We’re all buggered – when news is not news

According to Sky News today yesterday (note subtle hint that this might be a post-dated blogpost):

The Chief Medical Officer has raised the prospect of a future without cures for common infections – unless antibiotics are used more responsibly.

You don’t say, Professor Dame Sally Davies?

This isn’t news.

Over ten years ago, while in Oxford, I attended a seminar by Dr David Livermore, then Director of HPA’s Antibiotic Resistance Monitoring and Reference Laboratory in the UK. He basically told the gathered microbiologists (I have no idea what the correct collective noun is here – “a culture”?) that we were all buggered, because we were heading back to a pre-antibiotic era due to the prevalence of antibiotic resistance.

The effect of his stark warning on an educated, usually sceptical audience was interesting. Every single person agreed. Because we were already seeing more and more resistant bacteria in our laboratories every single day and we were having to resort to more and more outlandish, expensive and (in some cases) relatively untested antibiotic treatment regimens to cure patients of their infections.

But the time will come (soon), when we run out of antibiotics and we’ll be at the mercy of what are – at the moment at least – minor infections. Advanced surgery like transplantation, will become impossible – immunosuppressed patients will simply not survive the inevitable infections without prophylactic (preventative) antibiotic treatment. Even “basic” surgery will be impossible for the same reasons. Anything around the abdomen – appendicitis, for example – will effectively mean game over.
But it’s not just this “running out of options” that is the issue:

When somebody has a severe infection – say blood poisoning – causing a high fever, a hospital clinician will dispatch blood samples to the lab to find out exactly what he is dealing with. But that takes time. “He will start you on antibiotics because that will kill infection within 48 hours,” says Livermore. “So during 48 hours, you are being treated blind. The more resistant your bacteria are, the less likely the antibiotic is going to work.”

It’s an unpleasant thought, so why aren’t we more concerned?

Well, because this is an insidious problem. There’s hasn’t been and there’s not going to be one specific, defining moment in this horror story. No 9/11, no Marikana, no December 21, 2012. It’s just slowly happening and sadly, we’re pretty powerless to stop it. Here in South Africa, we have already had problems with first MDR, then XDR tuberculosis. If you think that it’s all ok, because things are going to end there, then maybe you shouldn’t google “TDR-TB”.

Professor Dame Sally Davies blames over-prescription of antibiotics for the rise is resistance, but the evidence for this is far from conclusive.
Livermore again:

Governments worldwide are pressing for reduced antibiotic use, hoping thereby to reverse resistance trends. Is success likely? The evidence is mixed, and expectations should be tempered by the growing realization that many resistant bacteria are biologically fit, making them difficult to displace.

Yes, he’s basically suggesting that the bacteria are actually too strong for us to defeat. We are being outwitted – out evolved – by microbes. It’s kind of difficult to stomach, but:

“The emergence of antibiotic resistance is the most eloquent example of Darwin’s principle of evolution that there ever was,” says Livermore. “It is a war of attrition. It is naive to think we can win.”

So there you have it. Happy thoughts for the weekend. I just thought that I really should tell you today, because with the country and the world so very full of good news right now, you probably needed a reality check.

None of it matters. We’re all buggered.

  • and here we were worried about global warming killing us first…

  • Mingbean

    Whilst I’m very grateful for the uplifting Saturday morning post, 6K, I don’t really see the point. If what you’re saying is true (and I’m not suggesting it’s not, I just don’t know enough to hold a valid opinion either way), then we are powerless to do anything about it. Is there a point in publicising this fact? Would we all be better off knowing, other than perhaps for the purposes of ditching the sunscreen and taking up smoking?

  • Ronnie

    The anticipation of this post was so much happier and funnier (in my head) than the reality. Thanks for that.

  • Wendy

    That’s frightening. What is the solution ? Or is it horrible death . Happy Saturday

  • Geoffrey Chisnall > Well, you could move to high ground and die there instead.

    Mingbean > What? Smoking will probably still accelerate your eventual and inevitable end.

    Ronnie > I’m good at the big, misleading build-up, hey?

    Wendy > Solution? No. We don’t have one of those. Sorry.
    Have a great week!

  • Gary

    Well, I suppose if one looks at it with a different spin, once our antibiotics stop working, we’ll stop using them, and eventually, should anyone actually survive that long (and it would be prudent to believe someone will, because people did survive before Madam Curie made her discovery), the microbes will evolve to a point that even the most basic antibiotic will once again start to work.

    Hey, it’s my dreamworld, so let me live in it.

    Oh, and for those that don’t make it to that evolutionary full cycle, sorry. Hope you enjoyed what time you had.

  • Gary > Oh sure. Some will make it through. But given that we’ve been working at being better than microbes for about 2 million years and we’ve use up our chemical advantage in about 80 years, I don’t suppose that any of us will live to see the other side.

  • Mingbean

    Ok, still no smoking. Can I spend my pension?

  • Mingbean > Sure. As long as it’s not on cigarettes.

  • Carl Botha

    But surely evolution will catch up and save us?

    I mean, evolution never let us down in … well … I dont know in how many millions of years … although, you might differ with me if you are driving a car in South Africa … but all in all, I think evolution is doing a superb job.

    However, your last paragraph (“None of it matters. We’re all buggered.”) is raising some red flags.

    “None of it matters.” reminds me of some passages in the Bible.

    ” We’re all buggered.” is what people told me when I said I dont believe in religion and Jesus.

    But I am sure I am just over-sensitive, and that you are a far cry from a closet-reborn.

  • Carl Botha > See here’s the problem: to evolve, you need to reproduce. You yourself can’t evolve, it’s a species thing. That’s because you only get the chance to shuffle the genetic cards when a new generation comes along. And we reproduce, let’s say on average, about once every twenty years. That’s a rough guesstimate from Limpopo schoolgirl through to aging, desperate, almost on-the-shelf, lastminute.com spinster.
    Bacteria though – well, they can do this every 20 MINUTES. That means that for every one generation of us, they have 525,600 generations. And that extra 525,599 card shuffles kinda gives them the edge.

  • Neo

    There has been numerous writings about the fact that we are trying to be too clean. We need exposure to build up our imune systems. What we need to do is stop using anti-bacterial soaps and anti-bacterial cleaners. We survised so far without it, and we will continue to survive without it.

    There was a trial by a doctor in one of the Scandanavian countries (forgot which one), where they stopped using harsh cleaning chemicals in the hospital, and all patients are screened for multi-drug-resistant bacteria before they enter.

    As for anti-biotics – I was always told that if it wasn’t used with great caution, it will make you even more sick to the point where they run out of options.

  • Carl Botha

    “You yourself can’t evolve, it’s a species thing. ”

    I think I have lost you.

    If species cannot evolve, how did we get to this stage where we are now? (As a specie)

    I assume that we agree that we were not CREATED by … whatever … , so surely evolution knows how to beat the odds by putting mankind into existence with the odds of 1 against 525,599 per 20 years.

  • Neo > Fair enough, but a couple of points. The “too clean” thing is generally associated with allergies and the like. If you kill off all the bugs around you, you won’t get ill.
    Also, the evidence linking anti-microbial soaps and the like (see Triclosan as an example) with antibiotic resistance is shaky, to say the least.
    All patients coming into hospitals for elective surgery are screened for nasty bugs. The problem is that not everyone going into hospital falls into that “pre-planned” category.

    Carl Botha > What I meant was that you personally cannot evolve. Your genes, your DNA, are fixed. The human species can certainly evolve and is evolving. And yes, you’re correct that we have more than held our own against the bacteria for millions of years. But we have grown up in an era when we had complete dominance over those pesky bugs.
    Strep throat? – penicillin.
    Dental abscess? – metronidazole (and absolutely no alcohol) (seriously?) (yes, seriously).
    Nasty infected insect bite? – flucloxacillin.

    So I’m not necessarily saying that the entire human race will die out (as Gary said above, some – even most – will survive). What I’m suggesting is that the illnesses and maladies which are currently trivial (because if they were dangerous, or even if they were annoying, we killed them with drugs) will not longer be trivial. They will be annoying and they will be fatal. Those complications that you never got from your sore throat because you killed the bugs before things got complicated? Well, they will complicate matters from now on, because that failsafe of killing the infection before it gets serious will no longer be an option.

    It really is a pretty scary thought. To me, at least.

  • Mingbean

    Greater use of vaccines? I can already hear the anti-vax lot raising their voices in protest…

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