Category Archives: General Interest

Items of general interest – for mass consumption

Will antibiotics stop working and will medicine be flung back to the 19th century?

Antibiotics have literally changed the world. Before antibiotics were invented, it was pretty routine for people to die of minor infections, like being scratched by a rose bush, or during childbirth. But antibiotics changed the world of medicine in ways that could only be described as miraculous.

Unfortunately, there is a possibility, that at some time in the near future, antibiotics will stop working as more and more antibiotic resistant strains of bacteria are emerging, and faster.

I first came across this article earlier this year, and was sufficiently alarmed, but on second thoughts, I wasn’t sure whether the author was simply overhyping the whole thing. However, a few weeks ago, WHO has come out with a report on this issue, which pretty much sounds a general worldwide alarm:

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

Where are “antibiotic-resistant” bacteria coming from? This works in pretty much the same way as vaccinations work. Basically, when bacteria are exposed to less than a full dose of antibiotics (i.e. when you discontinue antibiotics before the full course is over), they develop an immunity to that antibiotic. Basically, literally, what doesn’t kill them, makes them stronger. Now this strain of bacteria starts spreading… This process repeats with all the different antibiotics we have. And sooner or later we end up with strains of bacteria that are immune to all antibiotics known to man.

And this problem is getting worse. For example:

Tetracycline was introduced in 1950, and tetracycline-resistant Shigella emerged in 1959; erythromycin came on the market in 1953, and erythromycin-resistant strep appeared in 1968. As antibiotics became more affordable and their use increased, bacteria developed defenses more quickly. Methicillin arrived in 1960 and methicillin resistance in 1962; levofloxacin in 1996 and the first resistant cases the same year; linezolid in 2000 and resistance to it in 2001; daptomycin in 2003 and the first signs of resistance in 2004.

Source

What is the meaning of all this? A hundred years ago, people used to die of minor infections. We, who’ve been lucky enough to be born in the age of antibiotics don’t know what that feels like. But maybe we’ll get to experience that soon enough:

The chief medical officer of the United Kinigdom, Dame Sally Davies — who calls antibiotic resistance as serious a threat as terrorism — recently published a book in which she imagines what might come next. She sketches a world where infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. It is a dark vision, meant to disturb. But it may actually underplay what the loss of antibiotics would mean.

This is not just a problem for people who get injured. A lot of modern medicine depends upon antibiotics. Most surgery would become potentially lethal if antibiotics don’t work:

Many treatments require suppressing the immune system, to help destroy cancer or to keep a transplanted organ viable. That suppression makes people unusually vulnerable to infection. Antibiotics reduce the threat; without them, chemotherapy or radiation treatment would be as dangerous as the cancers they seek to cure. Dr. Michael Bell, who leads an infection-prevention division at the CDC, told me: “We deal with that risk now by loading people up with broad-spectrum antibiotics, sometimes for weeks at a stretch. But if you can’t do that, the decision to treat somebody takes on a different ethical tone. Similarly with transplantation. And severe burns are hugely susceptible to infection. Burn units would have a very, very difficult task keeping people alive.”

Forget surgery. Something as simple as childbirth will become dangerous once again:

Before antibiotics, five women died out of every 1,000 who gave birth. One out of nine people who got a skin infection died, even from something as simple as a scrape or an insect bite. Three out of ten people who contracted pneumonia died from it. Ear infections caused deafness; sore throats were followed by heart failure. In a post-antibiotic era, would you mess around with power tools? Let your kid climb a tree? Have another child?

Update: I was reminded by Farhat (see his comment below) of a few things that I left out of this post:

  • This is already happening. In the last one year, I know of at least two cases in my friends’ circle, where an elderly person, who was otherwise healthy, and was admitted to a hospital for a non-life-threatening condition, and was cured, but contracted a “hospital infection” just before getting a discharge, and then died less than 2 weeks later because the “hospital infection” did not respond to any antibiotics.

What should we do about this?

  • First and foremost, STOP ABUSING ANTIBIOTICS. Do not take antibiotics unless it is really necessary. And if you do take antibiotics, do not discontinue midway. Discontinuing antibiotics midway is one of the main sources of antibiotic resistant strains.
  • Stay away from hospitals unless it is life-threatening.

Should we be afraid? Very afraid?

References:

How India defeated Polio

A blog on the New York Times has an interesting article on how India eradicated polio which makes for interesting reading.

The method in which India went about getting 95% coverage for the polio vaccine is impressive, and can serve as a blueprint for other campaigns and other countries.

Multiple agencies – governmental and non-governmental – worked together, with well defined distinct roles to make this happen:

The Global Polio Eradication Initiative began in 1988 as a huge partnership among Unicef, the World Health Organization, the Centers for Disease Control and Prevention and Rotary International. Each organization took on a different job and this continues today as the focus broadens from just polio to all routine immunizations. Unicef handles communications, makes posters and banners, and ensures that the “word” spreads about the campaign, even if it’s through old-school techniques like hauling loudspeakers on a rickshaw through the city center.

The W.H.O. is the data machine, responsible for tracking the virus, collecting stool samples of possible cases and studying the data for any gaps. Rotary International has a Delhi-based team, the National PolioPlus Office, with regional and city-level tentacles to execute polio vaccinations four times a year during National Immunization Days (more days for high-risk areas). Globally, Rotary has been the cheerleader of the campaign, raising funds and keeping the issue in the spotlight.

And it needed a lot of very low level, very localized effort to ensure that nobody got missed:

Health workers, usually women, stand at the booths for eight hours to ensure that every child in the neighborhood is vaccinated. The vaccinated children are marked on the nail of their pinky with black ink. The following day, the health workers search for missed children by going door-to-door, carrying the vaccine in an icebox.

Just having people going around running the vaccination booths is not good enough. The system does not work unless there is measurement that completes the feedback loop, identifies gaps, and fixes them.

The government had elaborate machinery to do this:

Dr. Vishwakarma’s job is tiring, illustrating the depth and breadth of the polio surveillance effort. Based in Agra, he travels daily across Western Uttar Pradesh; he monitors 12 districts of the state, which cover a distance of about 125 miles from Delhi to Agra. His days begin at 5 a.m. and he retires at 10 p.m., after endless cups of tea with local officials, shadowing health workers, combing through stacks of data and overseeing surveillance efforts at regional offices.

“I cannot miss any details,” he says. “That’s where the solution lies. That’s why I’m constantly on the move.”

Overall, missing a single person would result in the whole campaign being set back by years:

The philosophy for the polio campaign was, Dr. Bahl says, “Who have we missed? Why have we missed them? Why did they not take the vaccine? And we constantly looked at the data to help us.”

In a country the size of India, just getting the message across to everybody, without it getting twisted in the process, was a big job with unique challenges. Here is one example:

Communication — Unicef’s job — is the last key pillar of the polio campaign. It goes beyond just fliers, banners and announcements. Previously, when Muslim communities refused the vaccine — on the grounds that the vaccine was designed to make their children sterile — communication became critical. “At the local level, we had to work with the ulema [Muslim clerics], to correct this message,” said Dr. Bahl. By collaborating with local leaders, Unicef found a new venue to preach the message of good health: the mosque. And it was the health workers who took that message further, by carrying letters, written and signed by local Muslim clerics, urging families to have their children inoculated.

Where do we go from here? India is getting ready to use this success and go after the next big challenge – routine child immunizations.

India’s routine immunization rates — for measles, rubella hepatitis B, TB and the like — were last recorded in 2009 at 61 percent nationally. India accounts for a third of the world’s measles deaths. Public health is dismal, and India’s per-capita spending on health care is among the lowest in the world. Yet with polio, India achieved 95 percent coverage.
The success of India’s polio effort has turned it into a blueprint for large-scale health campaigns. Now India is using what it did with polio to boost rates of routine vaccinations.

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Vaclav Smil on why we need manufacturing, vegetarianism, and less innovation

When Bill Gates says:

I’ve talked before about my favorite author Vaclav Smil. He doesn’t pull any punches in this @WIRED interview

I know it will be an interview worth reading. So I head over and find an excellent interview with Vaclav Smil

Here are some excerpts:

Let’s talk about manufacturing. You say a country that stops doing mass manufacturing falls apart. Why?

In every society, manufacturing builds the lower middle class. If you give up manufacturing, you end up with haves and have-nots and you get social polarization. The whole lower middle class sinks.

and

Restoring manufacturing would mean training Americans again to build things?

Only two countries have done this well: Germany and Switzerland. They’ve both maintained strong manufacturing sectors and they share a key thing: Kids go into apprentice programs at age 14 or 15. You spend a few years, depending on the skill, and you can make BMWs. And because you started young and learned from the older people, your products can’t be matched in quality. This is where it all starts.

On food:

Your other big subject is food. You’re a pretty grim thinker, but this is your most optimistic area. You actually think we can feed a planet of 10 billion people—if we eat less meat and waste less food.

We pour all this energy into growing corn and soybeans, and then we put all that into rearing animals while feeding them antibiotics. And then we throw away 40 percent of the food we produce.

Meat eaters don’t like me because I call for moderation, and vegetarians don’t like me because I say there’s nothing wrong with eating meat. It’s part of our evolutionary heritage! Meat has helped to make us what we are. Meat helps to make our big brains. The problem is with eating 200 pounds of meat per capita per year. Eating hamburgers every day. And steak.

You know, you take some chicken breast, cut it up into little cubes, and make a Chinese stew—three people can eat one chicken breast. When you cut meat into little pieces, as they do in India, China, and Malaysia, all you need to eat is maybe like 40 pounds a year.

On “innovation” as the solution to all our problems:

“Let’s not reform the education system, the tax system. Let’s not improve our dysfunctional government. Just wait for this innovation manna from a little group of people in Silicon Valley, preferably of Indian origin.”

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