to include some 150 compounds in 15 different categories.
Anticipation of Victory Smashed
By the 1950’s and 1960’s, some people had begun to celebrate victory over infectious diseases. Some microbiologists even believed that these diseases would soon be a nightmare of the past. In 1969 the U.S. surgeon general testified before Congress that humanity might soon “close the book on infectious disease.” In 1972, Nobel laureate Macfarlane Burnet along with David White wrote: “The most likely forecast about the future of infectious disease is that it will be very dull.” Indeed, some felt that such diseases might be eliminated altogether.
The belief that infectious diseases had, in effect, been defeated resulted in widespread overconfidence. One nurse who was familiar with the dire threat that germs posed before the introduction of antibiotics noted that some younger nurses had become lax in simple hygiene. When she reminded them to wash their hands, they would retort: “Don’t worry, we have antibiotics now.”
Yet, dependence on antibiotics and their overuse have had disastrous consequences. Infectious diseases have persisted. More than that, they have roared back to become the leading cause of death in the world! Other factors that have also contributed to the spread of infectious diseases include the chaos of warfare, widespread malnutrition in developing countries, lack of clean water, poor sanitation, rapid international travel, and global climate change.
Bacterial Resistance
The astounding resilience of everyday germs has proved a major problem, one not generally anticipated. Yet, in hindsight, that germs would develop immunity to drugs should have been anticipated. Why? Consider, for example, something related that happened with the introduction of the insecticide DDT in the mid-1940’s.b At that time dairymen rejoiced as flies essentially disappeared with the spraying of DDT. But a few flies survived, and their offspring inherited immunity to DDT. Soon these flies, unaffected by DDT, multiplied in vast numbers.
Even before DDT was used, and before penicillin became commercially available in 1944, harmful bacteria gave foregleams of their prodigious defensive weaponry. Dr. Alexander Fleming, penicillin’s discoverer, became aware of this. In his laboratory he watched as succeeding generations of Staphylococcus aureus (hospital staph) developed cell walls increasingly impervious to the drug that he had discovered.
This led Dr. Fleming to warn some 60 years ago that harmful bacteria in an infected person could develop resistance to penicillin. So if doses of penicillin did not kill sufficient numbers of the harmful bacteria, their resistant offspring would multiply. As a result, there would be a rebound of the disease that penicillin could not cure.
The book The Antibiotic Paradox comments: “Fleming’s predictions were borne out in a more devastating way than even he surmised.” How so? Well, it was learned that in some strains of bacteria, the genes—the tiny blueprints in a bacterium’s DNA—produce enzymes that make penicillin ineffective. As a result, even extensive courses of penicillin often prove useless. What a shock this was!
In an attempt to win the battle against infectious diseases, new antibiotics were regularly introduced into medicine from the 1940’s through the 1970’s, as well as a few during the 1980’s and the 1990’s. These could treat bacteria that defied earlier drugs. But within a few years, strains of bacteria surfaced that defied these new drugs as well.
Humans have come to learn that bacterial resistance is astonishingly ingenious. Bacteria have the ability to change their cell wall to keep the antibiotic out or to alter their own chemistry so that the antibiotic cannot kill them. On the other hand, the bacteria may pump the antibiotic out as fast as it enters, or the bacteria may simply render the antibiotic ineffectual by taking it apart.
As the use of antibiotics has increased, resistant strains of bacteria have multiplied and spread. A total disaster? No, at least not in most cases. If one antibiotic doesn’t work for a particular infection, another usually does. Resistance has been a nuisance, but until recently it has usually been manageable.
Multidrug Resistance
Then, to their horror, medical scientists learned that bacteria exchange genes among themselves. At first it was thought that only bacteria of the same type could exchange genes. But later the very same resistance genes were discovered in completely different types of bacteria. By means of such exchanges, bacteria of various types have accumulated resistance to many different commonly used drugs.
As if all of this were not enough, studies in the 1990’s showed that some bacteria can become drug resistant on their own. Even in the presence of only one antibiotic, some kinds of bacteria develop resistance to multiple antibiotics, both natural and synthetic.
A Foreboding Future
Although most antibiotics today still work in the majority of people, how effective will such drugs be in the future? The Antibiotic Paradox observes: “We can no longer expect that any infection will be cured by the first antibiotic chosen.” The book adds: “In some parts of the world, limited supplies of antibiotics mean that no available antibiotic is effective. . . . Patients are suffering and dying from diseases that some predicted 50 years ago would be wiped off the face of the earth.”
Bacteria are not the only germs that have become resistant to drugs used in medicine. Viruses as well as fungi and other tiny parasites have also shown amazing adaptability, offering the world strains that threaten to nullify all the efforts invested to discover and produce the drugs that fight them.
What, then, can be done? Can resistance be eliminated or at least contained? How can the victories won by antibiotics and other antimicrobials be preserved in a world increasingly beset by infectious diseases?
[Footnotes]
a “Antibiotic,” as the word is commonly used, is medicine that fights bacteria. “Antimicrobial” is a more general term and includes any drug that combats disease-causing microbes, be they viruses, bacteria, fungi, or tiny parasites.
b Insecticides are poisons, but so are drugs. Both have proved to be helpful as well as harmful. While antibiotic drugs may kill harmful germs, these drugs also kill beneficial bacteria.
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When Germs Will Not Harm AnyoneAwake!—2003 | October 22
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When Germs Will Not Harm Anyone
GERMS, or microorganisms, are essential to life. They make up a considerable portion of earth’s soil and of our own bodies. As the box “Kinds of Germs,” on page 7, notes, “bacteria inhabit our bodies by the trillions.” Most of these are beneficial—in fact, vital—to health. Although only relatively few cause disease, we can be confident that, in time, no germs will harm anyone.
Before we examine the means by which all harmful effects of germs will be eliminated, let’s consider current efforts to combat disease-causing germs. Besides examining the accompanying box “What You Can Do,” consider the efforts of health professionals to combat resistant germs.
Global Strategies
Dr. Gro Harlem Brundtland, the former director general of the World Health Organization (WHO), described efforts being made. In the Report on Infectious Diseases 2000, “Overcoming Antimicrobial Resistance,” she pointed to a need to develop “a global strategy to contain resistance” of germs. She also spoke of building “alliances involving all healthcare providers,” emphasizing: “We have an opportunity to launch a massive effort against infectious diseases.”
In 2001, WHO proposed a “Global Strategy for Containment of Antimicrobial Resistance.” This document presented a plan directed to health-care providers and people in general regarding “what to do and how to do it.” The strategy included educating people on how to avoid getting sick, as well as providing instruction to them on how to use antibiotics and other antimicrobials when they get an infection.
In addition, health-care workers—doctors and nurses as well as others working in hospitals and nursing homes—were urged to take better measures to avoid the spread of infection. Sadly, studies have revealed that many health professionals still neglect to wash their hands or change gloves between patients.
Surveys have also shown that doctors prescribe antibiotics when they shouldn’t. One reason for this is that people pressure their doctor to give an antibiotic as a quick cure. So doctors comply, simply to please patients. Often doctors neither take the time to educate their patients nor have the means available to identify the infecting germ. Also, they may prescribe newer but more expensive broad-spectrum antibiotics. And this too contributes to the drug-resistance problem.
Other areas addressed in WHO’s Global Strategy are hospitals, national health systems, food producers, pharmaceutical companies, and lawmakers. The report encourages cooperation among all of them in order to combat the global menace of drug-resistant germs. But will such a program work?
Obstacles to Success
The WHO Global Strategy alluded to a major obstacle to solving health problems. It is the profit motive—money. The Bible says that the love of it is responsible for “all sorts of injurious things.” (1 Timothy 6:9, 10) WHO urges: “Interactions with the pharmaceutical industry must also be considered, including appropriate control of the access of sales representatives to clinical staff and monitoring industry-sponsored educational programmes for providers.”
Drug companies have aggressively presented their products to doctors. Now they do so directly to the public through TV advertising. This has evidently contributed to the overuse of drugs, which, in turn, has been a major factor in the proliferation of drug-resistant germs.
In its chapter on the use of antimicrobials in food-producing animals, the WHO Global Strategy states: “Veterinarians in some countries earn as much as 40% or more of their income by the sale of drugs, so there is a disincentive to limit antimicrobial use.” As is well documented, resistant germs have emerged and flourished because of the inordinate use of antibiotics.
The production of antibiotics is, in fact, astounding. In the United States alone, some 50 million pounds [20 million kg] of antibiotics are produced annually! Of the world’s total production, only about half is used for people. The rest is either sprayed on crops or fed to animals. Antibiotics are commonly mixed with the feed of animals raised for food to speed their growth.
The Role of Governments
Significantly, the Executive Summary of the WHO Global Strategy states: “Much of the responsibility for implementation of the strategy will fall on individual countries. Governments have a critical role to play.”
To be sure, a number of governments have developed programs to contain antimicrobial resistance, with emphasis on collaboration inside and outside their national boundaries. These programs include better tracking of antimicrobial use and resistant microbes, improved infection control, appropriate use of antimicrobials in medicine and agriculture, research to understand resistance, and development of new medicines. WHO’s Report on Infectious Diseases 2000 was not optimistic. Why?
The report pointed to “a lack of political will on the part of governments whose priorities may not be public health.” It added: “Disease—and therefore resistance—also thrives in conditions of civil unrest, poverty, mass migration and environmental degradation where large numbers of people are exposed to infectious diseases.” Unfortunately, these very problems are ones that human governments have never been able to solve.
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When Germs Will Not Harm AnyoneAwake!—2003 | October 22
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[Box on page 9]
What You Can Do
What can you do to minimize the threat of resistant germs? The World Health Organization has provided some guidelines. First, it outlined measures we can take to reduce disease and the spread of infection. Second, it described how people can improve their use of antimicrobials.
Logically, the best way to reduce disease and its spread is to do whatever is necessary to keep healthy. What can you do to avoid getting sick?
Measures to Avoid Getting Sick
1. Do your best to obtain the following three things: proper nutrition, sufficient exercise, and adequate rest.
2. Practice personal hygiene. Authorities emphasize hand washing as the single most effective procedure to avoid getting ill and to keep from passing infection on to others.
3. Ensure the safety of the food you and your family eat. Be especially conscious that your hands as well as the area where meals are prepared are clean. Also, be sure that the water used to wash your hands and food is clean. Since germs flourish in food, cook meats thoroughly. Store and chill food properly.
4. In lands where serious disease is transmitted by flying insects, limit your nighttime or early-morning outdoor activity when these insects are most active. And regularly use protective netting.
5. Vaccines can help train your immune system to fight off some germs that are common where you live.
Use of Antimicrobials
1. Consult a health professional before buying or taking any antibiotic or antimicrobial. Direct-to-consumer promotions often benefit the seller more than the buyer.
2. Don’t press your doctor for an antibiotic prescription. If you do, he may give you one only because he fears losing you as a patient. Colds, for example, are caused by viruses, and antibiotics do not cure colds. Taking an antibiotic when you have a virus may suppress helpful bacteria, perhaps allowing resistant ones to breed.
3. Don’t insist on the latest medicine—it may not be the best for you and may cost you far more than is necessary.
4. Learn about any medication from a reliable source: What is it for? What are the possible side effects? What are its drug interactions and other factors that might make ingesting it dangerous?
5. If the antibiotic medication is truly appropriate, you are generally encouraged to take the full course that is prescribed, even if you feel better before you finish taking it all. The last portion helps ensure that all of the infection is gone.
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