One of the great medical issues of our times, unlike what most people, including medical men, think, is not H1N1 or the set of loonies killing people in the Middle East, but antibiotic resistance.
Antibiotic resistance happens when bacteria mutate to become resistant to the drugs used to treat the infections they cause. This has been a problem for many years but the process is accelerating. Modern medicine is utterly dependent on antibiotics. Think what would happen if we did not have antibiotics to treat abscesses, ear infections, pneumonia, TB, urinary tract infections and other more serious bacterial infections.
Statistics show that the introduction of antibiotics in 1936 caused deaths in the US to fall by 220 per 100,000 within 15 years. All other medical technologies combined over the next 45 years reduced deaths by only 20 per 100,000 people.
The only comparable medical advance was the introduction of oral rehydration therapy for cholera and other diarrhoeal diseases in 1976, called by the British Medical Journal The Lancet as "potentially the most important medical advance of this century."
Two years ago England's chief medical officer stated that "the rise in antibiotic resistance is comparable to the threat of global warming." As usual most people shrugged their shoulders. We are accustomed to alarmist announcements from governments. The oil reserves gone in 10 years? Chu fat! There is no forex? Chu fat! Corruption? Steups!
However, this week we got some really, really bad news about antibiotics. Now antibiotics is not news in T&T. Every hard-back Trini knows about antibiotics. Even though antibiotics only destroy bacteria, we use them against everything from pregnancy to pachydermoperiostosis, mad blood to muscle spasm.
Antibiotic is what you use when "yuh toenail buss or you has a cole!" Flu is joke for Trini antibiotic! "Oneadem red and yellow capsule and you good to go." Everybody know about amoxil and everybody know some pharmacist who will sell you a couple capsules under the counter.
Don't even mention sulfa drugs, freely available OTC. Some will have heard about Augmentin, now "dat is antibiotic fadder! Kill anyting! Clean out you body and make you a new man."
Well, not really, eh? Precisely because of this lax attitude towards antibiotics in which we all, doctors, vets, pharmacists and other red-blooded Trinis partake, more and more bacteria have become resistant to antibiotics and this week the last antibiotic in the world that no bacteria had developed resistance to, became obsolete.
Colistin is the antibiotic that doctors use as a last resort to wipe out dangerous bacteria.
It's what is used in the Intensive Care Units of hospitals when everything else has failed.
Researchers in China have found that the E. coli bacteria not only has become resistant to colistin, but has developed a mechanism to transfer resistance to neighbouring bacteria which can then transfer that resistance to other types of bacteria which transfer it to another bacteria and on and on. The possibility now exists that some time in the near future, we may find that there are no antibiotics to treat, not only serious infections, but minor ones like cuts and abscesses and ear infections and red eye and gonorrhoea and so on. You know, the minor little things that give you a worry now and then.
At the same time it turns out that we are not the only people who just do not understand antibiotic resistance business. The English have just published a report that looked at what their people understand about antibiotics and how best to talk to them about the problem of resistance. Two things really stand out.
One, the interviewees don't know how antibiotics work. Most don't make a distinction between bacterial and viruses, let alone understand that antibiotics are useless for the latter. Instead, they gauge their need for antibiotics on the severity of their illness. If they feel really bad, if they aren't getting better, or if over-the-counter drugs aren't working, it's time for a prescription. A prescription reassures people, it's proof that their disease is treatable, doh mind it does not help. Ent?
Understanding antibiotic resistance is even worse. Almost everyone assumed that it's the person who becomes resistant to antibiotics, not the microbes. Well, it make sense, ent? If you take too much of something, your body could get used to it and build up a tolerance. Right? Wrong. This is a pretty serious misunderstanding. Some people might think that if they do not complete the course, once they start feeling better, they are less likely to become resistant. That increases the odds that a bacteria could become resistant to the antibiotic and pass on that resistance to another bacteria.
The problem is, the people who write and talk to the public, doctors, scientists, journalists and columnists are not doing a good job explaining this to the public.
So most Trinis don't think antibiotic resistance is relevant to us. They don't see their antibiotic-seeking behaviour as anything to be concerned about. Why should they change, someday the American scientists will find a solution.
It's time we talk clear. Everybody could understand. People, look what happening. 1) Bacteria getting stronger! 2) Antibiotics won't work anymore! 3) You could die! 4) We have three, four years before the E. coli reaches us here in T&T.
Will this approach work? Will people go against their nature?
Ho hum! Why this man gieing we dis news before Crismass, leh we drink ah rum oui! Rum does kill bacteria, ent?