John Robson: The antibiotic window is slamming shut


Here’s an “end of the world news” item: super-gonorrhea is overwhelming the last antibiotic defences in Britain, so apparently we need new antibiotics. Anything but chastity.

Such stories clearly threaten the infamous TEOTWAWKI (“The End Of The World As We Know It”), not just an inconvenience. Yet they get brief space on the back pages while A1 goes to some politician’s latest fatuity that wouldn’t matter even if it were true and relevant.

Two things are ominously true and relevant about this particular gonorrhea story. First is the emergence of antibiotic resistance in any number of diseases that attack you in any number of places. Since the Second World War, we have enjoyed blessed immunity from sudden death by bacterial infection that haunted humans since we first saw the city lights.

We have forgotten what it was like when the president’s son got a blister playing lawn tennis … and died. (Calvin Coolidge Jr., age 16.) And it has contributed to our false sense, not just of security, but of omnipotence and impunity, as well.

It is not immediately obvious why people who embraced the theory of evolution so eagerly expected bacteria not to evolve. But we did.

Hence, second, when people can’t ignore the emerging evidence, they call for more of the same: better drugs, more careful prescriptions, less routine agricultural overuse. Science will find a way so we don’t have to change our ways.

When this newspaper reported briefly that Britain’s on “high alert” because the newest strain of “the clap” (a.k.a., Neisseria gonorrhoeae) doesn’t respond to azithromycin, it cited the country’s chief medical officer warning doctors and pharmacies not to prescribe older antibiotics it is also resistant to. Meanwhile, a longer Washington Post story said that in 2013, the U.S. Centers for Disease Control and Prevention called antibiotic-resistant gonorrhea an “urgent threat,” with about a third of cases resisting at least one antibiotic, so doctors should use ceftriaxone with azithromycin.

Fine … if you want to breed gonorrhea resistant to both. As the Post noted, “Bacteria are fast-evolving creatures” with a creepy capacity to share genes. So “it’s our use of antibiotics that really has to evolve.”

We cannot stop bacterial evolution or even delay it much

Well, sure. But the main point is, when the party’s over, you have to stop partying.

We cannot stop bacterial evolution or even delay it much. It’s an unstoppable tragedy of the commons where the most desperate, least careful and least scrupulous medical conduct sets the pace. A blistering pace, from tens of thousands of Indian newborns succumbing to untreatable infections, malaria resisting artemisinins, viral-drug-proof HIV, to flesh-eating bugs, VRE and MRSA. You name it, it’s coming. Head lice shrug off chemicals. Even Arctic birds show traces of drug-resistant E. coli. It’s everywhere, and the antibiotic window is slamming shut.

So what can we do, if ignoring it won’t work?

We should restore pre-antibiotic infection control protocols. But doing so would require moving away from big, centralized, bureaucratic government hospitals, which is unthinkable because … Because we don’t want to start thinking differently. We’ve bet the future on experts and life without consequences, including financial ones. So we cling to the hope of a a new class of antibiotics to which bacteria can’t adjust, sterilizing wipes, antibacterial soaps, creams, body washes and even pens and mattresses, as though germs will now kindly stop evolving at the touch of a button.

The illusion of technique convinces us there’s nothing nature can throw at us that the lab can’t throw back. But insanity is doing the same thing over and over and expecting a different result. Particularly turning our genitalia into Petrie dishes.

Wikipedia cites the CDC on gonorrhea that, “Testing all women who are sexually active and less than 25 years of age each year is recommended.” But “sexually active” does not mean what they think it means. A woman under 25 can swing naked from the chandelier without fear, provided only her husband is present and he’s faithful.

Oh but we can’t do that. We’re liberated. Well, over 20 years ago, P.J. O’Rourke wrote, “The sexual revolution is over and the microbes won.” And that’s not all they won. But while I have no solution to the grim issue of untreatable pneumonia or malaria, I know what protects you from drug-resistant gonorrhea: monogamy.

I also know what doesn’t: believing science has made us as gods, or at least godlets, who through political will can guarantee ourselves long, healthy pleasure quests with painless planned exits. It is not so, any more than happy pills can fix a wretched life.

Death still comes like a thief in the night, wielding accidents, cancers, lunatics, terrorists and more. But that’s no reason to invite him (or her, or them) into your bed.

If that’s the end of the world as you know it, it’s probably high time anyway.

National Post

04/01/2016 07:19  By: National Post