Fighting Back

Vegetarian Times, March, 1999 by Norine Dworkin, Suzanne Gerber

ANTIBIOTICS WERE SUPPOSED TO BE WONDER WEAPONS. NOW WE'RE LEARNING THAT THE BEST OFFENSE IS A GOOD DEFENSE

What's shaping up to be the defining public health scourge of the millennium? Here's a hint: It's not cancer, hepatitis C or even AIDS. It's the rise of new strains of deadly bacteria and the failure of our most potent antibiotics to stop them.

Over the past decade, diseases once under control--pneumonia, meningitis, tuberculosis, malaria, dysentery--have returned with a vengeance not witnessed since Dirty Harry. And scientists are bracing for the day when they'll no longer have the tools to fight even the most common infections. Currently infectious disease reigns as the leading cause of death worldwide (it's third in this country, after heart disease and cancer), according to the Centers for Disease Control and Prevention (CDC) in Atlanta. The cost of treating diseases caused by drug-resistant bacteria is escalating--the CDC estimates Americans spend more than $4 billion annually. And each year, the number of deaths from those diseases is growing perilously higher.

"We are not at `Armageddon,' but we're heading in that direction," says David Bell, M.D., assistant to the director for the Center for Infectious Disease and Antimicrobial Resistance at the CDC. "All at once, just about every human pathogen [disease-causing microorganism] all over the world is becoming resistant to the antibiotic used to treat it, and we're running out of alternatives. A few bugs have become virtually untreatable."

Many of the country's top doctors and researchers support Bell's contention. "We are in a crisis, on our way to disaster," says Stuart Levy, M.D., director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine in Boston and author of The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle (Plenum Press, 1992). "And this crisis is going to get worse if we do not use antibiotics more prudently."

THE FIRST SALVO

Ever since penicillin made its heroic debut in the aftermath of a 1942 Boston fire, saving hundreds of burn victims who might otherwise have died from subsequent skin infections, Americans have been obsessed with antibiotics. If a little was good, we reasoned, a lot must be even better.

The healing powers of penicillin (and its descendants tetracycline, erythromycin, streptomycin and vancomycin) took on mythic proportions. People believed these drugs could cure anything--even, cancer. Penicillin could be bought over the counter, like aspirin. And it wasn't long before antibiotics started turning up in everything from crop sprays to room disinfectants to throat lozenges to cosmetics. Household pets were given antibiotics reflexively and livestock was routinely kept on low dosages to prevent infection. Collectively, this rampant overuse set the stage for the rise of the supergerm.

Just last year, a survey by the American Society of Health-System Pharmacists found that people still don't know how or when to use antibiotics. Fifty-two percent of those surveyed wrongly believed antibiotics could treat colds and flu. (In a similar study conducted in Australia, that number jumped to 75 percent.) Antibiotics treat only bacterial infections, like staph or strep. Colds and flu are caused by viruses, against which antibiotics are powerless. Yet for some reason, we demand them when we get hit with the flu and--far more distressing--our doctors typically acquiesce.

The CDC reports that of the 150 million outpatient prescriptions written each year for antibiotics, one-third are unnecessary. That's 50 million people being given drugs without due cause. Often patients are "treated" without ever being seen by a doctor. "In pediatricians' offices, you'll hear prescriptions being made over the phone for amoxicillin," says Marc Lappe, Ph.D., author of When Antibiotics Fail (North Atlantic Books, 1995). The Physician's Desk Reference, the doctor's bible of pharmaceutical drugs, states that lab tests to identify the offending bacterium and indicate treatment should be done before and during antibiotic therapy. Yet the sad truth is, this doesn't always happen.

At the core of this crisis lies a very simple distinction, one that all doctors learn in medical school but too often fail to take into account when treating patients. Bacteria and viruses are similar in that they're both single-celled organisms, but bacteria are living organisms with their own metabolism and can live--and breed--outside other cells (ours, for instance). Viruses are not living--they're more like tiny pieces of DNA that must get inside a living cell to survive and reproduce.

Every one of us has more than a hundred thousand billion bacteria living on our skin and in our intestines--and then there are the countless bacteria that live on plants, animals and in the environment. Most coexist with us quite peaceably, aiding in digestion, manufacturing B vitamins and folic acid and helping prevent infections and food allergies, yet a handful can be extremely deadly.