The problem is becoming really serious, and our medical industry cannot be counted on to provide a solution.
While I was working on this article I took a routine look at the general news. It is as if someone is watching what I am up to: there were multiple stories emphasizing what I was writing, adding data to the main theses. “Antibiotic-resistant infections killing twice as many Americans as once thought” Dan Whitcomb blared out in Reuters. “The U.S. Centers for Disease Control and Prevention said it had determined that 2.8 million antibiotic resistant infections occur each year, killing 35,000 people.” That was up from 23,000 deaths in 2013. Maybe the higher numbers are the result of new and better data sources, not just a rise in fatalities. But things are clearly getting worse, today, as we speak (or as I write). In 2050 new forms of infection may be killing more people than ageing, heart disease and cancer.
So what is the problem? In my previous article on Penicillin I described how 75 years ago antibiotics changed the world — how for the first time in human history it became advisable to visit a doctor when illness struck, as opposed to not seeking one out. There followed years of plenty, where effective treatment for one disease after another was developed, and previously fatal ailments could be cured with a few shots or tablets of antibiotics. One after another the great diseases started to disappear.
But there was a downside, which biologists comprehended. It is rooted in the very structure of evolution, and was inevitable: when something occurs that threatens to wipe out a species (e.g. of bacteria), a few individuals, who happen to survive, go on to breed a new strain that by chance is more resistant to the agent that brought about the demise of the original species. After a while you have a new species that is resistant. Antibiotics are automatically breeding new species that are able to survive antibiotics — and we end up with what scientists call “superbugs”.
The process can be accelerated by a number of factors. In the case of antibiotics terminating the intake of the drug before the prescribed period of treatment will do the job. If you think you are cured after three of the seven days and stop taking the antibiotics, you have only killed the most susceptible of the bacteria. Those that have been able to, barely or comfortably, survive are left in place to breed the next generations of hardier bacteria. Think of it this way: you have a plague of rats in your barn, and start dispersing rat poison. After a while you see many dead rats, so you stop spreading the poison. Now the rats who managed to survive get over the stomach-ache (or whatever) to continue breeding. And the next generations will be much more capable of resisting the poison. And they may escape to other barns where the same kind of poison is dispersed. Again the most resistant individuals will survive and go on to breed an even more resistant species. You are breeding superrats.
There is an even more compelling way to generate antibiotic resistant bacteria. Remember that the greatest number of microbes do not reside in human or animal bodies, but in the soil beneath your feet. Using antibiotics to enhance crop or farm animal production means a lot of the antibacterial substance will be released into the ground, where once again evolution can take over: the hardiest strains of bacteria will survive and will go on to produce even hardier strains. And any human interaction with the soil will spread the new superbugs.
How to deal with them
There are two fundamental ways to deal with superbugs: on the one hand we could synthesize new antibiotics, in the laboratory, molecule by molecule. But this is very costly and difficult. The other option is to search for naturally occurring strains of bacteria-killing spores. And where should we look? Best of all in the place where the superbugs are being generated: in the soil. There evolution is in full action, with new resistant bacteria arising, and new spores developing that can kill them. It is pure biological warfare: bacteria killing spores, spores hitting back. All we need to do is identify the ones we need, collect and purify them into new antibiotic drugs.
So why is it not happening? Because it is too expensive and not profitable enough for drug companies. A new antibiotic can cost hundreds of millions to develop — up to a billion before it can be released to the general public. And once it is, there are serious follow-up problems: for instance the drug is seldom required. Blood pressure medication, statins, pain killers, or respiratory treatment is usually needed on a daily basis, but when was the last time you took an antibiotic? Probably a few years ago, for a period of one week. And hopefully will not have need to do so again for a number of years. So it is difficult for a pharmaceutical company to make a profit off it, and they have to charge as much as possible for the drug.
Secondly new antibiotics will, unlike other drugs, have a limited life span: new superbugs will make them obsolete, and new drugs will have to be developed. Not an attractive proposition for Big Pharma, which will find it difficult to make a profit. And remember: pharmaceutical companies are accountable to owners and share-holders, not to patients.
Another factor is that the number of deaths superbugs cause per year, 20 to 30 thousand , is too low to declare it a national or international emergency. It would have to go to 100,000 and above to be regarded as such. We tend to accept tens of thousands of fatalities, going into panic mode only when the number exceeds a hundred thousand across a nation like the USA.
That is the way we are clearly headed. But even as we approach the we’re-all-gonna-die panic numbers, Big Pharma is not going to want to do the job of saving lives on it own. Of course we can offer profit and tax incentives. But can we tell the general public that we want to give an industry that is making billions in profit, hideously overpaying management, making owners and share-holders obscenely rich — and in some cases, like the opioid pain-killer crisis has consciously let tens of thousand of people die in order to maximise profit — even more money, in form of tax breaks or government subsidies, we would encounter a great deal of resistance and bitterness.
How to make it happen
In my opinion there is only one acceptable alternative, one I am going to fight for: socialize medicine! I know a lot of people will be shocked and repulsed by this. Many have been indoctrinated to be deeply concerned for the well-being and profitability of Big Pharma and health insurance companies. This is basically the concern of the well-situated, who tend to prioritize keeping the current situation in place. I have good health care, which I can afford. I have the doctors I like. So what if for tens of millions of citizens serious illness leads to bankruptcy? Just don’t change anything as long as I am fine. And this minority view is adopted by a larger segment of the population than it deserves — just like the fact that there have been 230,00 cases of gun violence in US schools in the last twenty years, since the 1999 massacre in Columbine, and that has not led to any serious gun control. One rich and powerful lobby is able to cancel out the wishes of a vast majority of the population.
Now I live in Germany, and as a modestly well-off person have been paying around 750 Euros per month for public health insurance. Sounds like a lot, and is a lot: more than a quarter of a million in the last thirty years. But I accept it for two main reasons. I have not caused the health insurance costs anywhere near the sum I paid in, but I have the assurance that if anything really serious happens — heart transplant, major cancer surgery or whatever — I will never be in the financial lurch. In the last years I had to get an artificial knee, and a couple of heart stents. That cost me exactly nothing. It is similar in France: a dear friend, an American journalist working out of Paris, was diagnosed with advanced stomach cancer, and had to undergo major surgery, a number of times. He told me that the treatment had cost him, in total, around twenty Francs (the French currency at the time) for a taxi ride to the hospital which he had undertaken and had paid for himself.
The second reason I accept the amount I have been paying for public health insurance is that I know that I am supporting people less financially fortunate than myself. They pay far less into health insurance — if at all — but get the same grade of treatment in case of illness as me. So everyone is paying into a system that is providing health care to everyone. Some pay more, others less.
Of course German and French pharmaceutical companies are run with similar economic goals: maximise profit. Except we here in Europe have installed constraints and share the burden of universal health care. How this all works and whether it is a system every nation needs, that is a subject for a future article. But before I return to the subject of what we need to do, urgently, about superbugs, there is one more story to tell.
Some years ago a friend from Georgia, Salome, told me that her four-month-old daughter, Ketevan, was diagnosed with a serious heart problem— pulmonary atresia with ventricular septal defect — and needed surgery that was not available in her native country. Enquiries in America, specifically at the Stanford University Medical Center, revealed that the cost of initial treatment there would be between US $500,000 and $1,500,000. Fortunately the dismayed family discovered that the operation could be performed at the German Heart Center in Berlin at a cost of €60,000. This included complex interventional heart catheterization and complicated surgery utilizing the heart-lung machine. The procedure would take around 27 days and was around fifteen times cheaper if done in Germany than in the US.
I must mention that the cost was still way beyond the capability of the Georgian friend, and so I published an appeal for donations on my chess news page (the mother is a strong chess woman grandmaster). I expected many small sums to be paid into her account, but suddenly a British chess player who had moved to investment banking, contacted me and offered to pay the entire sum. Salome told me later that he had transferred the necessary funds to the Berlin Heart Center. “When I asked him why he was doing such a valuable favour,” she said, “he answered: ‘It’s a baby, and deserves to live.’ There are still some truly incredible people in the world.” A year later Salome told me that the operation had been a success and Ketevan was in great shape.
I had to tell you that story. During the operations Ketevan naturally received heavy doses of broad-spectrum antibiotics, and the hospital in Berlin was heavily guarded against superbugs. So that went well. But the only way, in my opinion, for us to encounter this grave danger to the future of humanity is to entrust nations to pay for the development of new super-antibiotics. It may be expensive and not enormously profitable, but it is the only way to do what is morally : keeping us alive. Medicine should be treated like Defence, road building, water supply, fire control, dams and levees, air traffic control, and many other things: it is the responsibility of the government installed by voters and tax payers. And it is the only way to prevent superbugs from becoming the prime killers of human beings — ahead of ageing, heart disease, cancer. In thirty years or so.
Much of the above came to my attention in the podcast Sam Harris made with Matt McCarthy, an infectious disease physician and assistant professor of medicine at Weill Cornell. Their discussion is far more knowledgable and deeper than what I have expounded above. As I have said recently, every inquisitive person should periodically download a bunch of files from the Sam Harris Making Sense Podcast page and listen to them, e.g. in the car, while driving, instead of news repeats and weather reports. You should try it — there is an endless supply of material on Sam’s podcast page.
If you are interested in medicine you can read my articles on the subject: