Antibiotic resistance, like climate change, is one of those issues that has been blinking red on the world’s dashboard for decades. Everyone agrees it’s potentially disastrous—in fact, has already reached crisis stage in some areas—but interest group politics and crippling political dysfunction combine to make sure nothing is done about it.
The issue got another boomlet of attention over the weekend when the CDC launched a new campaign to limit overuse of antibiotics, and Maryn McKenna published an excellent longform piece about it on Medium.
The problem: evolution. A new antibiotic works like magic for awhile. But as it is used, bacteria which are randomly resistant to it preferentially survive and spread, until the drug is no good anymore.
Not only are there are already strains of totally drug-resistant infections (like tuberculosis and gonorrhea), the time between the development of a new drug and discovery of resistant bacteria has sharply decreased as use becomes more and more widespread.
The end of antibiotics would reverse something like half of the gains modern medicine has made over the last few centuries. Many major operations would be impossible, pneumonia and routine skin infections would again become major killers, and the risk of childbirth would sharply increase. Intensive care would be, basically, impossible. Death rates would jump and life expectancies would fall.
The worst aspect of this, as is often the case, is the farm policy angle. Here’s McKenna:
To varying degrees depending on their size and age, cattle, pigs, and chickens—and, in other countries, fish and shrimp—receive regular doses to speed their growth, increase their weight, and protect them from disease. Out of all the antibiotics sold in the United States each year, 80 percent by weight are used in agriculture, primarily to fatten animals and protect them from the conditions in which they are raised.
An annual survey of retail meat conducted by the Food and Drug Administration—part of a larger project involving the CDC and the U.S. Department of Agriculture that examines animals, meat, and human illness—finds resistant organisms every year. In its 2011 report, published last February, the FDA found (among many other results) that 65 percent of chicken breasts and 44 percent of ground beef carried bacteria resistant to tetracycline, and 11 percent of pork chops carried bacteria resistant to five classes of drugs.
Obviously agricultural use of antibiotics needs to be very sharply restricted on simple precautionary principle grounds, and if that makes meat more expensive, so be it. I like being alive more than I like cheap steak.
But what to do about the weak antibiotic pipeline? As McKenna points out, antibiotics typically aren’t big moneymakers, and if they’ll run out within a few years then drug companies don’t have much incentive to develop new ones. A massive new government research program is needed (prize-based models sound good), yesterday.
But the really terrifying possibility is that there simply aren’t that many more new antibiotics to be discovered. People hate pharmaceutical companies, but while the industry has done a lot of terrible things it’s also true that they have spent untold billions on failed research. Focus on stuff like Cialis is driven, at least in part, by thirty years of failed moon-shot attempts to cure stuff like Alzheimer’s.
What’s more, most spectacular drug successes were discovered without researchers truly understanding the underlying causal mechanism. Everyone knows the story of penicillin being discovered by accident, but what is less well known is that most other antibiotics (indeed most drugs in general) were also discovered either by accident or by simple trial-and-error testing of thousands of random substances (or modifications thereof). Even drugs based on highly-studied things like the cholesterol enzyme pathway have failed spectacularly, leading to a total upheaval of underlying the biological model.
This ought to inspire some urgency to preserve what little advantage we have over the microbes, and massive research anyway, in case my dire pessimism is wrong. Because without that we’re left with fighting the microbes with their own strategy: people who can’t fight off infections die.