Culture, biophobia, and the post-antibiotic era, or why you're going to be just fine without antibiotics.


bacteriaThe FUD* machine went into overdrive a couple of weeks ago, when the World Health Organization breathlessly released a report predicting the imminent apocalypse which will  be upon us as bacteria become increasingly resistant to drug therapies. “The problem is so serious that it threatens the achievements of modern medicine,” the organization said, adding that when standard treatments fail,  infectious disease deaths will skyrocket and the risk of contamination will create epidemics.

There's only one problem with WHO's conclusions. They ignore 10,000 years of human history during which, without the aid of modern medicine, the human race not only survived, but thrived. As a species, we achieved our precarious (and overrated) dominance on this planet long before what we today call medicine arrived on the scene.

The CDC itself notes that by far the largest gains in human health and longevity came about, not as a result of any medical interventions (including smallpox and polio vaccines, by the way), but as a result of improved nutrition and sanitation. That's right; the most powerful weapon mankind has ever had in its arsenal against bugs has not been drugs, but indoor plumbing.

Another major step forward occurred when medical doctors were finally willing to listen to fellow physician Ignaz Semmelweis and started washing their hands between patients. Interestingly, "Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands...Semmelweis's practice earned widespread acceptance only years after his death."

Today, this cycle of denial and rejection repeats itself. Unstated in all the dire warnings about the coming global bacterial apocalypse is the fact that it is modern medicine and agriculture that has made these bacteria possible. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and drug-resistant Clostridium difficile exist today only because of our overuse of antibiotics and the pollution of our food chain with antibiotic-laden meats. Also as a result of antibiotic therapy, we have drug-resistant candida, gonorrhea, and pneumonia.

Had MDs not been handing out drugs like candy to any kid with an ouchy ear and any adult with a sore throat, drug-resistant bacteria would not exist.

Had agribusiness not been allowed to abuse livestock to the point of deathly illness and then stuff their food with antibiotics to keep the suffering animals alive long enough to reach the slaughterhouse, drug resistant bacteria would not exist.

Not to belabor the obvious, but I think it's fair to say that more of the same thinking that created the problem will not fix the problem. New drugs will only briefly plug the holes in the dyke created by the old drugs, while making new holes themselves.

The solutions to problems such as this require a paradigm shift. As doctors, we need to look at things, not in isolation, but as part of an integrated ecosystem. Instead of looking at the bugs and what kills them, we need to look at the cultural and environmental factors that allow them to proliferate. At the same time, we should examine, not the infectious agent, but the agent that it infects.

This is the exact opposite of the mainstream medical approach, which still chooses to derive its wisdom from research which mechanistically isolates components from their overall systems.

It is beyond the confines of this blog to describe a detailed analysis, but even a cursory examination from a more cybernetic perspective will yield some insight.

First of all, it is the overuse of antibiotics in medicine that is one of the primary causes of drug-resistant organisms, even medicine itself has acknowledged that. However, in doing so, medical apologists have consistently blamed the patient, not the doctor, for this failure. Even today, in conversation with my mainstream peers, I continue to hear the excuse that "my patient demanded an antibiotic," or "I had to give them something."

While the problem is being presented as a demanding patient, the actual problem is the doctor's failure to have the appropriate tool to address the patient's rightful request.

In my office, such a demand would not be a problem, because instead of handing out a useless antibiotic as an expensive and dangerous placebo, I instead utilize substances and procedures which oppose the offending organism by enhancing the patient's existing defense mechanisms. For example, instead of killing a fever, I encourage its appropriate control. A fever is one of your body's ways of destroying invaders, by overheating them to death. Like an overgrown forest can be thinned by a controlled fire, a bounded fever can restore a natural internal ecology.

Another way I help patients manage infection is by administration of herbs that are known to cause the proliferation or increased activity of immune cells. And I can couple that with the nutrients which support immune function, and which are in extremely high demand during infection. When these nutrients become scarce, they limit the effectiveness of the immune system; introducing greater amounts allows the immune system to attain peak activity.

These approaches do not suffer from the same problem as antibiotics, because my approach to restoring health is patient-centered, not disease-centered. This is an important distinction to make.

From the public health perspective, we need to adjust the cultural factors which allow for bacterial proliferation. That means reformation of how we produce and distribute our food, and the best way to do that is to change our consumption and purchase patterns; and that, of course, means farmers markets, CSAs and neighborhood (or individual) gardens. When you buy meat from a farmer who raises and butchers his livestock humanely, you are immediately reducing the likelihood of spreading food-borne diseases.

But there is an underlying cultural premise that inhibits these systemic changes from occurring. That premise being that bacteria are bad.

The trouble being, of course, that they aren't. We live, work, thrive, play and die in a organismic soup. The bacterial biome surrounds us, engulfs us, and, indeed, integrates us. Without bacteria, we would die. We have bacteria living in our gut, which helps us to digest our food, and bacteria living in our respiratory tract which aid our immune system. With all due apologies to Sting, every breath we take and every move we make is watched over by a billion bacteria, each with their own function. Some are detrimental, some are beneficial, but each is absolutely necessary for our life to exist.

Yet we have been taught that bacteria are bad, evil killers. To avoid confronting this misunderstanding, we even use euphemisms for the good bacteria. Instead of saying to a patient, "Here, take these bacteria for your intestinal problems," I have to say, "Here, let's use these probiotics to fix your intestines." If I actually reminded people that I was giving them bacteria to ingest, they would run screaming from my office.

(As an interesting side note, I have begun treating patients with chronic sinus infections as well as acute upper respiratory infections by giving them ENT "probiotics" in the same way I administer gastrointestinal "probiotics." It is a novel approach which has both support both experimentally and from clinical experience.)

I have even heard complaints from patients in my office that we use bar soap, rather than "antibacterial" liquid soap. The problem with that complaint being that all soap is sufficiently antibacterial for all but surgical purposes, and the so-called "antibacterial" soap is actually bad for your health.

The only thing we really need to do to avoid the predicted bacterial epidemic is to shed our irrational fear of bacteria. Like most other public relations wars  -- the War on Cancer, the War on Drugs, the War on Terrorism -- the War on Bacteria is a failure. We cannot exterminate, eliminate, or even control life forms that are so ubiquitous and so necessary to our survival.

Instead of looking at the problem like warriors, let's look at it like farmers, or like good managers of a profitable, long-term business enterprise. We need to create the conditions, in both our internal and external environments which cause the good bacteria to flourish, and the bad bacteria to shrink.

This, in turn, means we need adequate supplies of clean water and nutritious food. We need an economic system which encourages physical and mental health as core components of productivity. We need a cultural environment which admires health and intelligence over sloth and anti-intellectualism.

This will not eliminate death and disease due to bacteria, but on the other hand, nothing will. The advantages of an environmental approach like I am suggesting is that it utterly eliminates the arms race between us and bad bacteria, replacing it with a heterogeneous complex system which is adaptive to our health needs and maintains a healthy competitive advantage between us and the bad guys.

Approaching the post-antibiotic world from this perspective turns the apocalyptic predictions on their head. While not a utopia, a bacterially-healthy world based on good water, good food, and flexible stability is a far cry from the death and destruction the purveyors of drugs would have you believe.



*Fear, Uncertainty, and Doubt -- the marketing technique famously used by IBM, and more recently, mainstream medicine, to maintain a monopoly in the face of competing ideas and products.