Public Health

Superbugs Are Outstripping Antibiotics

Bacteria can evolve. Maybe federal policymakers can as well, before it's too late.

|

The old joke about making love to a gorilla is that you don't stop when you're tired; you stop when the gorilla is tired. In modern American agriculture, one of the gorillas is McDonald's, the biggest restaurant chain on Earth. The other day it announced a change for its U.S. outlets that will force suppliers to adapt.

Over the next two years it will stop buying chickens raised with antibiotics that are "important to human medicine." This is a response to complaints from medical groups, scientists and government agencies, who say farmers are eroding the effectiveness of these drugs by overusing them. Adding them to feed as routine growth stimulants speeds the emergence of bacteria they can't kill.

Decisions like the one by McDonald's may help, but much damage is already done. In 2007, a healthy 12-year-old California boy named Carlos Don went off to summer camp and got pneumonia. He was given antibiotics, but his condition got so bad he was put on a ventilator. Eventually he was diagnosed with a strain of staph that is resistant to antibiotics. After two weeks in intensive care, he died.

Last month, seven patients at Ronald Reagan UCLA Medical Center in Los Angeles were infected with a "superbug" blamed on inadequately sterilized equipment, and two of them didn't survive. Four more cases turned up at Cedars-Sinai Medical Center.

These stories will only get more common. Already the federal Centers for Disease Control and Prevention estimates that 2 million Americans contract antibiotic-resistant illnesses each year—and 23,000 die, despite the best efforts of 21st-century physicians deploying space-age technology.

These patients find themselves flung back into the world of our ancestors, before the discovery of penicillin, when infections were often deadly and medicine had few reliable means of treating them. Exceptionally virulent strains also pose a dire hazard to patients who need organ transplants or other surgery.

Most of the proposed remedies for this problem involve curbing the unnecessary application of these drugs. The federal Food and Drug Administration has a campaign to persuade agribusiness companies to stop using them to enhance growth and reduce feed costs. Sen. Dianne Feinstein, D-Calif., has proposed phasing out all use of antibiotics in animals for non-therapeutic purposes.

What is overlooked is that the looming shortage of effective antibiotics, like every shortage, has not only a demand component, but a supply component. Curbing their use, though helpful, only postpones the day when existing antibiotics lose their potency.

Every antibiotic, given the ability of bacteria to evolve rapidly to survive, is bound to become ineffective sooner or later. The trick is to ensure a steady stream of new drugs that the resistant microbes have never encountered before. We need medical science to advance more rapidly than the bacteria do.

But lately, it hasn't. Henry I. Miller, a physician and molecular biologist at Stanford's Hoover Institution, says one culprit is obvious. In 2002, the FDA established new rules for the clinical trials used to test new antibiotics—doubling the number of patients required, thus making drug development harder and more expensive.

Since then, he says, many of the big pharmaceutical companies have given up research and development on antibiotics. Clinical trials have grown rare. "New antibiotic development has slowed to a standstill," says the Infectious Diseases Society of America.

Research on antibiotics is especially vulnerable to overregulation because they are so much less profitable than many other medicines. Unlike new drugs that patients take permanently for chronic ailments, which produce mighty rivers of revenue, antibiotics usually don't sell at a high price and aren't needed for long.

Pfizer's most lucrative antibiotic has sales of $2 billion a year, according to Emory University economist Paul H. Rubin, writing in Regulation magazine. Its Lipitor, which is prescribed to lower blood cholesterol, pulled in $9 billion a year before its patent expired. Rubin notes that steps to reduce the use of antibiotics have the perverse effect of making them even less lucrative.

Even the FDA has had to acknowledge its role as an impediment. Last year, Janet Woodcock, director of its Center for Drug Evaluation and Research, told Congress that "streamlined development pathways will likely be needed to improve the climate" and that the agency "is working hard to streamline requirements for clinical trials for studying new antibacterial drugs." She has also endorsed legislation to allow smaller clinical trials for potent antibiotics.

Bacteria can evolve. So can McDonald's. Maybe federal policymakers can as well, before it's too late.

NEXT: Brickbat: The Stomp

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Last month, seven patients at Ronald Reagan UCLA Medical Center in Los Angeles were infected with a “superbug” blamed on inadequately sterilized equipment…

    When we all know who’s really to blame: Reagan himself. Obviously the solution is to switch out common antibiotics for placebos so that when the really important people get an infection it can be fought with the genuine stuff. (That can be the GOP’s contribution to the Obamacare fix.)

  2. The trick is to ensure a steady stream of new drugs that the resistant microbes have never encountered before. We need medical science to advance more rapidly than the bacteria do.

    It would have been no problem before Obamacare, anti-AGW spending, over-taxing and the rest of the wealth destroying dictates of recent. Medical progress now is set to die alongside the prosperity upon which it fully depended.

  3. The trick is to ensure a steady stream of new drugs that the resistant microbes have never encountered before

    No, I think the trick is to get docs to stop prescribing them everytime little Johnny gets a runny nose and save the antibiotics for when they are actually needed.

    1. This would be great. Of course, it doesn’t help much if other countries are not following the same protocol. There are a lot of places where antibiotics are over-the-counter medicines. Pretty fertile breeding grounds for resistance.

      Then there is the libertarian ideal, where there is no law preventing me from deciding my own course of therapy and purchasing the drugs that I decide are proper. That would really put a dent in the “don’t overprescribe” push.

      Also, finishing the course of antibiotics is probably just as important as not “prescribing them everytime little Johnny gets a runny nose”.

      And because almost every one of these antibiotics comes from fungi that use the chemical to defend against bacteria in the wild, resistance genes are already circulating out there for them – it is just a question of how long it takes for them to undergo horizontal gene transfer.

      1. libertarian ideal, where there is no law preventing me from deciding my own course of therapy and purchasing the drugs that I decide are proper

        Yeah, just like the abortion immunization debate on these pages recently

        finishing the course of antibiotics is probably just as important

        This too^
        It’s hard to imagine a better strategy for making bacteria stronger than what we are doing presently, completely inadvertently.

      2. Then there is the libertarian ideal, where there is no law preventing me from deciding my own course of therapy and purchasing the drugs that I decide are proper. That would really put a dent in the “don’t overprescribe” push.

        Generally, the more libertarian-leaning people I know are pretty self-reliant and aren’t the one’s rushing Johnny to the doctor at every opportunity and then failing to dose him for the full cycle. They tend to be the ones who are more readily aware of medical conditions they can handle and able to identify the ones they can’t.

        It’s the one’s who take Johnny in to the pediatrician with a cough, ask about measles, and won’t leave without the M.D. having done *something* even if that something is amoxicillin. Two days later when the weather gets more humid and Johnny’s rehydrated to the point where his throat isn’t raw, the amoxicillin is forgotten until it get poured down the drain.

    2. How about getting rid of anti-bacterial soap while we’re at it? I used to try to avoid that stuff but it’s gotten almost impossible.

      I admit I don’t know if this is part of the same problem; anti-bacterial, anti-biotic, what’s the difference once the marketeers have had their swing at mangling English?

      1. There is marketeer mangling but, by-and-large, anti-bacterial means gross chemical destruction while anti-biotic means targeted biological disruption.

        Bleach is a phenomenal anti-bacterial, that would either be too effective or ineffective against internal bacterial infections.

        While not directly related, there is evidence to suggest that, yes, consistently relying on environmental cleansing of infectious agents leaves your immune system more generally susceptible to hardier organisms.

        1. ricin works well too.

      2. I’ve heard of a lot of people saying it’s hard to find non-antibacterial products, even “almost impossible” like you, but unless they’re in some remote area where the store is tiny, they must just not want to take more than 10 secs. to look on the shelf. What do you like, liquid or solid? Antibacterials in cake soap is pretty much passe; many brands that used to be antibacterial either got rid of the antimicrobial agents or relegated them to specialty status. There’s a little more of it in liquids for washing hands or dishes, but few in body washes. Sheesh, 50 yrs. ago even Matey bubble bath and baby bath liquids had hexachlorophene; antimicrobials are unheard of in such products now.

        “Antibiotic” is a more specific term than “antimicrobial” (which is broader than “antibacterial”), although etymology wouldn’t tell you that. Antibiotics are substances from, or derivatives of substances from, living things that have very specific action killing or inhibiting growth of often fairly specific kinds of microbes. Antibacterials are more general chemical agents that have a more general action against bacterial life. Don’t blame marketeers for the terminology, it comes from academics.

        1. I usually get the liquid soaps. Last time I looked for refill bottles, every single one had “anti-bacterial” plastered all over the lable. Not a single one without it. This was probably a year ago or so, since I get the biggest ones possible out of laziness. Maybe things have improved since then, or maybe I need to try a different store.

          1. Meanwhile my friend Nadine has complained within the past couple yrs. about not being able to find refills that are antibacterial! Blame it on stores.

            BTW, have you considered making your own liquid soap? (From fat & caustic potash, I mean, not turning bars into jelly.)

            Hell, I could ship you a gallon jug of my stuff ? http://users.bestweb.net/~robgood/lather.html ? but it’s gotten clotted with age & so may not pump from your dispenser so easily.

        2. The “regular” grocery stores where I shop tend to have these in the health food aisles. The soft soap tends to be more difficult to find free of these products. I think “Kiss My Face” and definitely Dr. Bronners are options.

          Going to a co-op like place (or Whole Foods) should dial you into a product (no pun intended).

          It will be interesting to see how Mickey Ds can keep prices low while also sourcing ethically raised chickens. Feeding GMO grains grown in a monoculture with sprayed products while housing in CAFOs has a lower cost than free ranging.

          1. Dr Bonners! Haven’t seen that in ages. That will be interesing.

            But I wretch every time I have to step into a Whoel Foods, the way thay plaster ORGANIC on every package.

          2. Besides Bronner’s there are plenty of other options if you don’t confine yourself to using products according to how they’re labeled. Lots of overlap in formula between hand dish detergent, shower gel, bubble bath, shampoo, & hand wash. I read online that lots of people now are refilling liquid hand soap dispensers at home with liquid bubble bath to save money, which is funny because years ago bubble bath was more expensive than shampoo, etc. It’s all in how they position the products.

    3. If antibiotics are saved for when they are really needed then they will be saved for when they are really needed by those who really matter, and that wont be you or me.

  4. One of the cool technologies out there to address the antibiotic resistance problem is the use of bacteria phage to attack the bugs in question.

    The idea is to identify and grow anti-bacterial viruses (called phages) that kill harmful bacteria like MRSA. In principle it is very simple – you grow up a plate of the bacteria and then get an environmental phage isolate – like from the sewage treatment plant – and do a plaque assay to identify potential weapons. Phage and bacteria have been in an arms race forever, so they will continue to coevolve, providing an endless supply of bacteria killing machines.

    You simply give the patient a cocktail of purified phage strains and let them do their thing.

    Of course the stumbling block is the same as the one that this article points out – regulation. Phage therapies are hard to regulate. Because the strains change rapidly, the best plan is probably to design custom local cocktails against whatever is circulating in the community. This model doesn’t work at all for the big pharmaceutical companies or for the federal regulators.

    So they are plugging away trying to use phage as if they were designer drugs, following similar testing protocols and regulatory schemes.

  5. Huh. I dunno. I’ve had Penicillin a few times, and it sure killed the FUCK out of everything in my body in no time. That’s been around since, what, the 40’s or something? [a quick Bing says maybe 1928 – so the olden days, regardless]

    Yeah, I get that the little critters mutate and new antibiotics are needed. And, yes, government regulates too much, esp in the medical field.

    Mostly this is just a comment on how fucking AWESOME Penicillin is to keep itself relevant even longer than Madonna. You go, P!

    1. Yep, I am a bit skeptical that it is the bacteria that is becoming resistant and not individuals becoming resistant to the antibiotics. Penicillin works fantastic for me but not my wife who is a hypochondriac. Surely she doesn’t get infected with “super-bugs” but I only get infected with weak regular ones. Maybe it has something to do with the very large number of times she has taken antibiotics?

      1. No, it is manifestly the bacteria that become resistant.

        Now, you might take a bunch of courses of antibiotics and wind up getting yourself colonized by multiple resistant strains of bacteria, just waiting about for a chance to cause harm. But a person being antibiotic resistant doesn’t make a lot of sense. (one could posit an antibody that quickly clears a particular antibiotic from the bloodstream, I suppose. But that would probably be a pretty common phenomenon preventing the drug from being deployed after clinical trials)

        Different antibiotics are localized to different areas of the body and are more or less effective against different strains of bacteria. Most general physicians barely acknowledge this in their decisions about prescribing antibiotics. You have to have an infectious disease doctor in the room to guarantee a really well thought out antibiotic regimen. And even then there is still a good bit of guess-work involved (how many days? Well, how many fingers do you have? Ten it is!)

  6. We are always just 10 years away from matching Warty.

    1. That will NEVER happen. Might as well claim STEVE SMITH will develop male pattern baldness and settle down with a nice girl.

  7. “Bacteria can evolve. ”

    Scott Walker refused to comment.

    1. Do you believe in there germ theory of disease, Mr. Walker?

      1. be?lieve
        \b?-?l?v\

        : to accept or regard (something) as true

        http://i.word.com/idictionary/believe

      2. He dropped out before taking microbio?

    2. Antibiotic resistant bacteria were intelligently designed to test our faith. /sarc

    3. Scott Walker replied :
      How did the ribosome , which makes all proteins in all living entities evolve, when it is composed in large part of proteins itself ?

  8. That monkey don’t hunt.

  9. This is interesting.. Greeat wonderful Information Thanks..

    http://www.xycles.com

  10. You don’t understand! None of these antibiotics would exist if not for government funded research! You can’t blame government for fewer antibiotics, because without government there would be no antibiotics at all! No one does any research without government funding! Government funding is responsible for everything from the wheel to fire to the Internet! Fucking anarchist libertarians would die from the most minor infections if not for government funded research! All hail government! We need more government! Hooray for government!

  11. Janet Woodcock, director of its Center for Drug Evaluation and Research, told Congress that “streamlined development pathways will likely be needed to improve the climate” and that the agency “is working hard to streamline requirements for clinical trials for studying new antibacterial drugs.” She has also endorsed legislation to allow smaller clinical trials for potent antibiotics.

    Something’s off there! Why is the regulator asking Congress to legislate something that’s within the regulator’s control? Of course we’re seeing the same thing regarding controlled substances, and I’ve also read from the late 1960s of members of Congress similarly pushing regulatory changes on the administration, where the shoe was on the other foot. Either branch of gov’t has it in their power, and the people with the power are saying what the other branch should do, rather than doing it themselves.

    Last month, seven patients at Ronald Reagan UCLA Medical Center in Los Angeles were infected with a “superbug” blamed on inadequately sterilized equipment, and two of them didn’t survive.

    Not exactly a stellar example of why drug reform is needed.

    1. Not exactly a stellar example of why drug reform is needed.

      Agreed. Must be a pretty big hill for the shit to have rolled that far.

  12. My best friend’s mother-in-law makes $85 /hour on the internet . She has been out of work for 5 months but last month her pay was $16453 just working on the internet for a few hours.
    Visit this website ??????????????? http://www.jobsfish.com

  13. my friend’s sister-in-law makes $63 /hour on the internet . She has been fired from work for 6 months but last month her payment was $16955 just working on the internet for a few hours. go to the website…….

    ????? http://www.netjob70.com

  14. Note that current FDA biologics testing requirements makes both antibody therapy (transgenic and synthetic) and phage therapy both of which work well, were used extensively before antibiotics, and are capable of matching any bacterial adaptation, impossible. Since these are individual therapies each use would require a full phase 3 trial were sucha trial even possible, which it is not. The FDA is outdated. corrupt and a health menace.

  15. “Bacteria can evolve. So can McDonald’s. Maybe federal policymakers can as well, before it’s too late.”

    Maybe my ass will start smelling like fresh strawberries and shoot out piles of gold instead of poop.

    1. STEVE SMITH LIKE YOU COME BY CAVE OFTEN IF THAT HAPPEN.

  16. Free shipping. 100% Satisfaction guaranteed or Your money back.

    Put an end to office fidgeting and boredom. Introducing a whole new breed of desk toy. More than just super-strong rare-earth magnets, buckyballs? are a moldable desktop stress reliever. They’re an addictive 3-dimensional building toy that can be shaped, torn apart and snapped together in unlimited ways. Make sculptures, puzzles, shapes, jewelry ? you name it.

Please to post comments

Comments are closed.