A Superbug Nightmare: The Global Threat of Antimicrobial Resistance
A recent blog from the RAND corporation entitled “Who killed Mrs. X” cites Sir Alexander Fleming’s warning about the dangers of penicillin resistance when antibiotics are misused and discusses the global threat of antimicrobial resistance. The post warns that it may soon be too dangerous to undergo even routine surgical procedures because of an increased risk of contracting an infection from multiple drug-resistant organisms, for which we do not have a cure.
This is, of course, a critical situation. However, the plan of action outlined by the RAND authors to confront these issues— including: improving personal hygiene, behavior and awareness, incentivizing innovation to develop new drugs, and establishing an international agreement analogous to the WHO Framework Convention on Tobacco Control—appears to blame the victim, shows a bias towards benefiting the pharmaceutical industry, and needs to be stronger, given the extent of the threat to global public health. Below, I discuss some limitations of these proposed solutions, while offering suggestions to address the complexities inherent in solving public health problems.
1) Improve personal hygiene, behavior and awareness…
Plumbing, safe water and waste disposal, collectively known as the sanitation revolution, have had the greatest impact in human health history, ahead of antibiotics, anesthesia and vaccines. Yet, regrettably, by 2013, 783 million people still do not have access to clean water and almost 2.5 billion do not have access to adequate sanitation. On the other end of the spectrum, lies the frenzy towards living in a “microbe free” environment, which has led to a market-driven abuse of antibacterial soaps and cleaning supplies, which, while preventing some infections, are further contributing to the problem of bacterial resistance.
All of us live in an environment full of microorganisms; however, the overwhelming majority of microorganisms in our skin, mucous membranes, and digestive system are helpful to keep the “bad” bacteria from taking over, and thus maintaining equilibrium in our bodies. For this reason, the one tried and true solution for the prevention of infections is simply frequent hand washing in all settings, from restaurants to day cares, hospitals, or at home.
The bigger issue here, however, is the hurried and imprudent use of antimicrobials by health care professionals and patients alike. No doctor or other healthcare provider should prescribe medications to his or her patient on the basis of misguided patient pressure. Rather doctors and providers must educate the patient, and assert his or her position as a professional. So while it is important to acknowledge that there is a complex set of issues which influence physician behavior, like the uncertainty of the nature of the infection, time-constraints, and the litigious nature of current medical practice, health care professionals must focus more on patient education regarding the appropriate use of medication and the dangers of misuse.
Dr. Chiriboga obtained his postgraduate training in Preventive Medicine at the University of Massachusetts Medical School and School of Public Health. He designed and implemented a comprehensive healthcare system for the indigenous people in central Ecuador 1988-2001. He served as Minister of Health in Ecuador (2010-11) where he undertook a major re-structure of the healthcare system of the country. He also served as President of the Health Council for the Union of South American Nations (UNASUR) 2010, bringing key draft resolutions regarding generic medicines and research and development of medicines for neglected diseases, and a proposal for the need to re-structure the World Health Organization, which were approved by the World Health Assembly. Dr. Chiriboga was the keynote speaker for the European Union Conference in Global Health held in Brussels in 2010. His interests include global health equity, the development of affordable universal health care systems, as well as multisectorial prevention strategies.