Adam Butzler Part V

A Miracle of Disastrous Proportions

It was once said, “(the) public will demand [the drug and] … then will begin an era … of abuses” (Ventola).  These were the words of Sir Alexander Fleming, the man who discovered the drug first known as the “miracle drug” by the medical field and public.  The drug was said to cure all diseases, or as though it seemed; the drug Sir Alexander Fleming was referring to is the antibiotic.  An antibiotic is directly defined as, “any of a large group of chemical substances, [such] as penicillin or streptomycin, produced by various microorganisms and fungi, having the capacity in dilute solutions to inhibit the growth of or to destroy bacteria and other microorganisms, used chiefly in the treatment of infectious diseases” (“Antibiotic”).  The antibiotic or “miracle drug” has never been known to cause problems but rather solve them.  No one, except Fleming, could have thought that the “miracle” would become the travesty.  The drug that was originally thought to destroy bacteria is actually making them stronger.  How is it making bacteria stronger you may ask?  Bacteria resistance is the contributing factor, but before learning about what bacteria resistance is you need to know more about the miracle that enhanced the resistance.  Bacteria resistance is a growing problem because it is a natural phenomenon that is only being enhanced by the human population, whether it’s through the farming industry or the improper use of the drug in the medical field.

Alexander Fleming, a British scientist in the 1920’s, first discovered the antibiotic now known as Penicillin.  Fleming was working at St. Mary’s Hospital in London in an experiment that involved growing bacteria.  During his study, he observed that colonies of Staphylococcus aureus bacteria had been worn down in one of his petrie dishes.  The mold that wore this bacteria down was found to be penicillin.  Fleming would continue to conduct experiments with this new penicillin mold and use in destroying infectious bacteria (“History”).  Further advances in penicillin would be made when Howard Florey and Ernst Chain isolated the “bacteria killing substance” (Trueman).   This would not be the end of the penicillin process though, “In 1941, a doctor, Charles Fletcher, at a hospital in Oxford had heard of their work. He had a patient who was near to death as a result of bacteria getting into a wound. Fletcher used some of Chain’s and Florey’s penicillin on the patient and the wound made a spectacular recovery. Unfortunately, Fletcher did not have enough penicillin to fully rid the patient’s body of bacteria and he died a few weeks later as the bacteria took a hold.”  Even though Fletcher’s patient would pass away, further advances would be made with penicillin and other found antibiotics to save lives.  The discovery of penicillin and later antibiotics would be known as a miracle because, “Before antibiotics, 90% of children with bacterial meningitis [a bacterial disease] died” (History).  Those who survived this disease saw long lasting effects through physical and mental disabilities.  Before antibiotics, strep throat was considered a fatal disease and ear infections would spread from to the brain and cause severe problems. Tuberculosis, pneumonia, whooping cough, and other diseases were also caused by aggressive bacteria that reproduced at high speeds and led to serious illness and in the worse cases death (“History”).  Many illnesses and diseases, such as Gangrene, that were considered incurable before antibiotics can now be easily prevented and cured.  As it seems with everything in life, there is bad in every good situation, and the antibiotic is not the exception to the rule.

As was stated above, “As early as 1945, Sir Alexander Fleming raised the alarm regarding antibiotic overuse when he warned that the “public will demand [the drug (the antibiotic) and] … then will begin an era … of abuses” (Ventola).  What Fleming was eluding to was the development of antibiotic resistance.  An article on antibiotic resistance states, “Antibiotic/Antimicrobial resistance is the ability of microbes to resist the effects of drugs…” (“About”).  Antibiotic resistance is referred to as a “natural phenomenon”, but it is also increased by the overuse of the antibiotic drug (“General”). “General Background: About Antibiotic Resistance“ stated, “Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are “resistant” and continue to multiply in the presence of therapeutic levels of an antibiotic.”  A deeper look at the occurrence of resistance in bacteria points you to mutation of genes or the evolution bacteria.  Just as humans have evolved or “mutated” to survive so have bacteria (“General”). “Mutations [are], rare spontaneous changes of the bacteria’s genetic material, [they] are thought to occur in about one in one million to one in ten million cells. Different genetic mutations yield different types of resistance. Some mutations enable the bacteria to produce potent chemicals [enzymes] that inactivate antibiotics, while other mutations eliminate the cell target that the antibiotic attacks” as stated by “General Background: About Antibiotic Resistance.”  These mutations in the bacteria genes are passed “vertically” and “horizontally.”  Vertical genetic transfer is the transfer of resistant genes through inheritance, similar to how humans transfer genes.  Horizontal genetic transfer is when bacteria exchange genes (“General”).  In simple terms, these mutations allow bacteria to create a tolerance or resistance to antibiotics causing antibiotics that were once effective to be ineffective.  Little to no one believes that antibiotic resistance is a “myth” or not of concern.  On the other hand, people believe that antibiotics are too vital to human and animal health to decrease the use of them.  The animal farming industry has found great use of antibiotics with, “Approx. 80% of antibiotics in US used for animal use in Agriculture” (Martin, Thottahil, and Newman 2409).

For more than 40 years, antibiotics approved by the FDA (Food and Drug Administration) have been used to treat, control, and prevent diseases in animals (“Benefits”).  The use of these antibiotics are for large animal processing farms with the intent of keeping bacteria from spreading rapidly throughout the animals (“Responsible”).  “USDA [United States Department ofAgriculture] research in 2002 found that cattle fed neomycin sulfate for 48 hours, held for the mandatory 24 hour pre-slaughter drug with drawl, and then shipped to market, shed significantly fewer E. coli O157:H7 than pen mates not given the antibiotic” as stated byThere’s No Defense Like A Good Offense.”  Neomycin sulfate is an antibiotic often given to cattle.  In this example, animals given this antibiotic were shown to kill more E. coli O157:H7, a bacteria, compared to those animals not given the antibiotic before slaughtering.  A main concern of farmers and the use of antibiotics lies in the overall well being of their livestock or their animal’s welfare.  Animal Welfare is defined as “how well an animal is coping with the conditions in which it lives.  Animals have good welfare if – based on a scientific evaluation – they are healthy, comfortable, well-nourished and safe” (“Benefits”).   Farmers are stating they don’t want their livestock to suffer before butchering, and they believe that the halt of antibiotics will lead to poor animal welfare and more disease (“Benefits”).  They state that banning antibiotics would be completely unnecessary and that animals with good welfare consume both less food and water.  This ultimately makes meat more affordable to the public and helps the economy (“Responsible”).

Antibiotic use in the farming industry is stated to positively effects the people who consume their meat.  “Growing evidence points to the possibility antibiotics aren’t simply safe and effective in keeping animals healthy— they may actually help keep consumers safe by preventing food-borne disease” as stated by “There’s No Defense Like A Good Offense.” Singer and his colleagues, who were professors in the Department of Veterinary and Biomedical Sciences at the College of Veterinary Medicine, University of Minnesota stated, “At least one study has shown that even a slight increase in animal-illness rate leads to a greater human-illness rate than the development of antibiotic resistance.”  Ph. D. Scott Russell agreed with Singer stating, “In fact, research has shown that as rates of animal illnesses increase, so do rates of human illness” (Russell).   “The Responsible Use of Animal Antibiotics” state, “Studies conclude there is a 1 in a billion chance of treatment failure from antibiotic resistance related to the use of common animal antibiotics. To put that into context, you are thousands of times more likely to die from a dog bite or lightning strike than from treatment failure related to the use of antibiotics in animals.”  “Dr. Tony Cox, PhD. found that for every one day a human was sick because of the use antibiotics in chicken contributed to their treatment being less effective, 4,000 people were healthy because of the use of antibiotics” as cited by “There’s No Defense Like A Good Offense.”  For the Agricultural Animal Processing Industry, the continued use of antibiotics has positives that outweigh the negatives, but some think otherwise.

Centers for Disease Control and Prevention found the estimated minimum number of illnesses and deaths nationally caused by antibiotic resistance per year was 2,049,442 illnesses and 23,000 deaths (“About”).  Another study found, “A 2011 national survey of infectious-disease specialists, conducted by the IDSA Emerging Infections Network, found that more than 60% of participants had seen a pan-resistant, untreatable bacterial infection within the prior year” (Ventola).  This means that 60% of people have seen an infection from a bacteria resistant to multiple antibiotics and untreatable.   Antibiotic resistance is seen by some as a “serious” problem, “the World Health Organization called antimicrobial resistance an increasingly serious threat to global public health that requires action across all government sectors and society” (Martin, Thottathil, and Newman 2409).  Medical writer Lee Ventola stated, “The Centers for Disease Control and Prevention (CDC) has classified a number of bacteria as presenting urgent, serious, and concerning threats, many of which are already responsible for placing a substantial clinical and financial burden on the U.S. health care system, patients, and their families.”  This quote clearly states the antibiotic resistance problem is of growing concern and it’s a growing burden to the US. health care system.  The main problem with antibiotic resistance is that it’s a “natural phenomenon” (“General”).  Almost all of the microbes: bacteria, viruses, fungi, and parasites, develop resistance naturally (“About”).  Centers for Disease Control and Prevention states, “Simply using antibiotics creates resistance” (“About”).  Though the simple use of antibiotics develops resistance, researchers have concluded that the largest source of resistance is the overuse and abuse of antibiotics (“General”).  A field that is seen to overuse antibiotics is the agricultural field.  Approx. 80% of antibiotics used in the US is for animal use in agriculture (Martin, Thottathil, and Newman 2409).  Ventola also stated,  “An estimated 80% of antibiotics sold in the U.S. are used in animals, primarily to promote growth and to prevent infection.” Evidence shows non therapeutic antibiotic use in animals leads to antibiotic resistance in humans (Martin, Thottathil, and Newman 2409).  These antibiotics used in animals are then found to transfer through direct contact with animals, manure, consumption of uncooked meet (Martin, Thottathil, and Newman 2409). Martin discourages eating food with the use of non therapeutic antibiotics to help slow the resistance (2410).  Ventola also stated, “Up to 90% of the antibiotics given to livestock are excreted in urine and stool, then widely dispersed through fertilizer, groundwater, and surface runoff.”  Antibiotic resistance is seen to occur through the overuse of antibiotics in the agricultural field.  Michael J. Martin with the Department of Epidemiology and Biostatistics, University of California, San Francisco states that, Denmark has seen positive results in antibiotic resistance numbers when they restricted antibiotics for growth promotion in animals.  They found that it had no adverse effects to animals or production levels (2409).

The next reason for resistance to antibiotics lies in the responsibility of doctors and patients.  Dr. Rachel Nugent, an economist working on global health, with a particular interest in non-communicable diseases, and her colleagues Back, and Beith stated, “Two- thirdsof antibiotics in the world are sold without prescription, and the pipeline for new antibiotics is nearly dry” (2).  The Center for Disease Control and Prevention found, “up to 50% of the time antibiotics are not optimally prescribed, often done so when not needed, incorrect dosing or duration” (“About”).  Intensive care units have also seen troubles with, “…30% to 60% of the antibiotics prescribed in intensive care units (ICUs) have been found to be unnecessary, inappropriate, or suboptimal.”  Ventola stated, “An analysis of the IMS Health Midas database, which estimates antibiotic consumption based on the volume of antibiotics sold in retail and hospital pharmacies, indicated that in 2010, 22.0 standard units (a unit equaling one dose, i.e., one pill, capsule, or ampoule) of antibiotics were prescribed per person in the U.S.”  These statistics show a rate of overuse of antibiotics in America.  He continued to state,“….Treatment indication, choice of agent, or duration of antibiotic therapy is incorrect in 30%-50% of cases” (Ventola).  He continues to go into specifics stating, “One U.S. study reported that a pathogen (a disease producing agent such as a virus or bacterium) was defined in only 7.6% of 17,435 patients hospitalized with community-acquired pneumonia (CAP)” (Ventola).  Doctors have been warned to avoid unnecessary prescribing and incomplete cycle treatment (Martin, Thottathil, and Newman 2409).  The misuse of these antibiotics has been seen in patients who are being treated at the hospital.  “The duration of hospital stays for patients with antibiotic-resistant infections was found to be prolonged by 6.4 to 12.7 days, collectively adding an extra eight million hospital days” as found by Ventola.  “According to the Infectious Diseases Society of America, longer, more expensive hospital stays for treating antibiotic resistance cost the US health care sector an estimated $21 to $34 billion and eight million additional hospital days annually.” as stated by General Background: About Antibiotic Resistance (2409).  Though resistance seems to be a growing problem, little is being done to fight the resistance.

There is very little research being done in the implementation of new antibiotics.  Ventola found, that 15 of the 18 largest pharmaceutical companies have abandoned the antibiotic field.  You may ask why large companies would be stepping away from antibiotics if the topic of resistance is such a growing concern.  The problem lies within the money, like most problems seem to.  Ventola states, “Office of Health Economics in London calculated that the net present value (NPV) of a new antibiotic is only about $50 million, compared to approximately $1 billion for a drug used to treat a neuromuscular disease. Because medicines for chronic conditions are more profitable, pharmaceutical companies prefer to invest in them.”  The low costs of antibiotics lead to the decrease in company’s wants for sales.  Due to a decrease in want for new research and antibiotic sales, the decrease in antibiotic resistance relies heavily on prevention.

Some of the keys to antibiotic prevention are simple, while others are not.  The simplest way to avoid resistance is to avoid bacterial infections in the first place through immunizations, safe food preparation, hand washing, and using antibiotics as directed and when prescribed (“About”).  Other strategies for antibiotic resistance prevention include government regulation of antibiotics, proper drug manufacturing in companies, and proper medication prescribing (Nugent, Back, and Beith).  Proper medication prescribing includes prescribing the right amount of drugs and the patient taking the full cycle of drugs (Nugent, Back, and Beith).  Even more strategies include, tracking data on antibiotic resistance to develop more strategies to prevent resistance, improving antibiotic prescribing and stewardship, and developing new drugs and diagnostic tests (“About”).  Denmark is one country that created laws to decrease antibiotic resistance.  They found that when they restricted antibiotic use for growth promotion in large meat processing farms, they saw positives in resistance rates and no adverse effects to animals or production levels (Martin, Thottahil, and Newman 2409).

The views of many others have been stated above with little bias included.  After doing extensive research, I found that I believe drug resistance is a huge problem that needs to be fixed.  Like the global warming issue, the antibiotic resistance issue is human caused and will become an increasing problem unless something is done.  I know that a main concern of farmers is the welfare of their animals, but what about the welfare of the human race?  Should we not care more about our own species first.  I myself come from a long line of farmers and know the importance of having healthy animals to produce product, but their has been success in antibiotic cutbacks.  Furthermore, countries have experimented with the decreased use of antibiotics in the agricultural field and has seen positive effects in antibiotic resistance and little to no effects to animals.  Even though cutting back on antibiotic use would have a huge effect on the antibiotic resistance problem, it isn’t the only change that needs to be made.  We need to have more in depth research in the development of new antibiotics, because antibiotic resistance is a natural phenomenon!  Large pharmaceutical companies need to put their want for large money aside for the well being of the human race.  The health of a person is much more important than the amount of money large corporations make.

In conclusion, almost no one can disagree with the facts that antibiotic resistance is a real problem that needs to be fixed.  The difference in views comes in how the problem should be handled.  Should the major focus be set on prevention with a minor focus in drug development or should the major focus be on drug development with a minor focus in prevention.  Either way you view it, there is still a problem that needs to be fixed.  Remember Sir Alexander Fleming said, “(the) public will demand [the drug (the antibiotic) and] … then will begin an era … of abuses,” will we continue the misuse of a miracle or will we make that miracle pure again (Ventola)?

Works Cited

“About Antimicrobial Resistance.” Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, 8 Sept. 2015, https://www.cdc.gov/drugresistance/about.html.

“Antibiotic.” Dictionary.com, http://www.dictionary.com/browse/antibiotic?s=t.

“Benefits of Antibiotics.” Animal Health Institute, http://www.ahi.org/issues-advocacy/animal-antibiotics/ benefits-of-antibiotics/.

“General Background: About Antibiotic Resistance.” Alliance for the Prudent Use of Antibiotics, http://emerald.tufts.edu/med/apua/about_issue/about_antibioticres.shtml.

“The History of Antibiotics.” Healthychildren.org, Immunizations & Infectious Diseases: An Informed Parent’s Guide, 21 Nov. 2015, https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/The-History-of-Antibiotics.aspx.

Martin, Thottathil, and Thomas Newman. “Antibiotics Overuse in Animal Agriculture: A Call to Action for Health Care Providers.” EBSCOhost, http://web.a.ebscohost.com/ehost/detail/detail?vid=6&sid=d013ad9e-fb7e-419c-b6f5-e740f00d4dbc%40sessionmgr4006&hid=4109&bdata=JkF1dGhUeXBlPWNvb2tpZSxpcCxjcGlkJmN1c3RpZD1zNjI2OTI0NyZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=110787216&db=aph. American Journal of Public Health, Vol. 105 No. 12, Dec. 2015, 2409-2410. http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=d013ad9e-fb7e-419c-b6f5-e740f00d4dbc%40sessionmgr4006&vid=7&hid=4109. American Journal of Public Health, Vol. 105 No. 12, Dec. 2015. 2409-2410.

“There’s No Defense Like A Good Offense.” For the Record, Vol. 7 Issue 3, AlPHARMA Inc., Animal Health, Aug. 2008, http://www.ahi.org/wp-content/uploads/2011/06/ForTheRecord-27_additional-sources.pdf.

Nugent, Back, and Alexandra Beith. “The Race Against Drug Resistance.” Center for Global Development, https://www.cgdev.org/files/1424207_file_CGD_DRWG_FINAL.pdf.

“The Responsible Use of Animal Antibiotics.” Animal Antibiotics, http://animalantibiotics.org.

Russell, Scott M. “Ban Antibiotics In Poultry?” WATT PoultryUSA, Mar. 2003. http://www.ahi.org/wp- content/uploads/2011/06/Poultry-USA-Russell-Article.pdf.

Singer, Cox, et al. “Modeling the Relationship Between Food Animal Health and Human Food-borne illness.” Preventive Veterinary Medicine, https://e.edim.co/7824023/jKRvWig2aZfN5qnR.pdf?response-content-disposition=filename%3D%22MLA8__1_.pdf%22%3B%20filename%2A%3DUTF-8%27%27MLA8%2520%25281%2529.pdf&Expires=1490296435&Signature=ud~gGOh0aapeBCMQat0M9A5OApod6THNXin3Omq4obcYfaRKm–kaSsm0bmzN12AjSYmsh2drNy65QksTRQWJyxmyYZvzYHMyr9Ifh7r7KxKt~uyIlCH4NnFdqQDegPqKgBjkNJosNlL4GqSBS4WVaZ7DUNbsmCUlVf-bX25kJir6rewAZHDRpBEcZgCoAMk5hlFafkxpPVUl~MU3c7mUIRZG0d5cNDAPCbSOO5vvmjDU1R-VkKJRn-rBj-m~sjlTdzMWRZHRUAT-FN7wUSx6qY~heDIIv7RqWUHe39vIjY1RG54ok-o3~MdeKzIci4tgAcL~YR~2Mm1DxKHWDAMlQ__&Key-Pair-Id=APKAJMSU6JYPN6FG5PBQ

Trueman, C. N. “Antibiotics.” The History Learning Site, http://www.historylearningsite.co.uk/a-history-of-medicine/antibiotics/.

Ventola, Lee C. “The Antibiotic Resistance Crisis.” US National Library of Medicine National Institute of Health, NCBI, 4 April 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/.

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