From  The  Economist  -  May  2016



THE  GRIM  PROSPECT


The evolution of pathogens is making many medical problems worse. Time to take drug resistance seriously




FEW, nowadays, would regard gardening as dangerous. But on March 14th 1941 a British policeman called Albert Alexander died of it. Early that year he had been scratched on the face by a rose. The wound became infected by bacteria, probably Staphylococcus aureus with an admixture of various Streptococci, and turned septic. The sepsis spread. First, he lost an eye. Then, he lost his life.


What made Alexander doubly unlucky was that he was almost cured. The hospital treating him, the Radcliffe Infirmary in Oxford, was a few hundred metres from a university laboratory where Howard Florey and Ernst Chain were brewing up extracts of a mould called Penidllium chrysogenum. Repeated injections of this extract came close to abolishing Alexander's infection, but the two scientists ran out of their home-brewed drug before the bacteria had all been killed. When the treatment stopped the sepsis roared back.


Penicillin is now available in copious amounts, as are other bacteria-killing antibiotics. A thorn scratch today seems a minor irritant, not a potential killer. But that may be too sanguine. A study by America's Centres for Disease Control (cdc) found that the number of cases of sepsis rose from 621,000 to 1041,00 between 2000 and 2008, with deaths rising from 154,000 to 207,000. One reason for that is the emergence of MRSA - a variety of Staphylococcus aureus that cannot be killed with methicillin, one of penicillin's most effective descendants. 


This could just be a taste of things to come. 


Three years ago the CDC produced a list of 18 antibiotic-resistant microbes that threaten the health of Americans. Five of them (including MRSA) cause sepsis.


When people hear about antibiotic resistance creating "superbugs", they tend to think of new diseases and pandemics spreading out of control. 


The real threat is less flamboyant, but still serious: existing problems getting worse, sometimes dramatically. Infections acquired in hospital are a prime example. They are already a problem, but with more antibiotic resistance they could become a much worse one. Elective surgery, such as hip replacements, now routine, would come to carry what might be seen as unacceptable risk. So might Caesarean sections. The risks of procedures which suppress the immune system, such as organ transplants and cancer chemotherapies, would increase.


Such worsenings would not be restricted to hospitals. "Multi-drug resistant" and "extensively drug resistant" strains of tuberculosis cause 200,000 deaths a year, mostly in poor countries. Most people who die of tuberculosis at the moment do not die of one of these strains. But they are responsible for more than an eighth of fatal cases, and those cases might otherwise be susceptible to treatment.


Neisseria gonorrhoeae is another bug that has repeatedly developed resistance to antibiotics. 


When penicillin was first introduced it worked very well against gonorrhoea. When its effectiveness began to fall, it was replaced by tetracyclines. Those gave way to fluoroquinolones, and those, in turn, to cephalosporins. Now, some strains can be tackled only with a combination of ceftriaxone, a cephalosporin, and azythromicin, an azalide. There is nothing else in the locker!


If worries about microbial resistance are cast wider to include not just antibiotics (which attack bacteria) but drugs against parasites, like malaria, and viruses, like HIV, the problem multiplies, particularly in poor countries. 


In the case of malaria, resistance to drugs that kill the parasite responsible has been a problem for decades. 


Since the turn of the century deployment of a new medicine, artemisinin, has provided some respite. 


But now parasites resistant to artemisinin are turning up. And the same is true for first-line drug combinations against HIV, which go back to the 1990s. Such resistance can be dealt with by other medicines, kept in reserve for the purpose. 


But it still makes things worse, complicating treatment.


This trend is longstanding: 


Alexander Fleming, who first noticed penicillin's effects, warned of the dangers of resistance almost as soon as the drug had been shown to be a success. 


But the fact that these are old worries does not mean that they are not serious ones, nor that they cannot get worse. 


This week sees the publication of the final recommendations of a review on resistance to antimicrobial drugs led by Jim O'Neill, formerly chief  economist at Goldman Sachs, on behalf of the British government and the Wellcome Trust, a medical charity. According to Lord O'Neill and his colleagues 700,000 people die each year from infection by drug-resistant pathogens and parasites. 


And they say that if things carry on as they are that figure will rise to 10m by 2050, knocking 2-3.5% off global GDP. 


Already the cost to the American health-care system of dealing with infections resistant to one or more antibiotics is $20 billion a year.

……….


THE  ARTICLE  GOES  ON  FOR  SOME  LENGTH   


BUT  THIS  IS  ENOUGH  TO  GET  THE  POINT  ACROSS  IN  A  SERIOUS  WAY.


WE  ARE  HEADING  INTO  DEEP  TROUBLE  IF  WE  DON'T  CHANGE  OUR  WHOLE  SOCIETIES'  WAY  OF  PHYSICALLY  LIVING.  IT'S  TIME  THAT  EVERY  ADULT  RE-THINK  AS  TO  HOW  THEY  ARE  MENTALLY,  EMOTIONALLY,  AND  PHYSICALLY  LIVING.  TIME  FOR  EVERY  ADULT  TO  GET  SERIOUS  ABOUT  THE  WAY  THEY  ARE  PHYSICALLY  LIVING  AND  PASS  THAT  ATTITUDE  ON  TO  THEIR  CHILDREN.


Keith Hunt