Global antibiotic overuse is like a ‘slow motion train wreck’

Global antibiotic overuse is like a ‘slow motion train wreck’


JUDY WOODRUFF: Now: the enormous benefits
and significant perils of the recent upsurge in the availability of antibiotics around
the world. Lisa Desjardins talks to science correspondent
Miles O’Brien about the latest research. It’s part of our weekly science series, the
Leading Edge. LISA DESJARDINS: Antibiotic resistance contributes
to the death of 700,000 people around the world each year. Experts have predicted it will eclipse the
number of people affected by cancer by 2050. One of the biggest causes is the overuse of
antibiotics. On Monday, a group led by researchers from
the Center for Disease Dynamics, Economics and Policies released a new study looking
at the global consumption of antibiotics. They found the use of antibiotics worldwide
has increased 65 percent from 2000 to 2015. Miles O’Brien is here to help us understand
this latest study. Miles, first of all, just remind us, how does
the overuse of antibiotics lead to these resistant diseases, sometimes called superbugs? MILES O’BRIEN: Hello, Lisa. Yes, what happens is, antibiotics kill bacteria
that make us sick. That’s the simple explanation. But the bacteria over time evolve and develop
an ability to survive the onslaught of the antibiotics. They, in essence, get smart. So, over time, bacteria survive that have
resistance built in to the antibiotic themselves. Alexander Fleming, who invented penicillin,
discovered penicillin, just before World War II, warned against its over use precisely
because of this. Here’s a few more words about how antibiotic
resistance works from Dr. Helen Boucher of the Tufts University Medical Center. DR. HELEN BOUCHER, Tufts University Medical Center:
Resistance happens naturally. So, bacteria have various mechanisms to survive. And so if they’re presented with an environment
that is not so good, that is, there’s an antibiotic trying to break through their cell wall, they
might build a stronger cell wall, or they might — if there’s an antibiotic coming in,
they might pump it out. So they figure out ways to evade the effect
of the antibiotic. MILES O’BRIEN: So this study should give us
quite a bit of pause, because it means, with more antibiotics in use, there are more bugs
out there that develop the resistance, so-called superbugs. And now we have a much better global picture
of the scope of the problem. LISA DESJARDINS: That seems to be what’s new
here, is just the scope of this study, 76 countries’ worth of data over 15 years. And where did they see the biggest increases
in antibiotic use? Obviously, globally, but where specifically? MILES O’BRIEN: So, Lisa, they found the biggest
contributor to this problem is in low- to mid-income countries. Back in 2000, the usage of antibiotics in
the lower- to mid-income countries vs. high-income countries was about equal. In 2015, the usage in those low- to mid-income
countries doubled. So, that’s a significant thing. That’s good news for these countries. It means that GDP has improved, income is
greater. They have access to these drugs. All these things are good. But the consequences of their overuse are
just magnified. Here is Eili Klein, who is the lead author
of the study. EILI KLEIN, Center for Disease Dynamics, Economics
and Policy: Unlike, in high-income countries, where, when you go to the — the primary barrier
to getting antibiotics is, you have to go to the doctor to see — to get a prescription. In many low- and middle-income countries,
the barrier is the ability to afford the drugs. And so increased economic activity allows
for increased ability to purchase all sorts of things, all types of goods, including antibiotics. MILES O’BRIEN: OK, so the good news is that,
in the higher-income countries, the increase in antibiotics use is only about 6 percent. So the knowledge of this problem and the efforts
to guard against it may be having some effect. But this is a real conundrum for people in
medicine, Lisa, because doctors, on an individual basis, they want to make us well, and they
probably have about five minutes to diagnose us anyway. And so, in the individual case, it might make
more sense to give that Z-Pak to that patient. But they also need to be thinking about society
at large, and that’s not an easy thing to weigh when you are looking at a patient who
is sick and could use those antibiotics to feel better. LISA DESJARDINS: And I think that’s my biggest
question here. The study really gives me and I think many
of our viewers a lot of pause, but the incentives, as you say, all go the other way, toward prescribing
antibiotics right now. Does this study have any recommendations for
how to lower our use of antibiotics appropriately? MILES O’BRIEN: You know, it’s interesting. The recommendations were a little bit surprising
to me. One of them was, we should be more focused
on getting people vaccinated. Well, on the face of it, well, wait a minute,
vaccines are for viruses, not bacteria, which is what we’re talking about here. But what happens is, people get sick from
viruses. Doctors mistakenly give those people antibiotics,
which do nothing for viruses, and that just furthers the problem. Another thing that was discussed in the paper
is the idea that, as these emerging nations grow, as cities become more populated, the
issue of clean water and sanitation, the sources of many diarrheal diseases, need to be focused
on a lot more, because that is ultimately why people seek out antibiotics in many cases. Here’s more from Eili Klein: EILI KLEIN: If you look at the history of
the high-income countries in the 20th century, the primary driver that reduced infectious
diseases was improvement in infrastructure, reducing — eliminating bacteria and other
diseases from the water. And so investments in infrastructure, investments
in vaccines that can prevent diseases can be a really beneficial — can be really beneficial
to low- and middle-income countries, in terms of preventing disease and then reducing the
need for antibiotics. LISA DESJARDINS: There, Eili Klein laid out
the hope, the prescription. But if society doesn’t actually deal with
this problem, what happens in the future if we do not lower our antibiotic consumption? MILES O’BRIEN: Well, this is something we
all really need to pay attention to, Lisa. The projections are, by 2030, our use of antibiotics,
if nothing changes, will be triple what it is today. And what that means is, there are going to
be many more antibiotics which become really just basically useless, more so-called superbugs
out there. And we are facing the prospect of a post-antibiotic
world. We take for granted these miracle drugs, which
really since World War II have just dramatically changed medicine in ways that it would take
too long to enumerate right now. But we could get back to a world, Lisa, if
nothing is done, where something as simple as a cut or a blister could kill you, which
is what the world was like before we had antibiotics. So it’s time — this is like a slow-motion
train wreck. Researchers have been warning us all about
it. And it kind of reminds me a little bit of
climate change. But it’s time to get a handle on this, because,
right now, more than a half-million a year people globally are dying for lack of antibiotics. LISA DESJARDINS: Something for each of us
to think very carefully about. Miles O’Brien, thank you for bringing us this
story. MILES O’BRIEN: You’re welcome, Lisa.

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