Edgework

This past week, two things happened simultaneously to provide the synergy for writing this essay. One was the fact that a personal friend spent four days in hospital fighting an infection that proved resistant to various classes of antibiotics. Finally, when doctors administered what they called the “antibiotic of last resort,” her fever subsided and she able to return home. An unsettling question lingers in my mind: What if her infection had not responded to this final treatment?

While this was happening, I was in the process of reading the book, Missing Microbes, by Dr. Martin J. Blazer. I was struck by a statement Dr. Blazer made on page 188: “Antimicrobial resistance is happening in every community, in every health care facility, and in medical practices throughout the country. At least 2 million people per year in the U.S. get infections that are resistant to antibiotics, and 23,000 die. This is what happens when microbes outsmart our best antibiotics.” I am assuming something similar could be said about microbes residing in Canada. I am indeed thankful that my friend did not become a statistic like thousands of others do every year.

Dr. Blazer reminded me that the germ theory was discovered by Louis Pasteur in 1857. This led to greater efforts at sanitation which saved many lives. But the first effective antibiotic, penicillin, was only discovered in 1928 by Alexander Fleming. And then it took another seventeen years until large enough quantities could be made to treat wounded soldiers in World War II. And as Dr. Blazer says, “Almost all the great advances in medicine from the second half of the twentieth century through to today were catalyzed by the deployment of antibiotics. No harm could come from their use, or so it seemed” (63).

Yet here we are, some seventy years later, with the medical community and the general public on high alert because of the realization that antibiotics are becoming increasingly ineffective at controlling infections. It now seems possible, and perhaps even probable, that we are entering a post-antibiotic world. What this means on the ground is that more and more people will die of various kinds of infections which have been easily treated during my life-time. I was born in 1946, a year after antibiotics became generally available. And it is possible that my life will be cut short by an infection that antibiotics cannot conquer. Less than a life-time of the magic of antibiotics before the Antibiotic Winter, as Blazer calls it, sets in.

Blazer admits that our war against pathogenic bacteria using antibiotics has saved millions of lives. “But to our chagrin,” he says, “this battle seems to have no end. Bacteria mutate with lightning speed and have developed resistance against some of our most effective antibiotics. Even more worrisome, the battle we wage against pathogens has led to serious unintended consequences for our health and well-being” (42).

One of those consequences is that the overuse of antibiotics has severely damaged that “massive assemblage of competing and cooperating microbes known collectively as the microbiome” (5). Recent studies have established the fact that the approximately 100 trillion bacterial and fungal cells in the human microbiome have specific roles to play in keeping our bodies healthy. When overuse of antibiotics destroys its natural biodiversity we can expect myriad negative health effects in our bodies.

Overuse of antibiotics happens in a number of ways. One is by prescribing broad spectrum antibiotics for minor infections. While killing the offending pathogens, they also kill off large segments of the human microbiome needed to remain healthy. A second way is by prescribing antibiotics for viral infections even though viruses don’t respond to antibiotics. And a third is using antibiotics on factory farms to promote rapid growth and keep animals healthy in unnatural and crowded conditions. In Canada 88 percent of antibiotics produced are used on farm animals. And some of these antibiotics are finding their way into our food chain. “In 2011 more than half of samples of ground turkey, pork chops, and ground beef collected from supermarkets for testing by the federal government (USA) contained bacteria resistant to antibiotics, what we sometimes call superbugs” (83).

Dr. Blazer’s thesis, which he supports by citing many studies, is that our damaged microbiomes lie at the root of many of our modern plagues. He says, for example, that just like antibiotics put more weight more rapidly on farm animals, so human exposure to antibiotics is largely responsible for the global epidemic of obesity, even in third world countries where food is scarce. He also notes that Type I diabetes in children is doubling every 20 years. Celiac disease has quadrupled since 1950. Inflammatory bowel disease is 84 percent more likely in persons using antibiotics regularly. Peanut allergies tripled between 1997 and 2008. Autism now affects nearly one in eight children. Asthma, hay fever and eczema, once rare occurrences, have become common maladies in our communities. While other factors most certainly contribute to specific diseases, it is clear that the common denominator to all of them is the ubiquitous presence of antibiotics.

So where does that leave us? Dr. Blazer says that if you have a major infection antibiotics can be justified. He does, however, look forward to a time when broad spectrum antibiotics will be replaced with ones targeting specific pathogens in order to limit collateral damage to our microbiomes. But the watchword of our times is to “limit” our exposure to antibiotics as much as possible. Doctors and patients must agree to use antibiotics only when actually needed. And antibiotic use in farm animals to stimulate growth must be banned.

Dr. Blazer has the final word: “We have made so much progress in combating and eradicating terrible diseases. But now perhaps our efforts have peaked, and the fruits of our discovery have left their seeds, indigestible and toxic. We must act, for the consequences are beginning to swallow us, and stronger storms lie ahead” (220).