Books, Naturally
The Killers Within: The Deadly Rise of Drug-Resistant Bacteria
Michael Shnayerson and Mark J. Plotkin. 2002. Little, Brown and Company, Boston. 328 pp., clothbound. $24.95.A good friend recently died in one of our most dangerous places: a hospital. He was admitted to the prestigious hospital with an aneurysm but with treatment was soon recovering. Then he acquired a bacterial staph infection. It killed him.
To people like me who grew up after modern antibiotics were developed during World War II, this is shocking. Surely a course of some antibiotic should have cured this infection; to die of it in a hospital, while under the care of nurses and doctors, seemed impossible. But many hospitals harbor deadly drug-resistant strains of Staphylococcus, Streptococcus, and other bacteria, which in recent years have killed an estimated 40,000 people annually in the U.S. Moreover, drug-resistant bacteria are turning up in daycare centers, schools, and homes. Many medical scientists believe that the "golden age" of antibiotics is over and our ability to win the battle against bacterial diseases is about to disappear.
The Killers Within offers a litany of case studies of reasonably healthy people who have died, or nearly so, from bacterial infections that would not respond to any antibiotic. Sadly, we know how it got to this state and how to begin to address it, but too few people are listening. Shnayerson and Plotkin hope to raise the profile of the problem so more of us will demand policies and programs to solve it. At the very least, those little inclined to activism will be moved to change their personal practices and contribute to the solution.
Plotkin is the renowned ethnobotanist and best-selling author of The Shaman’s Apprentice and other books on the search for new drugs in the world’s vanishing natural habitats. You may wonder, as I and many others who know his work did, why an ethnobotanist would be writing about drug-resistant bacteria. You may also wonder why I would be reviewing this book. For one thing, scientists must continue to look to nature for new antibiotics, so the specter of killer bugs adds urgency to efforts to conserve wildlife and wild lands, and may create a new constituency for conservation among people who are indifferent to the plights of species other than our own. In one short, fascinating episode in this book, the authors describe the search for new weapons against bacteria in the saliva and blood of Komodo dragons, creatures admired only by ardent animal-lovers. The Komodo dragon often eats rotted carrion and as a result its mouth is a bacterial megalopolis. If a dragon’s bite doesn’t kill a deer or pig outright, the animal will die of a bloodstream infection within a few days. That the dragons can live with this deadly bacteria suggested that they possess some antibacterial agent, and, indeed, after a dangerous adventure to collect saliva and blood samples from wild dragons, researchers have isolated a promising antibiotic peptide.
Contrary to the complaints that environmentalists and conservationists care more about tigers and trees than about humans, people adopt these roles because they are concerned about our quality of life, and that of our children. The proliferation of deadly super bugs is an environmental problem of our own making, no different from water and air pollution that affect our health, or deforestation that contributes to global climate change, or the extinction of species that leaves us poorer in spirit.
Another subtext throughout this book is that people should know better. At the Zoo, we are devoted to improving biological literacy, and many of our exhibits explore themes of evolution and adaptation through natural selection—a fundamental principle of biology that we ignore or misunderstand at our peril. This principle predicts the rise of bacteria resistant to antibiotics. Scientists think of the relationship between a predator (whether a bacteria or a bear) and its prey as an arm’s race. As prey evolve to outwit or outrun their predators, the predators evolve to outwit or outrun their prey. If one doesn’t evolve, it will likely go extinct. We and our bacteria are in an arm’s race. But while our bacteria evolve quickly, we reproduce too slowly to keep up. In the 20 years since a new class of antibiotics was developed—roughly one human generation—most bacteria have gone through about 100,000 generations. Instead, we have to be smart and change our behavior to defend ourselves.
A variety of factors have brought us to the verge of a "post-antibiotic world." One is the over-prescription of antibiotics. Another is prescribing antibiotics for viral infections, when doctors, the authors write, "might as well be prescribing M&Ms." Patients demand drugs when they are sick and doctors are reluctant to say no. Another is our tendency not to finish prescriptions—when we take half the dosage, we kill the least resistant bacteria, leaving the strong to survive. Another is the routine, massive, and uncontrolled use of antibiotics to promote rapid growth in livestock. We eat antibiotics in our meat and drink them in our milk. This use has led to resistant bacteria in livestock, some of which have passed to people. According to the authors, two food-borne bacteria account for 75 percent of food-related deaths in the U.S., and "many if not most of those deaths involved multi-drug resistant strains." And—surprisingly—the use of antibacterial soaps is counterproductive, killing harmless strains and leaving room for the dangerous ones to grow!
The good news is that all of these problems can be solved, mostly through education, because it is up to each of us to take all our medicine, not demand "M&M" prescriptions, and press our food producers to reduce or eliminate antibiotics in livestock feed (or eat organic). This book should help wake people up.
The Killers Within reads like murder mystery, and you’ll find it hard to put down because you’ll want to know how the scientist-detectives will solve the case. Unfortunately, there is no tidy revelation of a culprit who can be prosecuted and put away. We are all implicated in the crisis, and ignoring it is potentially murder and suicide.
—Susan Lumpkin
ZooGoer 32(1) 2003.
Copyright 2003 Friends of the National Zoo.
All rights reserved.
