Frontline’s Hunting the Nightmare Bacteria Is a Wake Up Call regarding the End of the Antibiotic Era — and a Related Comment on Capitalism’s Inability to Do What Is Needs to Be Done in the Development of Antibiotics

© 2013 Peter Free

 

23 October 2013

 

 

Citation

 

Frontline, Hunting the Nightmare Bacteria, PBS (22 October 2013)

  

Antibiotic resistance is a big deal

 

The story-telling power of this documentary will give viewers a “do something” perspective on the global drug-resistant bacteria problem.  This is a rapidly evolving phenomenon that is inevitably and eventually going to nastily kill some of the healthy among you — or someone you know.

 

The development of universally antibiotic-resistant bacteria is arguably the single most universally applicable public health crisis that I have witnessed in my life time.

 

And it is the only one that has received virtually no meaningful attention from people in positions to do something about it.

 

For general background regarding antibiotic resistance, see here.

 

 

The biological mechanisms — that make this public health problem so difficult to cope with

 

I suspect that most people wrongly think that (a) antibiotic resistance only develops in bacteria that are directly exposed to antimicrobial drugs, (b) resistance remains confined to the bacterial species and individuals under pharmaceutical attack, and (c) people are unlikely to catch resistant infections outside hospital settings.

 

None of this is so.

 

Organisms of varying types have been proven to be able to transfer antibiotic resistance genes from a resistant one to a non-resistant other.  This mischief does not even require bacterial form to pull it off.

 

Once bacterial antibiotic resistance starts (or enters) into the general environment, it is impossible to control.  Some organisms inevitably donate their resistance mechanisms to members of even unrelated species —  metaphorically behind our backs and all around us.

 

For the skeptical, there are reports of finding antibiotic resistant bacteria living freely in environmental waters.  See, for example:

 

Suzanne Young, Andrew Juhl, and Gregory D. O’Mullan, Antibiotic-resistant bacteria in the Hudson River Estuary linked to wet weather sewage contamination, Journal of Water and Health 11(2): 297–310, DOI:10.2166/wh.2013.131 (2013)

 

Rachel E. Rosenberg Goldstein, Shirley A. Micallef,  Shawn G. Gibbs,  Johnnie A. Davis, Xin He, Ashish George, Lara M. Kleinfelter, Nicole A. Schreiber, Sampa Mukherjee, Amir Sapkota, Sam W. Joseph, and Amy R. Sapkota, Methicillin-Resistant Staphylococcus aureus (MRSA) Detected at Four U.S. Wastewater Treatment Plants, Environmental Health Perspectives 120(11): 1551–1558, http://dx.doi.org/10.1289/ehp.1205436 (early online publication, 06 September 2012)

 

Timothy M. LaPara, Tucker R. Burch, Patrick J. McNamara, David T. Tan, Mi Yan, and Jessica J. Eichmiller, Tertiary-Treated Municipal Wastewater is a Significant Point Source of Antibiotic Resistance Genes into Duluth-Superior Harbor, Environmental Science & Technology 45(22): 9543–9549 (15 November 2011)

 

Timothy R. Walsh, Janice Weeks, David M. Livermore, and Mark A. Toleman, Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study, Lancet Infectious Diseases 11(5): 355-362 (May 2011)

 

 

The Frontline documentary begins with two instances of environmentally acquired multidrug resistant infections — and goes on to show that . . .

 

 

These organisms cannot be exterminated, even from within the essentially closed confines of one of the world’s most advanced hospitals.

 

Frontline’s story begins with two young people, as representative examples of the ever present potential deadliness of the world’s antibiotic resistance problem.

 

The account also discusses consternation at the National Institutes of Health, when the elite staff could not track, much less eliminate, deadly antibiotic-resistant “KPC-K” bacteria from their hospital.

 

Note — what’s in a name

 

KPC-K stands for Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae.

 

This strain of resistant Klebsiella penumoniae is named after the enzyme that its resistance gene produces.  The enzyme, carbapenemase, inactivates carbapenem (beta-lactam) antibiotics that usually kill its non-resistant kin.

 

For brevity, most people drop the “carbapenemase-producing” reference and simplify the name to “carbapenem-resistant” Klebsiella pneumoniae.

 

 

For the technically minded — a scientific paper regarding the KPC-K outbreak at NIH

 

Frontline does an excellent job of capturing the concern at NIH, when this deadly outbreak happened.  However, for the medically minded, a more scientifically detailed account is found in:

 

 

Evan S. Snitkin, Adrian M. Zelazny, Pamela J. Thomas, Frida Stock, NISC Comparative Sequencing Program, David K. Henderson, Tara N. Palmore, and Julia A. Segre, Tracking a Hospital Outbreak of Carbapenem-Resistant Klebsiella pneumoniae with Whole-Genome Sequencing, Science Translational Medicine 4(148): 148ra116, DOI:10.1126/scitranslmed.3004129 (22 August 2013)

 

 

And a socio-political conundrum — capitalism does not work to provide public health solutions in unprofitable instances like these

 

Frontline goes where most superficial accounts of antibiotic resistance do not — namely to the fact that capitalism is not set up to produce unprofitable pharmaceuticals like antibiotics.

 

A Frontline interview at Pfizer, historically a leader in antibiotics development, indicates that the company is leaving that field of economic endeavor.

 

The reason?

 

Because it easily cost $1 billion USD to come up with a potentially effective antimicrobial, the corporation cannot justify the expenditure to shareholders.  Antibiotics are, by nature, short term drugs.  Unlike blood pressure and cholesterol medications (for example), individual patients do not use antibiotics over the long term.

 

Consequently, there is no money to be made.  Ergo, no more antibiotic research from Pfizer and, increasingly, anyone else.

 

 

Our too frequently blind federal government is not helping

 

Frontline astutely points out that:

 

 

(a) not only do the Feds not track the incidence of antibiotic-resistant illness (unlike other nations),

 

(b) they act as if multidrug resistance, and the lack of antibiotic innovation, do not comprise huge American public health problems.

 

According to the documentary, the National Institutes of Health have financially prioritized antibiotic research in 70th place.  That is quantitatively and qualitatively absurd, given the scope of the problem.

 

So, how did this “ignore it and it will go away” prioritization happen?

 

 

For the same reason that Pfizer dumped their research.  There is no money to be made and no affected interest groups to push for it.

 

As I have (repeatedly) pointed out in other articles, medicine is increasingly about money.  More and more researchers are directly connected with profit-making enterprises.  It does not matter whether they are employed in the private, public, or university sectors.

 

Everyone is interested in getting in on the next rich-making thing.

 

So, when Pfizer, with all its experience, says “no” to a line of research — why would an ambitious science team anywhere else bother to waste its time on something that everyone around them sees as a risky and profitless loser?

 

 

The jumbo problem? — Going against the American cultural grain

 

We like to think that free markets solve all problems.  Clearly, that’s nonsense and anyone with half a brain and a knowledge of history and political science would know it.

 

But, for some reason, the free market untruth prevails in the United States.  When anyone questions its applicability to the thorny subset of “no money to be made” social problems, Americans react as if their pleasure-making reproductive organs are going to be sliced off.

 

The case of antibiotics research and development is a perfect example of the occasional social inutility of capitalistic thinking.  People need these drugs — unless you subscribe to the idea that healthy folks, who get sick, should be taking their iffy survival chances — along with all the other beetles in the Darwinian stream.

 

Government has to get involved in the development of antibiotics, even if only indirectly to incentivize research and development.

 

But, as yet, not a noticeable peep from anyone in political power.  We have no national antimicrobial development plan.  Nor do we have anyone prominently in the public eye hinting that maybe we need one.

 

Instead, we have narcissistic pseudo-imbeciles like Senator Ted Cruz taking steps to shut government down.  And a stomping herd of uniformly Republican enablers to help him.

 

One of the philosophical ironies of American politics is the near certainty that a successful plutocrat — like former Governor and 2012 Republican presidential candidate Mitt Romney — might have had the mind and expertise necessary to accomplish implementing a workable plan to Make America Safe from Antibiotic-Resistant Bacteria.

 

Yet, it was the same group of Cruz-lauding Republican pseudo-imbeciles, who guaranteed that Governor Romney would have to drift so far toward the extreme, as to make himself unelectable in nationwide America.

 

As for the Democratic Obama Administration — that crew cannot even get the information technology necessary to implement ObamaCare enrollment off the ground.

 

I doubt that this Administration is capable of looking beyond the fiascos of the last minute, much less into the necessary future.

 

Consequently, in their political murders of the Republican Party’s few respect-worthy candidates, the Party’s “crack-head faction” is literally killing the rest of us.

 

 

The moral? — Watch Frontline’s Hunting the Nightmare Bacteria

 

Then try to persuade me, we’re fine as we are.