Antibiotics: A Broken Promise
A few decades ago the
development of antibiotics led many people to believe that the threat offered by
infectious diseases had, to a large extent, been conquered.
combination of greed and stupidity has changed all that. The effectiveness of
antibiotics has been dramatically weakened by three main groups: the companies
making them, the medical profession and the farming industry. Each of these
groups has acted irresponsibly and dangerously. Since they cannot possibly have
been unaware of the impact their actions would have it is impossible to avoid
the conclusion that the effectiveness of antibiotics has been deliberately
destroyed for short term profit. The drug companies, the medical establishment
and the farming industry will together be responsible for millions of deaths.
The politicians who have stood to one side and allowed all this to happen must
share the responsibility.
The destruction of antibiotics as a weapon in
the fight against infection is not a reason why we are now more vulnerable to
infection. But it is an important reason why the number of people dying from
infections is rising - and will rise dramatically during the next decade or so.
The introduction of antibiotics, just half a century or so ago, led many
people (including most doctors) to believe that infectious diseases had been
But during the last two decades simple, widespread infections
have been striking back and once again re-establishing themselves as serious
threats to our health - as serious as cancer and heart disease.
virtually all infections caused by staphylococcus could be cured by penicillin.
But by 1982 a worrying 90% of patients infected with the staphylococcus bug
needed treatment with other antibiotics. Penicillin - the best known, cheapest
and most widely available antibiotic in the world - no longer worked against
Doctors didn't worry about this because they had other
antibiotics to prescribe. With remarkable arrogance the medical profession
assumed that it could always stay one step ahead of the bugs.
doctors failed to realise was that yeasts, fungi and bacteria have been
producing antibiotics more or less since time began. They use the antibiotics
they make to protect themselves. Other yeasts, fungi and bacteria mutate
naturally in order to protect themselves against those antibiotics. Through a
mixture of ignorance and arrogance doctors speeded up the rate at which bugs
acquired resistance by spreading antibiotics around with reckless abandon.
The Staphylococcus Story
The staphylococcus bug
is widespread and constantly being passed from one person to another. It is
possible to pick up staphylococcus simply through a handshake. It also affects
some mammalian pets and so can be picked up that way too.
Most of the
time the body's immune system deals with the bug fairly quickly and effectively.
The staphylococcus only becomes a real problem when it is picked up by a human
being with a wound of some kind - or an immune system that is out of condition
or already stretched so much that it cannot cope. Under those circumstances the
staphylococcus can kill.
In order to try to stop staphylococcus bugs
causing so many deaths in hospitals doctors started routinely giving antibiotics
to all the patients whom they thought might be at risk - and this category
naturally included all those patients who were destined for surgery.
prescribing doctors either didn't realise or didn't care that by dishing out
antibiotics so freely they were giving the bugs a greatly increased chance of
Staphylococcus has not, of course, been the only bug
to become resistant. In 1990 Jim Henson, the inventor of TV puppet stars the
Muppets, died of a new, resistant streptococcal infection. Doctors suddenly
started to report the existence of antibiotic resistant strains of streptococcus
pneumoniae - which were new enough and virulent enough to kill individuals with
weakened immune systems.
Leprosy, easily treated until the late 1970s,
became a major problem again when a new, resistant type of the bacterium
mycobacterium leprae appeared in Ethiopia. Gonorrhoea acquired worldwide
resistance to penicillin and other drugs. By 1990 eight out of ten illnesses
caused by shigella were resistant to antibiotics. Malaria, apparently almost
under control in the 1950s, has become a major killer because of the drug
resistant plasmodium falciparum parasites. Tuberculosis, still apparently
regarded by many doctors as a disease of the 19th century, has come back with a
vengeance with the development of a drug resistant strain. UNICEF is now warning
that antibiotic resistant strains of tuberculosis need to be taken seriously.
Tuberculosis kills over three million people every year. I have been warning
about the resurgence of tuberculosis since the early 1990s.
the early 1990s doctors in the developed world tried to combat new outbreaks of
infectious disease by prescribing antibiotics in ever increasing quantities.
They also tried to protect patients against infection by prescribing antibiotics
for healthy patients. Naturally enough the drug industry, which was making huge
profits out of the sale of antibiotics, did not object to this. Politicians,
constantly afraid of offending the drug companies, did everything they could to
stifle protests by people like me who wrote about this problem and warned about
the future consequences.
In the developing countries, where doctors were
not always available, patients simply bought their own antibiotics. (Ironically
- and in my view with considerable cheek - some observers in the developed world
are now blaming the overuse of antibiotics in the developing world for the fact
that new antibiotic resistant bugs are now a serious worldwide threat.)
Today the future is truly bleak. Infectious diseases which we thought we
had conquered are coming back with a vengeance. More and more people are dying
of simple, uncomplicated infections. The bugs are getting stronger. And our
ability to zap them is diminishing almost daily.
The Overprescribing Of Antibiotics
I have, for many
years, written about the way that doctors do harm by over-prescribing. The best
example of the modern tendency to over-prescribe probably lies in the way that
antibiotics are used. One in six prescriptions is for an antibiotic and there
are at least a hundred different antibiotics available for doctors to choose
When antibiotics - drugs such as penicillin - were first
introduced in the 1930s they gave doctors a chance to kill the bacteria causing
infections. My educated guestimate is that for several decades between half and
three quarters of all the prescriptions written for antibiotics have been
unnecessary or inappropriate. That is still the situation today.
certain extent doctors over-prescribe because they like to do something when
faced with a patient - and prescribing a drug is virtually the only thing most
of them can do. Prescribing a drug is also a defence against any possible future
charge of negligence (on the basis that if the patient dies it is better to have
done something than to have done nothing).
But the main reason for the
over-prescribing of antibiotics is, without doubt, the fact that doctors are
under the influence of the drug companies. The makers of the antibiotics want
their drugs prescribed in vast quantities. It makes no difference to them
whether or not the prescriptions are necessary. There is now no doubt that many
of our most useful drugs have been devalued by overuse and are no longer
Doctors regularly hand out these potentially life-saving
pills for minor coughs and infections that would have got better anyway within
days. Colds and flu are caused by viruses - which are not susceptible to
The excessive quantities of antibiotics we have swallowed
by the ton have weakened our general resistance to infection and paradoxically,
strengthened the power of the bugs.
The existence of many antibiotic
resistant organisms is the main reason why infections are such a major problem
in hospitals. Alarmingly, at least 1 in 20 of all hospital patients will pick up
an infection in hospital - mostly urinary tract, chest or wound infections.
Bizarrely, the spread of these antibiotic resistant organisms is mostly caused
by doctors and nurses failing to wash their hands often enough. Since Ignaz
Philipp Semmelweiss first demonstrated (in the mid-19th century) that deaths in
the delivery room were caused by dirty hands every child has been taught the
importance of basic personal hygiene. Sadly, the message does not seem to have
got through to the medical and nursing professions. Several recent studies have
shown that neither doctors nor nurses wash their hands anywhere near as often as
they should. At least one-third of all hospital infections are caused by dirty
hands and the cost in simple financial terms is colossal (though not, of course,
as horrendous or as unforgivable as the cost in human terms). It is hardly
surprising that people who stay at home to be treated - or who go home quickly
after day-case or short-stay surgery - usually get better much quicker than
people who need long-stay treatment.
The Emergence Of Superbugs
By the mid 1980s it was
already becoming clear that all this bad prescribing was causing serious
problems. Strains of staphylococcus were appearing which were resistant to many
At first the new superbugs only caused problems within
hospitals - where they caused many deaths among patients whose immune systems
had been compromised by other diseases or by physical or mental stresses. It was
in hospitals that many superbugs first started to appear but by the early 1990s
the staphylococcal superbugs were appearing inside and outside hospitals all
around the world.
The problem was so great that the extra costs incurred
when doctors had to prescribe increasingly expensive antibiotics was beginning
to add an enormous burden to all those responsible for providing health care
facilities. In America the extra cost of dealing with antibiotic resistant
organisms was, by the end of the 1980s, estimated at being in excess of $30
billion a year.
The Threat of Salmonella
Salmonella became a more or
less untreatable disease in 1993 and now poses a serious health threat.
According to the U.S. Department of Agriculture 661,000 people are made ill
every year by salmonella-infected eggs. Of those around 400 people die. The
Department of Agriculture's original count was considerably higher. The figure
of 661,000 was obtained after a recount. I don't have any figures I trust for
any other country. In the U.K. I certainly wouldn't trust any figures produced
by the Ministry of Agriculture and Fisheries.
The big problem with
salmonella bacteria is that some strains are already resistant to ampicillin,
streptomycin, tetracycline, sulphonamides and chloramphenicol. It won't be long
before some salmonella bacteria are resistant to all known antibiotics. When
that happens the death rate from salmonella will rocket.
antibiotic resistance develops on farms where half of all antibiotics produced
are used (I will explain why in a moment or two). Naturally, the salmonella
bacteria in chickens affect the flesh of the birds as well as their eggs. And
the bacteria can easily spread from chicken flesh to other products.
informed and considered view is that if you are an egg eating heterosexual and
you don't mainline illegal drugs with dirty needles then you are more likely to
contract and/or die of salmonella poisoning than you are to contract and/or die
of AIDS. Moreover, there seems little doubt that unless the mass use of
antibiotics on farms is stopped then salmonella poisoning will pose a
considerably greater threat to future generations of the human race than AIDS.
Nevertheless, I have no doubt that governments will continue to spend billions
on researching still fashionable AIDS but will not risk offending the rich
farming lobby by suggesting that antibiotic use be reduced.
Partly thanks to doctors and
drug companies the future is truly bleak. Infectious diseases which we thought
we had conquered are coming back with a vengeance. More and more people are
dying of simple, uncomplicated infections. The bugs are getting stronger. And
our ability to kill them is diminishing almost daily.
around with genes are making things considerably worse and ensuring that the
future is even more bleak than the present.
However, it is the overuse
of antibiotics by farmers which is one of the main reasons why infectious
diseases are making a dramatic comeback. Farmers are going to be directly
responsible for millions of deaths.
Astonishingly, considerably more
than half of all the antibiotics sold are given by farmers to healthy animals.
Giving antibiotics helps improve the size and therefore the value of animals. I
first wrote about this grossly irresponsible but profitable habit back in the
1970s but politicians have steadfastly refused to take on the farming community
and stop farmers using antibiotics.
Why do farmers give their animals so
Well, to start with, farmers give some antibiotics to
animals to help prevent (and treat) disease. Animals on modern farms are
exceptionally susceptible to disease because they are kept in overcrowded
conditions and they are constantly highly stressed. Antibiotics help to keep
sick animals alive long enough to be slaughtered and fed into the food chain.
Antibiotics are also given because they help to stop diseases spreading quickly
among animals who are kept in cramped and entirely unnatural conditions. When
animals live in hideously confined quarters it is nigh on impossible to stop
infections spreading without using antibiotics.
Many farmers also
routinely put antibiotics into the feed they give their animals to prevent
infections developing and the antibiotics that are dished out in this grossly
irresponsible way are often the same antibiotics that are becoming dramatically
less effective in the treatment of human diseases.
But farmers don't
just give antibiotics to animals in order to deal with disease. It was reported
in 1998 that some 10,000 pig, poultry and beef farms in Britain alone were
mixing antibiotics into their animal feed in order to promote growth.
Back in the 1940s it was noticed that animals who were regularly given
antibiotics put on weight more rapidly than animals who weren't. I don't think
anyone knows why this happens but antibiotics increase the muscle bulk of
animals - and therefore increase their value and the farmer's eventual profit.
Despite the fact that antibiotic resistance was, even then, acknowledged to be a
problem, farmers started to give their animals antibiotics in order to increase
their profits. To their eternal shame vets and politicians succumbed to pressure
from the farmers and allowed this to happen. (In an attempt to disguise their
guilt - and to hide what they are doing - farmers describe the antibiotics they
give to animals as`digestive enhancers'.)
Amazingly, farmers do not need
a prescription from a vet in order to give antibiotics to their animals on a
regular, daily basis. You need to visit a doctor to get an antibiotic if you
have an infection which needs treatment. But farmers can buy their antibiotics
in bulk - and throw them into the animal feed by the fistful.
there have over the years been a few pretty half hearted attempts to stop this
grossly irresponsible practice. Various committees and organisations (including
the World Health Organization) have recommended phasing out the routine use of
antibiotics as growth enhancers.
(I am afraid I cannot explain why
`phasing out' has been recommended instead of simply halting this outrageous
practice - though undoubtedly the power of the farming industry has much to do
In December 1998 the European Union finally proposed a ban
on the use of some antibiotics by farmers. The British government said it would
probably support such a ban but it was clear that any such move would probably
prove pointless when drug companies said they would challenge any such ban in
the courts. A legal battle on such a complex issue would, with all the
appropriate appeals, probably last for at least a decade. In the end the EU
announced with a great fanfare that it had banned farmers from using just four
antibiotics. But they did not introduce a general ban on the use of the
tetracyclines and penicillins - the drugs which are most commonly used both on
animals and for human patients. In my view this was akin to making murder
illegal between 10.45 pm and 10.50 pm on alternate Wednesdays.
process by which antibiotic resistance develops is simple to explain. When
animals are given antibiotics the bacteria in their intestines build up an
immunity to those antibiotics. Those antibiotic resistant organisms then pass on
to farmers and others who have contact with the animals. They pass into the
environment (even though most animals are denied access to fields their faeces
and urine still reach the environment when they are dumped onto fields or
discharged into rivers). And, of course, the antibiotic resistant organisms pass
into the food chain directly when animals are killed, chopped up and eaten by
humans. When milk in the US was tested researchers identified 52 different
As if all this wasn't bad enough there is also
evidence that the antibiotic resistant organisms can pass their resistance on to
other, more dangerous bacteria. There are already some dangerous infections
which are virtually untreatable because the bugs involved are resistant to all
the available antibiotics.