Sally Speaks

Professor Dame Sally Davies – Britain’s Chief Medical Officer – was a busy lady yesterday, speaking to the Commons Science and Technology Committee on a range of health related issues, two of which will come as no surprise to readers of this blog.

First off, as I reminded you guys late last year, we’re all going to die horribly because pretty soon we’re not going to have any useful antibiotics available to us. By “useful”, I mean ones that work.

Prof Davies even went as far as to suggest that:

“…the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s national risk register of civil emergencies.”

She described what she called an “apocalyptic scenario” where people going for simple operations in 20 years’ time die of routine infections “because we have run out of antibiotics”.

I would (and do) agree, but I take exception with her use of the term “apocalyptic”. Recent failed apocalypses (Harold Camping, The Mayans) have meant that the word lacks any sort of gravitas amongst the general public any more. They simply don’t take it seriously. And this is serious, although there’s actually very little that the general public can do about it. Except die. Horribly.

On a lighter, far more comedic note, the meeting of the Science and Technology Committee also included a brief discussion on Homeopathy. This is about as appropriate a conversation about tree-felling methods at a meeting of the Monetary Policy Committee or a chat about the fungal diseases of goldfish at a meeting of the Institute of Motor Mechanics Committee, but fortuitously, Dame Sally dealt with the subject with the ridicule it so richly deserves.

Professor Dame Sally Davies said she was “perpetually surprised” homeopathy was provided on the NHS, and branded homeopaths “peddlers””

She also expressed fears about the prescription of homeopathic remedies to treat malaria and other illnesses:
“I’m very concerned when homeopathic practitioners try to peddle this way of life to prevent malaria or other infectious disease,” she said. “I am perpetually surprised that homeopathy is available on the NHS.”

Dame Sally, who is England’s most senior doctor, concluded by remarking that homeopathy “is rubbish”.

Now all that we need is a Secretary of State for Health that chooses to listen to scientific and er… medical advice. Not like the incumbent Jeremy Hunt, who is an idiot.

We’re all buggered – when news is not news

According to Sky News today yesterday (note subtle hint that this might be a post-dated blogpost):

The Chief Medical Officer has raised the prospect of a future without cures for common infections – unless antibiotics are used more responsibly.

You don’t say, Professor Dame Sally Davies?

This isn’t news.

Over ten years ago, while in Oxford, I attended a seminar by Dr David Livermore, then Director of HPA’s Antibiotic Resistance Monitoring and Reference Laboratory in the UK. He basically told the gathered microbiologists (I have no idea what the correct collective noun is here – “a culture”?) that we were all buggered, because we were heading back to a pre-antibiotic era due to the prevalence of antibiotic resistance.

The effect of his stark warning on an educated, usually sceptical audience was interesting. Every single person agreed. Because we were already seeing more and more resistant bacteria in our laboratories every single day and we were having to resort to more and more outlandish, expensive and (in some cases) relatively untested antibiotic treatment regimens to cure patients of their infections.

But the time will come (soon), when we run out of antibiotics and we’ll be at the mercy of what are – at the moment at least – minor infections. Advanced surgery like transplantation, will become impossible – immunosuppressed patients will simply not survive the inevitable infections without prophylactic (preventative) antibiotic treatment. Even “basic” surgery will be impossible for the same reasons. Anything around the abdomen – appendicitis, for example – will effectively mean game over.
But it’s not just this “running out of options” that is the issue:

When somebody has a severe infection – say blood poisoning – causing a high fever, a hospital clinician will dispatch blood samples to the lab to find out exactly what he is dealing with. But that takes time. “He will start you on antibiotics because that will kill infection within 48 hours,” says Livermore. “So during 48 hours, you are being treated blind. The more resistant your bacteria are, the less likely the antibiotic is going to work.”

It’s an unpleasant thought, so why aren’t we more concerned?

Well, because this is an insidious problem. There’s hasn’t been and there’s not going to be one specific, defining moment in this horror story. No 9/11, no Marikana, no December 21, 2012. It’s just slowly happening and sadly, we’re pretty powerless to stop it. Here in South Africa, we have already had problems with first MDR, then XDR tuberculosis. If you think that it’s all ok, because things are going to end there, then maybe you shouldn’t google “TDR-TB”.

Professor Dame Sally Davies blames over-prescription of antibiotics for the rise is resistance, but the evidence for this is far from conclusive.
Livermore again:

Governments worldwide are pressing for reduced antibiotic use, hoping thereby to reverse resistance trends. Is success likely? The evidence is mixed, and expectations should be tempered by the growing realization that many resistant bacteria are biologically fit, making them difficult to displace.

Yes, he’s basically suggesting that the bacteria are actually too strong for us to defeat. We are being outwitted – out evolved – by microbes. It’s kind of difficult to stomach, but:

“The emergence of antibiotic resistance is the most eloquent example of Darwin’s principle of evolution that there ever was,” says Livermore. “It is a war of attrition. It is naive to think we can win.”

So there you have it. Happy thoughts for the weekend. I just thought that I really should tell you today, because with the country and the world so very full of good news right now, you probably needed a reality check.

None of it matters. We’re all buggered.