Drug resistant bacteria and hope on the horizon
Introduction
There have been a few stories in the news lately about antibiotic-resistant bacteria, so I thought I’d do a rundown of them, plus my own thoughts on the matter as someone who works and studies in the field of medicine.
Just about everyone is familiar with the concept of bacteria and viruses. Most people know that antibiotics don’t kill viruses, and conversely that antivirals have no effect on bacteria. The problem is, we don’t have therapies that combat the viruses that ail most people (for instance, the “common” cold). We have antivirals that target specific viruses, like Tamiflu to combat influenza. We also have anti-retrovirals (ARVs) which are used to fight HIV. The problem with creating drugs to fight viruses is that there are so many different kinds of viruses that targeting them requires very specific chemicals. What compounds this problem is that viruses are incredibly simple which makes them remarkably robust and adaptable. Viruses consist of a protein coat over strands of DNA or RNA, that’s about it. This means that the virus needs a host to do its dirty work: replication, or making more copies of itself. In comparison, bacteria are far more complex, and they are able to replicated themselves without the need for a host. More complex systems means easier targeting from a pharmaceutical perspective because there are more ways to disrupt the lifecycle of the bacterium in question. In the case of an antibiotic, a single drug may be effective against dozens of different types of bacteria, infectious and otherwise. (These are referred to as broad-spectrum antibiotics.)
In short, simple biological systems means complex pharmaceutical treatments and complex living systems means easier drug targeting. But the problem when dealing with both bacteria and viruses is that they both adapt relatively quickly. This means that viruses like HIV are only vulnerable to most ARVs for a few years, and that bacteria evolve defenses which block the action of antibiotics meant to kill them. This is probably the single biggest challenge facing allopathic medicine today, especially given that research into new antibiotics has largely fallen by the wayside in favor of more profitable “lifestyle” drugs. As “superbugs” become more common, though, the pendulum will again swing back the other direction.
The real world
In the real world, even if a patient knows all these things when the see their doctors, it doesn’t necessarily help when they demand something that will make them feel better. Doctors have long felt the pressure to write prescriptions for antibiotics when the cause of the ailment is likely viral. This keeps the patients happy, but it is causing problems for the reasons I outlined above. Doctors know they’re digging a pharmaceutical hole by giving in to patient demands, but often appeasement is easier than sending a patient home unhappy without a prescription. (Not to mention that having angry customers is bad for business.) Nonetheless, doctors should try to explain these concepts, but they often don’t for one reason or another. This happened to me a few years back when I visited the doctor: “You have a virus, let me write you a prescription for an antibiotic, though.” This sort of lackadaisical attitude must change, else the medical profession is going to have quite the problem on its hands in a few years.
There are many reasons that patients request a prescription when they shouldn’t. These include the feeling that money was wasted if they went home empty-handed; the “what-if” factor (what if the virus is actually a bacterial infection); and the biggest one of all: thinking long-term is often difficult when the here-and-now is uncomfortable. Patients just want something to latch onto that will make them feel better even if that solution is “simply” placebo. Regardless of the reasons behind doling out scripts to those that don’t need them, it is creating a much bigger problem that my generation will have face, soon. (Not that I resent this; I’m sure my generation will leave its share of problems, too.) Antibiotic-resistant bacteria are rapidly becoming a problem in hospitals where secondary infections from bacteria like MRSA on the rise.
Doctors can get around writing prescriptions, by relying almost entirely on the placebo effect, which isn’t a medical tool to be discarded as worthless. Look for an upcoming introduction to the placebo effect, which is actually a fairly complex subject, where I’ll discuss this more in-depth.
Next: How do antibiotic-resistant bacteria become a problem?
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Pingback by polyscience.org » Introduction to antibiotic resistance and what it means for you — September 14, 2005 @ 10:24 pm
[...] There’s a push and pull, of course. Doctors get paid for procedures they perform, and they don’t get paid if they don’t perform them. Most docs aren’t money-hungry treatment-pushers, but they do arguably have vested interests on both sides of the dollar sign. On the one hand there are their patients who might benefit more from simply letting things ride, and then there are the revenues for their hospital or practice that they stand to generate if they prescribe a certain treatment or test. And then there’s also the issue of “patient satisfaction,” which in the era of medicine-as-a-business places more emphasis on keeping the customer happy than it does on positive therapeutic outcomes. This leads to the phenomenon of patients feeling entitled to a prescription simply because they visited their doctor. If the doc doesn’t provide at least something, the patient may feel as though they aren’t truly being served. It’s a tough balancing act, and these pressures are the reasons things like antibiotic-resistant bacteria are becoming a bigger problems in the first world. | 5:00 pm | [...]
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