It will be very important, if we want to continue to enjoy the benefits of antibiotics, to address the serious issue of overuse. Medical science’s ability to come up with new, effective antibiotics is lagging behind bacteria’s ability to develop resistance to them, and the Center for Disease Control considers the emerging antibiotic resistance of bacteria one of the most pressing health problems facing the world today.

 

The root of the problem lies in the extremely short generation time of bacteria. A slow-growing bacterium will double itself in a few days, but a fast-growing one can double in as little as fifteen minutes. When microbes double, the DNA of the “old” microbe is copied for the new organism, but often, “mistakes” take place in the replication process. This is known as mutation, which is usually to the organism’s detriment. Sometimes, though, the new information coded in the organism’s DNA confers a selective advantage. If the mutation creates resistance to an antibiotic, for example, and an antibiotic is present in the microbe’s environment, then only the bacteria which possess resistance will survive and replicate. A resistant population can obviously develop very quickly if the doubling time is less than an hour.  In addition, viruses swap genes from bacteria, sometimes conferring resistance that way, and a number of bacteria have ways of exchanging genetic material with one another as well.

 

Given this most basic and unalterable genetic fact, it would seem prudent to do everything in our power to prevent this from happening. But instead, our personal, medical, and commercial practices encourage just the opposite. When you think about the breadth and pervasiveness of the problem, it really is alarming. Consider:

 

In the late 1940s, farmers began using antibiotics to cure their sick animals. They soon noticed that animals given antibiotics grew faster and larger, which increased their profits. Soon, they were giving antibiotics routinely to commercial livestock, which, in addition, allowed them to raise more animals in more confined spaces. Normally, dense populations in confined spaces increase the likelihood of an infectious disease outbreak. For now, that has been circumvented by the regular use of antibiotics. And of course, with the advent of corporate farming and ranching, the amount of money involved has selected for larger operations with greater crowding.

 

Up to 75 – 80% of an antibiotic is excreted, so drugs fed to livestock go into the watershed where they are out there, just in general, selecting for antibiotic-resistant bacteria. The same goes for antibiotics consumed by humans. Up to 80% of the drug is excreted into the watershed, where no treatment process removes it or neutralizes it.  

 

Now that fish have started to be farmed, massive amounts of antibiotics are being used in those environments as well. In this case, the antibiotics in the fish feed are being introduced directly into the watershed. The Union of Concerned Scientists estimates that 70% of the antibiotics used in the U.S. goes to farming operations. In 2001, the American Medical Association considered this practice dangerous enough that it went on record to oppose the non-therapeutic use of medically important antibiotics. It’s now 2009 and not much has changed.

 

Routine feeding of antibiotics to livestock isn’t the only problem, though. For years, both physicians and patients didn’t think it would hurt to prescribe antibiotics if it wasn’t clear whether a patient had a viral or a bacterial infection. Some patients will demand antibiotics from their physician for a viral illness, not realizing the difference, and many physicians, to keep the patient happy or avoid a time-consuming discussion, will go ahead and prescribe them.

 

Let’s be clear here for anyone who is still confused about this: Antibiotics work only on bacteria. Bacteria use their own genetic machinery to replicate themselves. Also, bacteria have a cell membrane and a cell wall, which is what many antibiotics use in their attack. Viruses have a protein coat that is very simple, no membrane and no cell wall. They use their hosts’ (that would be us, in the case of human viruses) genetic machinery to replicate themselves. This is one major reason why it’s so difficult to design a drug that kills a virus that doesn’t also kill their host.

 

So, antibiotics have been and still are being over-prescribed in the human population. In addition, a lot of times people don’t realize that they need to take the entire prescription, even if they start to feel better before they’ve taken all of it. When you don’t take the entire prescription of antibiotics, you’re unwittingly selecting for the more resistant bugs, which then go on to replicate. When I was in grad school, I battled a recurrent set of bronchial infections. The antibiotics made me feel lousy and I couldn’t eat any dairy while I was on them, and no one, neither the prescribing physician nor the pharmacy, told me I needed to take the entire course of them (this was back in the mid-1970s; this information vacuum, at least, has changed since then). I would stop taking them as soon as I started feeling better. It wasn’t until someone clued me in that I had to take the whole bottle that I managed to stop coming down with bronchitis.

 

Another serious problem: Germ phobia. This has several facets. For one, people who are germ-phobic (and the level that is considered normal in this country is pathological compared to a lot of others) think that they need to live in near-sterile environments to be safe. While they’re busily wiping down every surface with some antimicrobial cleaner, they’re selecting for resistant bacteria. I read about a study one time that examined the kitchen surfaces in different homes and it found that the bachelor pads were actually the least microbe-riddled. They were the ones who did the least amount of cleaning. Those households that were the most “conscientious” in trying to keep everything spotless had the most resistant bacteria spread over counters and surfaces.

 

In addition, when we treat our environment this way, we’re not giving our immune systems anything to build up memory to, so when an infectious bug does come along, our immune systems are less able to fight it using its arsenal. Further, rates of auto-immune diseases such as allergies and asthma appear to go up when people are not exposed to a regular dose of microbes (most of which are either harmless or beneficial, BTW). It’s like the immune system is primed to do its job but doesn’t get to, so it goes after the closest thing it can come up with: the body’s own cells and substances.

 

Germ phobia has even begun to invade some of the most quotidian, even ridiculous arenas. You can buy anti-bacterial hand soaps (which have not been shown to be more effective than regular soap in any setting outside of a hospital; but they do contribute to antibiotic resistance), socks, shoes, shopping baskets, toothpaste—to name a few items.

 

These products are being marketed with fear and germ phobia—not health—in mind. These companies know that American consumers have been terrified practically their entire lives with the possibility of contracting some kind of infectious illness, and that bacteria make a very potent bogeyman. The irony is, this fear and the mindless way we’ve dealt with it may bring this bogeyman to life.

 

It would be nice if these companies would stop making these products, but since companies care only about their bottom line, it’s not realistic to expect them to cooperate unless consumers bring pressure to bear. I read an article recently that discussed the similarities between the behavior of corporations and that of sociopaths, and the author’s conclusion was that corporations behave sociopathically. They feel entitled to whatever market share they can obtain using whatever tactics they can come up with, they are deceitful and secretive, they seduce the consumer in the beginning and stick it to them in the end, and they do not care about the well-being of the individual or society, only their own.

 

One recent movement has given me hope, though, that, as powerful, deceitful, and self-interested as corporations are, they are not immune to concerted consumer action. For years, bioengineering companies were pressuring farmers to give their dairy cows bovine growth hormone, rBST. But when consumers became aware of the practice and the risks, they started buying more and more milk that was marketed as rBST-free. Now it’s harder to find milk that is produced by cows treated with this hormone than not.  

 

So, even though this is a huge and daunting problem with multiple players, there are things that we can do. And it truly is imperative that we do them. Before antibiotics, people lost limbs and died from common bacterial infections. We’re headed in that direction right now.

 

Do not buy antimicrobial products such antibacterial hand-soaps, and tell any place you shop at or obtain services from that you’re uncomfortable with the use of products such as shopping baskets treated with antimicrobial substances—that you’ll be looking to patronize places who take this threat seriously.

 

 

When you do take antibiotics for a bacterial infection, make sure that you take the entire course of medication, even if you start feeling better, or you risk leaving antibiotic-resistant survivors in your body.

 

Buy as much organic meat and produce as you can afford; patronize small, local farms that raise their animals and produce without the use of antibiotics. Or raise your own. Some people have become vegetarians out of concerns for the environment, including the antibiotic overuse problem associated with livestock. I’m too much of an omnivore to adopt that solution, but it is one to consider for those less carnivorously inclined. One thing that I find very frustrating is the fact that agriculture in this country produces 4000 calories’ worth of food per person per day. That’s at least twice as many calories as most of us need to maintain a healthy weight. We don’t need to have such artificially-induced productivity; and in fact, obesity is a serious health issue all on its own.

 

 

Trying to deal with bacterial infections without the use of antibiotics is a truly frightening prospect. More and more people are starting to experience horror stories involving resistant microbes. Antibiotics are one of the most powerful medical gifts the human race has ever stumbled upon. Let’s hope we haven’t squandered it in less than a hundred years.

 

 

Above:  Another photograph from the ghost mining town of Bodie; beautiful oxidation patterns on the metal siding of one of the buildings, juked up a little with Photoshop :)