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Wednesday, October 23, 2013

The end of medicine as we know it?

The more you use an antibiotic, the more you expose a bacteria to an antibiotic, the greater the likelihood that resistance to that antibiotic is going to develop. So the more antibiotics we put into people, we put into the environment, we put into livestock, the more opportunities we create for these bacteria to become resistant. …We also know that we’ve greatly overused antibiotics and in overusing these antibiotics, we have set ourselves up for the scenario that we find ourselves in now, where we’re running out of antibiotics.

We are quickly running out of therapies to treat some of these infections that previously had been eminently treatable. There are bacteria that we encounter, particularly in health-care settings, that are resistant to nearly all — or, in some cases, all — the antibiotics that we have available to us, and we are thus entering an era that people have talked about for a long time.

For a long time, there have been newspaper stories and covers of magazines that talked about “The end of antibiotics, question mark?” Well, now I would say you can change the title to “The end of antibiotics, period.”

We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t. …
Do you think very many people are even aware of this problem? Do you think the ones who who do know about it actually care very much about it? Not being a doctor or scientist I'm torn between dismissing it as more sky-is-falling nonsense, or the CDC crying wolf again, or Cassandra—of Greek myth—who could foretell the future, but was cursed by the gods so that she was never believed. My hunch is that Cassandra is telling the truth. I've lived long enough to notice that they keep coming out with new medicines and new pesticides because the old ones just don't work anymore. Bugs whether visible or microscopic are problems that are going to get worse, not better.
And when he had opened the fourth seal, I heard the voice of the fourth beast say, Come and see. And I looked, and behold a pale horse: and his name that sat on him was Death, and Hell followed with him. And power was given unto them over the fourth part of the earth, to kill with sword, and with hunger, and with death, and with the beasts of the earth.
I've often wondered if the hour of the prophesied Biblical Armageddon was impossible to predict because it depended on the decisions that mankind has made over the centuries. We have free-will. Is it possible that our own actions will bring about the end either sooner or perhaps later? We've constructed and positioned a number of Damoclesian Swords over our heads. The most frightening is the nuclear one, but there are others. There's the danger of a famine caused by the failure of pesticides to control crop devouring insects. The one looming most threateningly right now to me is the inevitable failure of antibiotics to cure infections at some point in the near future. If bacteria can't be killed by available antibiotics, then we can't perform surgeries. We can't do organ transplants. We can't treat most cancers. We'll be back to staying home and hoping for miracles.

I can't help feeling like we're all on some careening bob-sled rollicking down the chute at some impossibly terrifying speed, and we can't see around the corner of the next curve and we're just hanging on for dear life. What's at the end? Is it the Four Horsemen or will we stave-off that final reckoning with more manmade miracles? What possibilities remain beyond antibiotics? One avenue that I pray scientists are pursuing is viral research. The enemy of my enemy may perhaps be turned into a friend. Bacteria can be beneficial, like the ones in our intestines, but when they go rogue on us wouldn't it be nice if we could custom tailor a virus specifically engineered to wipe out that particular infectious breed of virulent bacteria?

Computers keep getting faster and robots keep getting smarter, their parts keep getting smaller, and we rely on them more and more every day. It's possible that as the field of nanotechnology advances, we'll one day be able to design microscopic little robots that perform a function similar to our own white-blood cells. It's all in the timing isn't it? In movies they disarm the Illudium Q-36 Explosive Space Modulator at the very last second, and the audience gives a sigh of relief. These sure are some interesting times.

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