Nearly every major technological advancement made by science in the last two hundred years has brought about increased prosperity and driven human progress. Unfortunately, new problems requiring novel solutions accompany these advancements despite their benefits. Antibiotics, the miracle drugs upon which the entirety of modern medicine is based, are no different in this respect. In fact, the problem facing these life-saving chemicals is that they may become obsolete in the coming decades due to the increasing amount of resistance that bacteria develop towards them. But why is the spread of antibiotic resistance of any concern to the public? Well, in their 2011 article, the Infectious Diseases Society of America (IDSA) states that:
“Without effective antibiotics, diverse fields of medicine will be severely hampered, including surgery, the care of premature infants, cancer chemotherapy, care of the critically ill, and transplantation medicine, all of which are only feasible in the context of effective antibiotic therapy.”
A world in which scratches can be fatal and healthy people perish even in world class facilities because we can no longer cure infections is irrefutably terrifying. For this reason, the purpose here is to examine what antibiotic resistance is, how and why it is a problem, and to propose to the government a general plan involving legislative action to help mitigate this impending crisis.
Before discussing how to address the problem of antibiotic resistance, it is necessary to establish an understanding of what antibiotic resistance is and how/why it is a problem. Simply put, the Center for Disease Control and Prevention (CDC) describes antibiotic resistance as “the ability [of bacteria] to defeat the drugs designed to kill them. When bacteria become resistant, antibiotics cannot fight them, and the bacteria multiply.” These microscopic saboteurs of health can acquire resistance to a given antibiotic in several ways. Some bacteria happen to already be capable of altering antibiotic drugs into harmless forms after they enter the cell, or instead can pump the drug back out of the cell before it can accomplish its purpose. Other bacteria do not come with happenstance resistance, but instead develop resistance to a given drug by mutating upon exposure to said drug. The last path through which bacteria can acquire resistance is called “horizontal transfer,” a process which involves “transfer to genes from outside sources,” (Chambers, DeLeo, Sept. 2009). In other words, bacteria are capable of sharing genetic material with one another, even across species, meaning that a susceptible bacterium or group of bacteria can obtain antibiotic resistance just by coming into contact with another bacterium that has resistant genes. With these mechanisms of acquisition in mind, it is apparent that the spread of antibiotic resistance is natural and inevitable.
At this point, it would be prudent to ask if more antibiotics are being developed to replace those that are becoming increasingly obsolete. The answer is yes, but the degree to which new antibiotics are being researched, developed, and approved falls far short of what is required to keep pace with, let alone eclipse the spread of antibiotic resistance. In 2011, the World Economic Forum interviewed experts who disturbingly “caution that we are decades behind in comparison with the historical rate at which we have discovered and developed new antibiotics… there hasn’t been a discovery of a new class of antibiotics since 1987,” (WEF 29, 31). In light of this fact, it is utterly clear that more resources must be thrown at this endeavor, and the IDSA would agree. Their point can be summed up thus:
“The market approach for R&D of new antibiotics has been a failure due to lack of incentive characterized by the high risk and low return on investment of this long, difficult task. The government must incentivize antibiotic R&D by offering grants, contracts, and tax credits while guaranteeing markets, liability protection, patent extensions, and assistance in funding expensive phase II clinical trials. Additionally, funding must be increased for firms that share risk of developing high-priority drugs such as antibiotics with smaller companies in order to help them secure more private investment.”
While everything the IDSA suggests would encourage companies to help solve the problem, the major hold up preventing companies from investing in development of new antibiotics, the profit motive, will still be there to divert their resources to other projects. This is why the government should consider establishing new publicly funded national laboratories in which R&D for new antibiotics can be pursued with complete detachment from the profit motive. By devoting public resources towards both reinvigorating market R&D and funding new public sector R&D operations, the U.S can help make up for a lack of progress experienced over the last three decades.
Unfortunately, coming up with new antibiotics is not sufficient. It will not be enough to simply invent more antibiotics to replace those whose usefulness dwindles ever faster since “heavy use of the latest antibiotic can lead to the emergence of resistance in as little as two years,” (Alliance for the Prudent Use of Antibiotics). The more often that antibiotics are used, the faster resistance will spread. Public action must be taken to prevent the disproportionate use of antibiotics so as to slow down the rate at which bacteria are exposed to them. The two areas in which irresponsible use of antibiotics is most prevalent will be considered here: the healthcare industry and agriculture.
Perhaps the most familiar context in which most people are exposed to antibiotics is when they are prescribed these drugs themselves by their healthcare practitioner. However, according to the study conducted by Katherine Fleming-Dutra and company, “the United States in 2010-2011 [saw] an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate.” This translates to roughly 69.8% of antibiotic prescriptions being reasonable and suggests that much of the remaining ~30% is characterized by inappropriate prescriptions. Since the problem with market R&D of new antibiotics is that those drugs aren’t as profitable as others, it would not make sense to assume that doctors are overprescribing them as repayment for “donations” or “favors” that pharmaceutical companies have provided. The only other things that could explain the observed degree of overprescription is a lack of knowledge and serious awareness of the problem along with errors on the part of physicians. Support for this assumption can be found in shortened findings of parts in the WEF report: “Europe has shown that when information on antibiotic use and resistance is publicly available [and prevalent], and nationally coordinated policies are enforced, significant reduction in antibiotic use can be achieved,” (33). Besides a public education campaign on the issue, the government should bolster organizations that contribute to monitoring improper use of antibiotics. It may also be ideal to establish a new agency tasked with putting repeat offenders on a watchlist, a status that would be made publicly known. Inappropriate use of these drugs must be stigmatized in the medical community, and giving doctors some entity to be accountable to when they are guilty of this practice seems like a good start. If a culture of caution towards antibiotics among medical professionals were truly priority, laws designed to punish poor prescription of antibiotics via fines could be defined and put into effect as well. While this may be considered a step too far, such punishments need not be strongly enforced because simply having punitive legal codes for carelessly prescribed antibiotics is likely to discourage doctors from unnecessarily prescribing them anyway. In short, increased public awareness of antibiotic resistance and further legislation discouraging shortsighted use of the drugs are what is needed to help decrease the ~30% of unnecessary U.S prescriptions.
While minimizing antibiotic use in medicine is important for mitigating antibiotic resistance, the implementation of laws designed to cut down on usage in food production is of greater significance. According to Stephanie Strom, “the Agricultural Department has confirmed that almost 80% of all antibiotics sold in the U.S. are used in animal agriculture.” This figure gives one pause as to whether the threat of bacterial infection to animals is really four times greater than in humans. Although antibiotics are in fact used on animals “to treat and prevent disease,” the more dominant reasons for such inflated consumption of the drugs by farm creatures is that they “increase feed efficacy and substitute [for] labor previously devoted to the care of individual animals,” (Kirchhelle, p. 2). The bottom line is that antibiotics given to animals saves money for meat producers while simultaneously increasing bacteria exposure to these drugs and thereby accelerating the rate at which resistance spreads. While one can go to the store and see “No Antibiotics”-labeled meat as proof that some companies are becoming more sensitive to the issue of antibiotic resistance, there is still rampant use of these drugs on farm animals by many others. As suggested by experts at the IDSA and elsewhere, the government ought to start with a fee charged to animal farms by the dose for purchasing antibiotics. From there, an approach that can further help minimize the problem would require the introduction of strict regulatory guidelines for appropriate antibiotic use in animal agriculture that result in severe fines if breached. It makes sense to threaten monetary consequences since businesses are profit-driven. All money garnered between these two types of regulation would ideally be reinvested to fund government programs designed to combat antibiotic resistance. Regardless of specifics on how it chooses to do so, the government must respond strongly to the gross overusage of antibiotics by animal farmers.
By now it is clear that widespread government action is required to combat the threat of antibiotic resistance. If not, we risk a future in which many fields of modern medicine regress to a state of practice roughly equivalent to early 20th century medicine. However, if enough resources are devoted to R&D for new antibiotics and their overuse in healthcare and agricultural settings is regulated more tightly, this problem can be managed until hopefully science bypasses the need for antibiotics at all.
Alliance for the Prudent Use of Antibiotics. “General Background: What Can Be Done about Antibiotic Resistance?” Tufts University, APUA, 2014, emerald.tufts.edu/med/apua/about_issue/what_can_be_done.shtml.
This source is exactly as its title suggests: a compilation of general background information on antibiotic resistance. The knowledge they present tells individuals not to request the drugs and to take them as prescribed. It also discusses how antibiotics are currently regulated in different countries, what international action is needed to deal with the issue, and finally their ambivalence about whether antibiotic resistance can be overcome. This source was a great start to my research and helped me realize that my original notion of simply inventing more antibiotics will not be enough to solve the issue. It also provided me with a quote useful for communicating this idea to the audience. Having a name like the Alliance for the Prudent Use of Antibiotics and being hosted on a university website suggests that this source is reliable enough for how it is used in the essay.
Center for Disease Control and Prevention. “Antibiotic Resistance Questions and Answers.” CDC, 17 Apr 2015, https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html.
This webpage contains questions and answers regarding antibiotic resistance with curious citizens in mind. The page includes information on surrounding topics such as the different kinds of microbes, what antibiotics and antibiotic resistance are, how and why resistance is acquired by bacteria, and what both patients and healthcare professionals can do to help minimize the spread of resistance. While nearly all of the information contained on this page is already known to me from science courses, it is a good source for quotes that help me define the overall problem for my audience. They’d probably rather hear it from an official source like the CDC than a community college student. Being a government agency whose entire purpose is to control and prevent disease, it is doubtful that anyone would say that the CDC is a poor source with regard to the issue of antibiotic resistance.
Chambers, Henry F., DeLeo Frank R. “Waves of Resistance: Staphylococcus Aureus in the Antibiotic Era.” Nature reviews. Microbiology, 7.9, September 2009, pp. 629–641. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2871281/.
This source is a scientific review article on a particular strain of bacteria, Staphylococcus aureus, and its above-average tendency to acquire antibiotic resistance. Background on this species’ history in the antibiotic era is given before shifting to a discussion of the molecular biological side of things. They talk about the different alleles and proteins linked to S.aureus’ resistance capabilities and move on to talk about what still works and what will need to be done to preserve our ability to use antibiotics against bacteria in general. Since this source is a scientific review article with a relatively narrow focus in the broad scope of antibiotic resistance, it is incredibly technical and thus much of it is useless to me. However, their introduction, discussion, and conclusion sections contained valuable information and more than a few candidates for supportive quotes. This article was published in a scientific journal and is now available on NCBI. There is no reason to question the credibility of such a review article.
Fleming-Dutra, Katherine E., et al. “Prevalence of Inappropriate Antibiotic Prescriptions Among Ambulatory Care Visits, 2010-2011.” JAMA, American Medical Association, 3 May 2016, jamanetwork.com/journals/jama/fullarticle/2518263.
This source is basically a study designed to help determine the degree of inappropriate antibiotic prescription nationwide. In order to ensure that efforts at reducing irresponsible prescribing of the drugs is effective, those in charge must have an idea of how prevalent the phenomenon is. This group made their contribution by gathering data on ambulatory care and running statistical analysis on the cases that involved antibiotic prescription in order to find a rate of inappropriate prescriptions per 1000 population. This source provides useful statistics to quote in order to show the reader that inappropriate prescription is a big contributor to the overprescription of antibiotics and therefore the issue of resistance. Beyond useful numerical figures, this source is not particularly needed for my paper. Since the two primary investigators directing this study have an MD and an MD plus a Ph.D respectively, this source seems trustworthy. Further bolstering its credibility is the fact that it was published in the widely cited Journal of American Medical Association.
World Economic Forum. “Global Risks 2013 Eighth Edition.” WEF, 30 Oct 2012, http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2013.pdf.
This report is one in which nearly every major phenomenon posing considerable risk across the globe is assessed and evaluated. In section 2 of the report, they discuss antibiotic resistance as the central topic and connect it to other global risks that could increase the severity of a crisis involving either risk category. With respect to antibiotic resistance, the report looks at how and why antibiotic resistance is a problem in the first place before taking stock of what different nations around the globe are doing to minimize the problem. They also make some suggestions as to what can be further done to help curtail the problem. For the purposes of this proposal, much of the report can be ignored and focus placed on section 2. Since other sources and my own background knowledge were sufficient to detail the problem, this source is more useful for providing evidence of what other countries have done as guidance to enact better policies here in the U.S. This source is reliable due to its quality of production and nuanced content, as well as the World Economic Forum’s collaboration with organizations in academia and industry from several nations in producing this report.
Infectious Diseases Society of America. “Combating Antimicrobial Resistance: Policy Recommendations to Save Lives.” Clinical Infectious Diseases, Vol. 52, Issue suppl_5, May 2011, https://doi.org/10.1093/cid/cir154.
This source is essentially a detailed proposal on what the United States government needs to do in order to combat the threat of antibiotic resistance. It lists many smaller, tangible goals that add up to a seemingly comprehensive plan, and is specific in telling what each goal is, which government organizations will be involved, how much they would need to accomplish the desired goal, and if its already been or is being attempted, they have suggestions on how to strengthen those efforts. I learned much from this source, particularly that producing a detailed proposal truly aimed at solving the problem would take a great amount of manpower, time, and expertise that I don’t have. That said, summarizing their information proves quite useful for giving my audience a more specific sense of direction in implementing different kinds of solutions for antibiotic resistance. While the source provides much more than just information on the topics mentioned in this essay, drawing on it too much would see the paper become more of a summary. Coming from an academic journal, its impressive breadth and specificity of information in this article leaves no doubt about its reliability.
Kirchhelle, Claas. “Pharming Animals: a Global History of Antibiotics in Food Production (1935–2017).” Palgrave Communications, vol. 4, no. 96, 7 August 2018. Nature, http://www.nature.com.chaffey.idm.oclc.org/articles/s41599-018-0152-2#Abs1.
This article is a concise yet reasonably specific history of antibiotics with the major focus being on their role in the production of food. It begins by talking about the general impact that the advent of antibiotics had on the world and moves on to chronologically detail the history of their use and the way they’ve been treated in terms of policy across the globe. In the telling of this history, the author could not avoid some discussion of the dangers of excessive antibiotic use as well as approaches that can be implemented to reduce those dangers. The article has a dreary conclusion describing the “history of failure” regarding attempts to slow the threat of antibiotic resistance through animal agriculture, and claiming that current efforts will have limited success until such practices in that industry are seriously challenged. This source was useful for learning about the history of the problem and yielded a few potential quotes. Being published under the umbrella of Nature gives this source credibility, and so does the author’s association to the University of Oxford.
Strom, Stephanie. “Report on U.S. Meat Sounds Alarm on ‘Superbugs’.” The New York Times, 16 Apr. 2013, www.nytimes.com/2013/04/17/business/report-on-us-meat-sounds-alarm-on-superbugs.html.
This article takes an overall look at the issue of antibiotic resistance and its close relationship to animal agriculture. It reports on government data that showed a substantial increase in the number of antibiotic-resistant bacteria in several species. Presenting the issue fairly, the author presents the opinions of an expert who criticized the study as well as those experts who think the data reflects reality. The author goes on to consider that public health officials in the U.S and Europe have warned of antibiotics in meat being linked to resistance in humans, discusses what other noteworthy organizations have said, and routinely provides statistics supporting public officials’ concerns. This source was a good start to the antibiotic resistance issue in the context of animal agriculture. Many of the statistics are worth quoting, and are reliable because they came from public data. The New York Times may not be as nuanced and insightful as the above sources for a topic like antibiotic resistance, but its still a credible newspaper cited by many.