Antimicrobial Resistance

What causes antimicrobial resistance?

Resistance is related to total antibiotic pressure upon available bacteria.

What contributes to total antibiotic pressure?

1.  Antibiotics used in farming and agriculture.

2.  Waste antibiotics released into rivers by Big Pharma.  

3.  Total antibiotics being prescribed by healthcare providers.

4.  Antibiotics that are being sold legally or illegally on the open market without prescription.

In summary, the greater the antibiotic pressure, the greater chance of resistance.

How do resistant bacteria form and propagate?

They mutate.

Once they mutate they can either reproduce or spread the mutated genetic material through plasmid exchange.

A plasmid is a small DNA molecule within a cell that is separated from chromosomal DNA and can replicate independently.

The bacteria come together and form a joining point like a handshake. Then the genetic information is exchanged.

How important is sanitation to Antibiotic Resistance?

There is a doctor from Australia named Peter Calignon, Ph. D. from the Australian National University Medical School.

He and his colleagues feel that contagion is an important factor in spreading antimicrobial resistance.

I agree.

He feels that poor sanitation and overcrowding plays a real and vital role in the spread of resistance.

If we examine where much of the antimicrobial resistance comes from – India, China and others – we can see that he may have a point.

These countries do not have the best sanitation services available for all their people.

It makes sense that if you have more available bacteria for antibiotics to be exposed to, you should get more resistance, especially if the bacteria are more prone to come from infected people.

Of course there are people who do not agree with him.  They feel that overuse of antibiotics is the main cause of resistance.

I am not so sure of that, and I will explain why.

WHERE DOES ANTIMICROBIAL RESISTANCE COME FROM?

Most of the deaths that arise from antimicrobial resistance come from Asia and Africa.

Is this because healthcare is sub-standard there?

Or is it because there are more resistant bacteria being generated there?

There are maps available.

I can go all day with these maps, but you can play with them yourselves by searching the web for CDDEP Resistance Map.

You will see that MOST of resistance is coming from India, China, Russia, Mexico, Argentina and Venezuela.  

Most of the resistance is NOT coming from the United States.

Assuming that antimicrobial resistance is coming primarily from these parts of the world, why would that be?

Here are some potential reasons.

1.  Poor oversight of Big Pharma allowing corporations to dump effluent into the rivers.

2.  Poor sanitation and overcrowding.

3.  Open pharmacy whereby antibiotics can be obtained without a prescription.

WHERE DOES ANTIMICROBIAL RESISTANCE NOT COME FROM?

Let’s turn the question upside down.

Why do we see less resistance coming from the more developed countries?

The United States and the West.

Here are some potential factors.

1.  Better oversight of Big Pharma.

2.  Better sanitation.

3.  Closed pharmacy.  You can not buy antibiotics at the supermarket.

WHAT’S MY POINT?

This is my opinion.

Maybe we are being too hard on ourselves in thinking that over-prescription of antibiotics is a major cause of antimicrobial resistance.

Maybe we are doing more harm by overly cutting back on our prescription of antibiotics.

If we can nip an infection in the bud, we can prevent much morbidity.  Morbidity is like a forest fire – catch it early and you can prevent a massive conflagration.

A massive conflagration of bacterial infection can paradoxically cause more antibiotic use.

Maybe what we should be more aggressive with antibiotics.

Some people argue that doctors prescribe too many antibiotics.

But it isn’t as if doctors are handing out antibiotics on the street corner.

We have a controlled process in the United States.

We have a closed pharmacy.

We are already doing enough to control resistance.

But by cutting back on antibiotic use for people WHO ARE SICK, we are effectively increasing contagion by allowing more people to get sick.

Let us define contagion in the following way:

Contagion = Number of Sick People x Overcrowding x Poor Sanitation.

WARNING!

By badgering doctors to stop prescribing antibiotics we will increase the number of sick people and cause more antimicrobial resistance.

Thus we will validate the contagion theory that this doctor from Australia, Peter Colignon, was talking about.

SO WHAT’S THE SOLUTION?

The solution is to develop new classes of antibiotics.

There are many areas worth investigating.

If we think we have developed all the ways to kill a bacteria, that is surely a testament to our arrogance.

Indeed, there are many exciting areas to explore.

Why, just the other day, I was cuddling up next to the fireplace with the latest issue of Molecular Cell, a lively, witty magazine.

I was looking at this article: Inhibiting the Evolution of Antibiotic Resistance. Molecular Cell. Volume 73.  Issue 1.

Surely this made the NY Times bestseller list.

In this particular article the authors, Ragheb, et. al, discuss a mutagenesis factor in the bacteria which if shut down could inhibit bacteria from mutating.

Now, this is an avenue, among many, that should be explored.

Yes, it may be a blind alley. Or, it may not even be advisable to shut down the mutability of bacteria.

That’s not the point.

The point is that Big Pharma should be aggressively investigating these avenues.

Are they?

Many say they are not.

Why not?

WHY DOESN’T BIG PHARMA CARE?

They don’t have to care anymore.

They’re too big to care.

There has simply been too much consolidation within the healthcare industry.

Big Pharma is too big.

Their only concern now is profits.

The leaders of their firms are financial guys, not pharmaceutical guys.

One of their false gods is precise cost accounting.

They believe that every single drug must be justified on its own merits.

If they can’t see the profits in it, they don’t go down that road.

This isn’t like the old days where the leader of the firm would take a chance on an idea.

Furthermore, the antibiotics that they have currently are already making them enough money.

They are not thinking ahead to the day when the new antibiotics might be necessary.

There are no profits in that.

They are not statesman; they are profiteers.

But that is not the only reason why they do not innovate.

There is an even darker reason.

THE NEW WORLD ORDER

Do you believe in the New World Order?

You better.

Although Big Pharma loves nothing more than profits, sometimes their profits have to take a back seat to a larger concern.

Control.

Big Pharma is now controlled fully by the elites.

The elites look at medicines as a weapon they can you use to control you.

Antibiotics are a major part of that arsenal.

By depriving you of antibiotics, the elites can keep you a little more sick and dependent upon them.

You see, the elites view antibiotics as medicines for them, not you.

Why, what would happen if the commoners kept using antibiotics, they ask themselves.

Pretty soon, they answer, we won’t have useful antibiotics for ourselves.

That just won’t do, they conclude.

So rather than spend money that can be better used for their new yacht, they convince you that antibiotics don’t work.

They enlist their academics to convince you.

But you know better.

You know that antibiotics work.

Antibiotics put out fires and keep you out of the hospital.

That is precisely the point.

If you get sick as an outpatient and can’t get timely medicines, you are more likely to enter the hospital.

This is a bad thing for you.

But it is a good thing for Corporate America.

They make more money this way.

That improves their bottom line.

Is this too dark for you?

Think again, Pollyanna.

In Pennsylvania not too long ago, a judge was sent to prison because he was sending children to juvenile detention in exchange for kickbacks.

Men are evil and will game the system any way they can.

The days are gone when Big Pharma engages in innovation unless there is an extreme profit motive.  They don’t have to care.

Big Pharma is a quasi governmental entity], entrenched with elites.  They are ossified.

We won’t see innovation like we used to.

Their CEOs aren’t emotionally invested in their company.

This is a bd thing because we need new antibiotics.

Antibiotics work.

I know it with my patients and with me.

Patients have figured it out also.

That’s why bodegas sell antibiotics over the counter.

People in the 3rd World have figured it out.

And we need antibiotics even though the academics say we have don’t.

Academics don’t understand how infections begin.

How do infections begin?

Most respiratory infections begin as viral infections.

After a few days, the bacteria set in and what you get as a mixed infection.

By the time you visit your doctor, you probably have a mixed infection. There are probably bacteria in there.

This is why antibiotics work. The antibiotics work against the bacteria that are in the mixed infection., Now, your academic will tell you that your infection is either pure viral or pure bacterial. This is not true.

The majority of infections are mixed.

By aggressively treating with antibiotics we can get people better faster.

Not only will we be decreasing morbidity and mortality, we will also be decreasing contagiousness.

Not prescribing antibiotics aggressively will cause increased contagiousness which in turn will cause more infections which will paradoxically cause more antibiotics to be prescribed.

The road to hell will be paved with good intentions.

Sincerely,

Archer Crosley

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