Are we just distancing the finish line on a race we will inevitably lose?
I just checked, and I have five books in the health section of my library that pertain to the potential for worldwide medical catastrophe. I have clearly expected trouble for many years. Now it seems closer.
Recent newspaper commentary has inspired me to sit down and collect my thoughts on this subject. I should admit at the outset that I have no advanced training in medical science, but the field fascinates me. And in spite of all the wonders that conventional medicine has wrought, I have recently recommitted to do everything I can to avoid needing it. I am also being so presumptuous as to suggest that we need to rethink the whole field.
The problem is those microbes, most specifically bacteria and viruses, which have been around for about 3.5 billion years compared to our 4 million. They outnumber us by a factor too large to put the brain around, and they adapt to changing environments with a speed and ingenuity that leaves medical science trailing in the dust. For example, there are some bacteria that have not only become resistant to antibiotics but also use them as a food source. My focus today is on bacteria.
With the introduction of penicillin in 1940, the medical world believed that the “war against pestilence” was won. However, as Brad Spellberg, MD, a specialist in infectious diseases, wrote in Rising Plague in 2009, the truth is painfully other. Bacteria are developing resistance to medications at confounding speed. Antibiotics are the only technology, he writes, that becomes less effective the more it is used.
The pharmaceutical companies are focused on profit, of course, and this is very bad business news. It takes about ten years and costs around a billion dollars to get each new drug developed, tested, and approved by the FDA, so a brief shelf life is financially disastrous. Even while effective, an antibiotic is typically used for only a few weeks at a time and thus doesn’t make a lot of money. Investment in drugs for chronic diseases makes a lot more sense.
For such medication to be profitable, however, a lot of living patients are required; and life expectancy will plummet in the absence of antibiotics. Surgery of every kind would become extremely dangerous. Chemotherapy, which depresses the immune system, would be impossible. Deaths from pneumonia and countless other infections would soar. Battlefield losses would be catastrophic.
Carl F. Nathan, MD, chairman of the Department of Microbiology and Immunology at Weill Cornell Medical College, addressed a looming emergency in commentary titled “Let’s Gang Up on Killer Bugs.” (The New York Times, December 10, 2012). He proposed that government, academia, biotech scientists, and pharmaceutical companies collaborate on the development of new antibiotics. An intergovernmental fund would “reward drug makers for products in proportion to their impact in reducing the loss of healthy years of life.”
Would that have significant appeal to pharmaceutical companies, and how much time do we have? Considering how ingenious these microbes are at adapting to antibiotics, it seems that exposure may actually benefit them. It is as though treatment is like sending them to the gym from which surviving “super bugs” emerge. Would the proposed collaboration just distance the finish line on a race we will inevitably lose?
I have often thought that there was a fork in the road in the history of medicine. We took the path defined by the terminology of war like “attack,” “conquer,” “kill,” and “destroy” in the pursuit of victory over the microbes. The other path would have been one of the following inquiry: Why do deadly microbes fail to infect some people and why do some who have been infected nevertheless survive? Answers would have led to ways of fortifying the body’s own defenses and healing capacity without drugs.
We have now recognized that in spite of the preliminary miracles wrought, overexposure to antibiotics in our food is now actually impairing the human immune system. And brilliant in their own way beyond anything we can imagine, dangerous microbes are much more likely to wipe us out than the other way around. In fact, they are providing us with a teaching: We need to evolve and become stronger just as they have in the face of attack.
At the moment, the challenge of maximizing human health seems to lie first and foremost with the individual rather than the medical establishment. The undertaking is complicated, time-consuming, even expensive; and it requires discipline and the willingness to forego many indulgences. In the coming time of antibiotic deficit, however, it will surely be essential to survival.