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?
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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.
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.
