Superbugs pose a worldwide health threat, according to the World Health Organization (WHO) in a statement issued Wednesday by the United Nations agency charged with monitoring and improving the world’s health. Long predicted as the inevitable consequence of excessive use of more and more powerful antibiotic drugs to combat disease, the specter of once controllable diseases spiraling out of control, once a staple of science fiction, has now become actual fact.
In a landmark report with far-reaching consequences, WHO officials have found that antibiotic resistance, once found only in “first world” communities with access to the most recent medical miracles, is now affecting people all over the planet, in every country, from all walks of life. In a statement attached to the report, Dr. Keiji Fukuda, the WHO’s assistant director-general for health security summarized the threat with a warning that common infections, once easily controlled with antibiotics could once again become lethal illnesses.
Antibiotics Brewed From Natural Sources
An antibiotic is anything that interferes with the life cycle of a microorganism. Generally synthesized from a naturally occurring substance, such as the fungi that produce penicillin, antibiotics are “brewed” from things found in nature by concentrating the active ingredients found in sample sources to create highly concentrated, and therefore more powerful, versions of those natural agents. Also called antibacterial agents, most of the drugs in this category today are “semi-synthetic” modifications of naturally occurring compounds. Others are purely synthetic agents, but all antibiotics do the same thing: they kill bacteria.
The WHO report, Antimicrobial Resistance: Global Report on Surveillance, documents the increasing degree of resistance to antibiotics in seven groups of bacteria that cause sepsis, a blood infection, diarrhea, pneumonia, urinary tract infections and gonorrhea, all of which have become increasingly resistant to the specific antibiotics formerly used to defeat them. While each of these conditions may be caused by several different types of bacteria, as well as non-bacterial agents, most have responded well to “broad-spectrum” antibiotics that have become more and more widely used because caregivers do not have to determine which bacterial agent was responsible for a given patient’s illness.
One of the factors contributing to what has been called an impending global health crisis – the rise of the superbugs – has been the worldwide reliance on treatment to cure illnesses that could have been easily prevented through better sanitation and public health initiatives. The old adage, “an ounce of prevention is worth a pound of cure,” has been turned upside down in recent years because prevention is often much more expensive than treatment. The cost of correcting unsanitary living conditions is often far higher than the relatively inexpensive drugs used to cure illnesses that could have been prevented.
Hospital Bred Infections
One example of this phenomenon is the curious case of hospital-bred infections. Many patients – even at world-renowned medical institutions are often exposed to infection from inadequate preventive measures. Serious staph infections are common among wound victims, who come to the hospital with a physical injury that was not life threatening, but becomes so when the wound gets infected while the patient is being treated. Better sanitary measures, such as frequent hand washing by hospital staff, regular disinfecting of hospital rooms and public areas, and the installation of germ-killing air purification systems could dramatically reduce hospital-bred infections, but these measures are time-consuming and expensive.
One specific bacteria, called K. pneumoniae, is responsible for the majority of hospital-acquired pneumonia and bloodstream infections. The bacteria are especially prevalent in newborn infant cases and with patients in intensive care, two patient categories that most people would consider the most likely to have better than average sanitary conditions. The treatment of last resort for this bacteria, carbapenem-based antibiotics, are ineffective with more than 50 percent of the reported cases in some countries.
In many countries, including most of Europe, Canada, Australia and Japan and South Africa, the go-to treatment for gonorrhea, cephalosporins, are no longer effective against the more than one million new cases of gonorrhea per day around the world. Patients with methicillin-resistant Staphylococcus aureus (MERS), are 64 percent more likely to die than those with the non-resistant form of Staph infections. In North America, which may be the epicenter of the growing crisis, up to 90 percent of the Staphylococcus aureus infections are now methicillin-resistant. In the United States, 19,o00 people died from MERS last year, as many as MERS-related deaths throughout Europe in the same year.
How Superbugs Are Created
The process through which bacterial agents become resistant to medications is well-known. Whenever the human body becomes a host to an infection, there are various mutant versions of the same infectious agent present in the body, some of which are more resistant to the antibacterial agents being used. Over time, even when antibiotics are taken properly, the most resistant mutants of the bug survive and are passed along to other hosts, where the process begins again. This syndrome becomes even more prevalent when patients do not take the full course of treatment of an antibiotic regimen, which is often the case, as patients stop taking their prescribed medication when the illness for which the medication was prescribed “goes away.” In fact, what is happening is that the viral load, the amount of bacteria in the patient’s system, has simply been decreased below the point where symptoms continue, but the bacteria is still alive, and more potent than ever.
This process has become self-evident in agriculture, where American farmers are experiencing a backlash from the rootworm and the corn borer, two insect pests that attack corn crops after the widespread overuse of genetically modified corn seed has resulted in a resurgence of the crop destroying bugs. Agricultural scientists have repeatedly warned that the overuse of insecticides would produce resistant forms of the same pests the farmers were trying to eradicate. Studies show that the “boomerang effect” occurs whenever insecticide treatments are applied to more than 50 percent of the fields in a given growing area. The analogy is not exact, but there is a general principle that, when inoculating a given community against a specific contagion, unless you inoculate everyone simultaneously, inadequate treatment leaves pockets of untreated contagion that serve as reservoirs for the disease agents.
However, the analogy does help to explain how a seemingly recovered patient could pass along a more resistant version of the same bug that bit them to everyone they come into contact with. In effect, then, the human race has become an enormous, world-wide incubator uniquely designed to process and refine bacterial infections to make them even more deadly superbugs than they ever were before.
An Ounce of Prevention is Worth a Pound of Cure
The WHO report emphasizes what doctors have been saying for years, without effect. an ounce of prevention is worth a pound of cure. The first, and most important, step is to encourage frequent hand washing with a powerful disinfectant soap, and this is especially true in hospitals. Hands are the primary access route for most infections. Anyone entering or leaving a hospital room, even briefly, should disinfect their hands upon entering or leaving a hospital room, as well as before entering the hospital and after leaving, and this is true for any medical facility, and any sick room where a patient is being cared for in the home.
Increased vaccination against biological conditions, such as pneumonia, should be encouraged. At present, vaccinations appear to be effective against drug-resistant bacteria but that effectiveness may not be guaranteed as drug resistant versions of disease agents become more prevalent in the environment. Better home sanitation, including wiping down exposed surfaces with an antibacterial agent will help create “safe zones” where it is less likely for an infection to spread. Better yet, ultraviolet radiation systems installed in air handling equipment have been shown to create a far safer air quality in the home, a fact that has not penetrated the thinking of many hospital administrators. Out in the community, better sanitation services, clean water, and pest eradication programs will help to thwart the spread of many conditions. Vitamin supplements, beginning with Vitamin C, and mineral supplements like Iodine, have been shown efficacious at diminishing the risk of acquiring a superbug infection. There is also some evidence that large doses of cinnamon may also help reduce the risk of contagion.
Health care workers around the world are confirming the reports findings, with AID missions in various third world countries reporting “horrendous” increases in the percentages of their patients whose illnesses are resistant to what were formerly considered the treatments of choice for those ailments. Doctors in some of the wealthiest communities in the world are battling once easily managed diseases that are now starting to run rampant through first class medical facilities.
Burning Bridges to Health
Prescriptions for antibiotic agents are running at an all time high. Pharmaceutical industry revenues worldwide were $300 billion last year and, with 30 percent industry-wide profit margin, earnings will run close to $100 billion this year alone, and revenues are predicted to increase to $400 billion within three years according to the WHO.
There is also some consternation over whether or not all of this medication is really necessary. Big Pharma spends more than 33 percent of its revenues on marketing its products, twice as much as the industry spends on research and development, raising the question of whether the misuse of antibiotics is not in part due to the pharmaceutical industries efforts to convince patients to demand their products from their physicians, often demanding treatment for conditions that will run their course without pharmaceutical intervention.
As one health professional put it in an off-the-record conversation, “Superbugs may be coming to get us….and I’m not sure there is one damned thing we can do about it. Prevention costs too much and, paradoxically, there’s no money in it for the big corporations. This is going to wind up being a battle between public health advocates and the pharmaceutical industry, health against profits, because their vested interests are threatened by effective preventive measures.”
In a sense, the impending “bacteria” epidemic is a result of the world’s increasingly diligent efforts to improve worldwide health quality. By killing off the least durable strains of various bacteria, the medical profession and the pharmaceutical industry may very well have created a new breed of superbugs for which no treatments yet exist.
By Alan M. Milner
Look for me on Twitter:@alanmilner