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roundtable: the evolving enemy Watch Show 4:
"The Evolutionary Arms Race"
on PBS
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bottle of prescription antibiotics
In the battle against infectious disease, humankind has inadvertently given rise to deadly enemies. Antibiotic resistance is a stunning example of evolution by natural selection. Bacteria with traits that allow them to survive the onslaught of drugs can thrive, re-ignite infections, and launch to new hosts on a cough. Evolution generates a medical arms race. The bad news is that bacteria -- with their fast doubling times and ability to swap genes like trading cards -- evolve quickly. The good news is that in the 150 years since Darwin, we have grown to understand the rules of the race. But can we win this war?
Tamar Barlam
  George Beran
  Stuar Levy
  Stephen Palumbi
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Tamar Barlam (a woman)Tamar Barlam is director of the Project on Antibiotic Resistance at the Center for Science in the Public Interest, in Washington, D.C. An M.D. board-certified in infectious disease, she has been involved in antibiotic policy and physician training in hospitals. She is on leave of absence from Harvard Medical School where she is an assistant professor of medicine.

As an infectious disease specialist, I have long been concerned about the misuse of antibiotics. Responsible uses of those precious drugs to minimize antibiotic-resistant infections -- by physicians, veterinarians, consumers, farmers, and livestock producers -- is crucial, but other steps must be taken.

Recently, an "action plan" was developed by the Centers for Disease Control and other agencies, but it has not been adequately funded. Even so, the plan might better be called an "inaction" plan, emphasizing education and research rather than stronger interventions, such as mandatory programs at hospitals to ensure judicious antibiotic use. Such programs can be highly successful, when overseen by an antibiotics expert.
Pharmaceutical companies play an indispensable role in developing new antibiotics, but they are also part of the problem. The companies have legions of salespeople that encourage doctors to use their antibiotics. Antibiotic prescribing should be based on what's best for the patient, and what the scientific literature tells us, not on a sales pitch. Similarly, doctors who receive funding from these companies should be carefully monitored regarding how they promote and prescribe their antibiotic products.
Antibiotics that are related to human use should be banned from use in food animals. Two years ago, the Center for Science in the Public Interest and other organizations petitioned the Food and Drug Administration to do just that, but the FDA has indicated that it likely will never ban most of the agricultural uses of the drugs.
A bill that would make it easier for the FDA to ban inappropriate uses of antibiotics on farms was introduced in Congress last year, but died a quiet death.
It is clear what steps must be taken, if the priority is health. The challenge is for health experts and the public to overcome the political power of the drug companies.
(Boldface added.)
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