Tuesday, July 8, 2014

Are the media right and are we all going to die from antibiotic resistance?

A brief post - I've long been unhappy with the media's reporting on science. It appears that news sites aren't there to disseminate truth and educate the populace, but to sell advertisement and clicks. Took me long enough to find that out.

So we get lots of news on how we are all going to die because all antibiotics have failed. We even see repeated claims that nobody is working on new antibiotics, that the pipeline for new discoveries is empty, and nothing is on the horizon. I saw so much of this that I actually started to believe it too.

Remember MRSA and how it would kill us all? Oddly enough it didn't, and while it is a nasty bug, there are now protocols to get a handle on it. You probably missed the article telling you so because "we're all going to die" gets a lot more clicks than "with careful work, MRSA outbreaks can be controlled".

"We're all going to die" is a potent way to draw in an audience. Simultaneously, scientists are happy to big it up, since it is a real problem, and it deserves more attention than it gets. Don't get me wrong on that! The world of medicine spends way way more on cholesterol lowering (to dubious effect) than on antibiotics (which actually save lives). And a dead patient needs no cholesterol lowering, so they should get on it pronto.

So, where are we? Bacteria can be divided (roughly) into "gram positive" and "gram negative". On the gram positive front, a whole new class of antibiotics has now been trialed for a few years, and they are called lipoglycopeptides. The two most recently tested (dalbavancin and oritavancin) show excellent effectiveness against MRSA. Interestingly, these new antibiotics require a single dose which does its work for the next weeks, so you can't even forget to take the pills. The great Richard Lehmann discusses these over at the BMJ (and here, even more here).

Gram negative bacteria are different, and have an outer membrane that protects them against many antibiotics in the first place, and the situation there is less hopeful, and currently far more worrying than MRSA. The main worry now are carbapenem-resistant Enterobacteriaceae (CRE), equipped with the scarily named New Delhi metallo-beta-lactamase (NDM-1) enzyme. These are the superbugs that hit the news a lot.

What did not hit the news was a result published last week where a whole swath of NDM-1 carrying bacteria was effectively treated (in mice) with regular antibiotics plus a known compound previously considered as a hypertension drug (which sadly failed to lower blood pressure). An infection that with best current treatment killed 100% of test animals now only killed 5%. Of mainstream media, only the Wall Street Journal reported on it. "It it bleeds, it leads" - and modest but important progress does not, it appears.

Now, are we all saved? No, not yet. In the end it is a battle of bacterial genes against our whits, but our arsenal of methods these days is astounding. There is every reason to be sure we'll keep on winning this battle. The next stage will be winning it cheaply and durably.

But my main point is - whenever you see the news reporting "there are no new antibiotics" and that nobody is working on it, think back to this page. Not only are those claims false, a whole new class of antibiotics are now coming out of the lab (53 at last count) and we're also finding ways of revitalizing our existing arsenal.

Meanwhile "we're all going to die" gets a lot more clicks than "we're working on it and making tangible progress"...