Antibiotics are the invisible glue holding modern medicine together. Without them, doctors would be amputating infected limbs like it was the Civil War. Your kid's bout of strep throat could leave her in an iron lung. And most modern surgeries would be pretty much impossible.
Sadly, that's exactly the direction healthcare is heading in today. Thanks to the overuse of antibiotics, hospitals, pharmacies, and big farms are all basically breeding programs for super-resilient, drug-resistant bacteria that can survive the strongest weapons humanity has against infection. For this reason, the federal government has convened the superlatively self-descriptive Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria.
Chairing that mouthful of a task force is Dr. Martin Blaser, a physician and researcher at NYU's Langone Medical Center—and bulldog for antibiotic temperance. Last year, Blaser's book Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues showed that our society's overuse of antibiotics isn't just breeding superbugs. Antibiotics also wreak havoc on the beneficial microbiome that helps humans digest food, fight disease, and generally stay healthy.
Blaser's task force has its first meeting on September 29. It is open to the public, and open for public comment.
This interview has been edited for length and clarity.
WIRED: Let's start with the very basics: How do antibiotics turn normal bacteria into superbugs?
Blaser: Antibiotics are chemicals that are designed to suppress or kill bacteria. They are generally natural compounds found in other microbes, in soil, fungi, and other places. Take penicillin: It's a compound isolated from mold. In fact, most penicillin around the world comes from a single moldy cantaloupe in Peoria, Illinois in the 1940s. That strain of penicillium has been propagated many times and has been a very reliable source.
We use antibiotics clinically when somebody has an infection due to bacterium, such as an infected wound, skin sore, strep throat. Now, when there is a big population of organisms, there may be a few in there that are resistant to that antibiotic. When the antibiotic suppresses all the susceptible bacteria, the resistant ones can grow up because their neighbors are no longer living. It is exact extension of what Charles Darwin talked about: Survival of the fittest.
In your book you discuss how antibiotics aren’t just making superbugs, but are causing collateral damage to the body's microbiome. What's happening?
So let’s just say that you or your child has strep throat, and I’m a doctor and I prescribe penicillin. That penicillin will act against the strep, but it will also act against all the other, helpful bacteria that make up your body's microbiome. That’s what I mean by collateral damage. If you were after a terrorist, you could attack with a laser or nuke the village. Right now we’re nuking the village.
In my laboratory, we're doing research on the health effects of collateral damage, and we have evidence in mice that antibiotics are making the mice fatter.
How bad is this? How much do we know? What are the known unknowns? The unknown unknowns?
That’s one of the purposes of the panel: To gather data and get information about the whole realm of antibiotic resistance. We know some specific examples of organisms like MRSA have skyrocketed in recent years. Numbers of antibiotic-resistant Clostridium (which causes gastrointestinal disorders - ed.) have also gone up dramatically. But in terms of general understanding, we don't know how big of a problem we have.
Specifically, what's the task force going to do to reduce antibiotic resistance?
It's a little premature to say, as we've just been appointed. On September 29 we'll have our first meeting, and it's open to the public. We have a broad charge to look at the extent of the problem.
We'll be asking questions like: How do we curtail antibiotic use? Can we come up with alternatives to antibiotics? Can we have narrow spectrum antibiotics that only target harmful bacteria? Can we develop new diagnostics to show viral versus antibacterial infections? For example, when kids come in with ear infections, 80 percent of these are due to viruses. But 70 percent of those kids walk out with antibiotics. Antibiotics don’t work against viruses. Another charge is to educate the public about the different risks, and also to educate other international agencies.
I’m looking at a big bottle of hand sanitizer, wondering whether I'll be contributing to antibiotic resistance if I use it.
I also talk about that in the book. There are circumstances where hand cleanliness is tremendously important. During flu season we know that hand sanitizer is important. But most of the time, people are not using it in appropriate situations. One question we want to discuss in the council is how to educate people on how to know when personal antiseptics are doing more good or more harm.
Antibiotic overuse doesn’t just come from hospitals. Overuse in livestock is a big driver of antibiotic resistance. How will the task force address ag?
I’m pleased because there’s a very broad representation on the task force. The vice chair was dean of the veterinary school of Ohio State. There are members representing agriculture groups, pharmaceutical representatives, nurses' groups, government agencies. Like many councils we will probably have a number of subcommittees.
You run a research lab and practice clinical medicine. How is chairing this task force going to impact your time?
I mean, it’s already taking time, but as I said to some of my friends, this is what I want to do when I grow up. I’m very concerned about the consequences of antibiotic resistance. We’ve been thinking as a society that antibiotics are basically free, that we can take them wherever we want. I think that we’ve been living in a kind of bubble for the past 70 years. I include myself. Like most physicians, I didn’t consider that there might be other costs to prescribing antibiotics.
Is there a danger of going too far in rolling back our use of antibiotics?
There’s always a danger of going too far with anything. That’s why we have health professionals, so they can make professional judgements on what’s needed. As a society we definitely need to roll back. In Sweden, they only use 40 percent of the antibiotics we use, and the Swedes seem at least as healthy as we are.