I know that I am always happy, intellectually, to have my doctor seriously look at my symptoms and bring up their own knowledge of what bugs are circulating (“…we are seeing a lot of viral infections right now…your symptoms look like that”) when I go in to see about the sore throat, achy body and fever I am suffering. I am delighted that the doctor is taking a stand and trying to be thoughtful about applying the right ‘cure’ and I will not be contributing to the next MRSA infection. Emotionally, I am less happy that I have to suffer when virus is the answer. An article in the April 2-8 edition of The Economist about superbugs, antibiotic resistant bacteria, kick started that intellectual part of me. The article focuses on the ways in which resistance evolves, the costs and risks of super-bugs, and our options for dealing with them – and whether they are palatable. One surprise for me was finding out that Alexander Fleming, the man responsible for identifying the Penicillium mold and its ability to kill bacteria, predicted this risk in his Nobel prize speech in 1945. The article also provided a very pointed reminder about the role economics and human nature play in the medical system and its problems.
The emotional dismay at having to put my life on hold and feel yucky often overwhelms my intellectual knowledge, and I am not alone in that. We know antibiotics exist so we want them to fix all our sore throats and runny noses. Antibiotics are not miracles, we and our doctors know this, but we do not like it. Doctors lack, even today, the ability to do rapid screening of infection sources that would ensure they never give someone with a virus an antibiotic. This also mean they lack a test result to toss in the face of our emotionalism and make us accept that our aching throat is simply going to be around for 7-10 days and we need to endure.
This is one of the main options examined in “The spread of superbugs”, in The Economist. Patients need to accept that not all infections respond to antibiotics and that using them, necessarily or unnecessarily, creates resistance in bacteria. The benefit of curing the bacterial infection does outweigh the risk of creating resistant bacteria that can, at least in the case of streptocci bacteria,
endure for up to a year. The same risk/benefit analysis does not apply to treating viral infections with antibiotics. This also ignores the possibility for yeast infections resulting from the depletion of our enterobacteria and the co-occurring impacts the depletion on our digestion and the health of our intestinal tract.
A second issue is the lack of new antibiotics, especially those to treat drug-resistant bacteria, being brought to the market. Here is where economics start to come in. Unlike anti-depressants or blood pressure medications antibiotics are a self-eliminating drug. Once you take it you should not need to take it again for some time. The other aspect that cuts into profit, especially for the super-bugs antibiotics, is that the majority of infections occur in poor countries. We tend to hear about outbreaks in hospitals and care facilities, which are the primary hotspots here in Canada, but in poorer countries the problem can be more widespread. Where lack of education about antibiotics and the sale of poor quality and strength drugs are problems, the development of resistant bacterial stains is more common. The same lacks which allow these practices to flourish impede the ability to afford the more expensive treatment needed to treat infections.
Another issue that will directly impact our quality of life here in the first world is the elimination of many non-vital but life improving and functionally beneficial operations. I had never thought of what the potential consequence of an increase in frequency in antibiotic resistant infections in our hospitals might be in terms of our medical care beyond the increased costs. Tummy-tucks and eye lifts are not the procedures I am talking about. I mean cataract surgeries and what the article calls “orthopaedic surgeries”, which I suspect include knee arthroscopies and joint replacements. In a world with an ageing population that has come to expect a level of physical function into their golden years this is daunting prospect.