Rising Plague

The author of a new book on the antibiotic resistance crisis entreats scientific and lay communities for help in the quest for new weapons

Aug 27, 2009
Brad Spellberg
How do you look the family members of a critically ill patient in the eyes and tell them that their loved one is going to die because there are no drugs left to treat their illness? I'm an infectious diseases specialist. I'm not supposed to have to bear such bad news to patients or their families. I expect to cure my patients' infections, and their families and friends hope that I can. It's been that way ever since the 1940s, when penicillin burst onto the scene. But this is the 21st century, and things are different now.
The discovery of antibiotics in the mid 20th century was nothing less than a revolution in public health and medicine. It was a revolution as significant to human civilization as the discoveries of Isaac Newton or Thomas Edison's first light bulb. Physicians trained in the era immediately preceding the dawn of antibiotics learned how to resign themselves to the fact that they could not change the course of their patients' illnesses in most cases. Their job was largely to make an accurate diagnosis so they could relate the unalterable prognosis to the patient. In an instant, antibiotics changed all that by empowering physicians to eradicate diseases with aplomb. What a stunning power to acquire!How ghastly then, having acquired this brilliant power, to watch helplessly as it shrinks back into history, leaving us once again at the mercy of even the most mundane microbes. That's the reality that we're facing now. linkurl:__Rising Plague__;http://www.prometheusbooks.com/index.php?main_page=product_info&cPath=57_187&products_id=1932 is a fervent plea -- in the words of the poet -- that we not let antibiotics "go gentle into that good night."In my latest book I describe how the relentless escalation of antibiotic resistance has created a critical need for new antibiotics. Just when we need it most, the discovery and development of new antibiotics is dying. I share with you real patient stories to underscore that the loss of effective antibiotics is not a hypothetical problem. Antibiotic resistance is killing thousands of people every year, and devastating their families. I know this because I have seen it first-hand.The antibiotic problem didn't take shape overnight. And one can't blame physician misuse of antibiotics for all of our problems. Despite how widespread that belief is, it does not reflect reality, and it serves as a poor foundation for effective response planning.We instead must alter our worldview of antibiotics and bacteria. Bacteria have been creating and defeating antibiotics for 20 million times longer than humans have known of the chemicals' existence. We will never stop antibiotic resistance from occurring. Efforts to conserve antibiotic use can help slow down the spread of resistance. But, ultimately, focusing all of our energies on conserving antibiotics will only delay the inevitable exhaustion of effective antibiotic resource. Rather, what is needed is a comprehensive response strategy that includes continued efforts to conserve antibiotics combined with efforts to replenish the resource by reinvigorating the discovery and development of new antibiotics.
"...with today's [antibiotics] it is possible to place in the hands of a barefoot, nonliterate villager more real power to affect the outcome of a critically ill [patient] than could have been exerted by the most highly trained urban physicians of twenty-five years ago."

-- From W. McDermott, et al. "Introducing modern medicine in a Najavo community." Science, 131:197-205, 1960.
The problem here is not scientific. New antibiotics are dying before they have a chance to enter the marketplace due to a murky regulatory landscape and also due to unfavorable economics (i.e., the relatively low rate of return on investment afforded by sales of short-course antibiotics compared to sales of drugs for chronic conditions, such as hypertension, dementia, cancer, arthritis, and high cholesterol). Big Pharma has largely exited the scene. Some biotech companies have picked up the torch, but many are already out of business due to their inability to get antibiotics approved. The US Food and Drug Administration rejected the last eight antibiotics that have been proposed for approval. It is truly ugly out there for antibiotics.We must stop being myopic and complacent. Miracle drugs will not fall from the sky when we need them. If we want to continue to live in an "antibiotic era" -- a unique, 74-year-old interval in the five-thousand-year annals of medicine -- we must act now. If we do nothing, we run the risk of inviting a bleak "post-antibiotic" future, in which infectious diseases once again reign supreme.I wrote __Rising Plague__ because my colleagues and I need your help. This crisis will not be averted without your support, without a grassroots movement to put pressure on all sides -- political, medical, pharmaceutical, and consumer -- to band together to act. I will tell you what can be done, but we need your help to do it.linkurl:__Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them__,;http://www.amazon.com/Rising-Plague-Bacteria-Dwindling-Arsenal/dp/1591027500 by Brad Spellberg, MD, Prometheus Books, Amherst, New York, 2009. 264 pp. ISBN: 978-1-59102-750-8. $26.00 US.linkurl:__Brad Spellberg;http://www.harboruclamed.com/Faculty/spellberg.html is associate professor of medicine at the David Geffen School of Medicine at UCLA and is based in the Divisions of General Internal Medicine and Infectious Diseases at the Los Angeles Biomedical Research Institute and Harbor-UCLA Medical Center. He was featured on an Emmy-award-winning episode of __NOVA__ called "Rise of the Superbugs."__
**__Related stories:__***linkurl:Gut harbors antibiotic resistance;http://www.the-scientist.com/blog/display/55928/
[27th August 2009]*linkurl:The Microbial Health Factor;http://www.the-scientist.com/article/display/55864/
[August 2009]*linkurl:Mysterious resistance;http://www.the-scientist.com/article/display/54963/
[September 2008]