The Killers Within: The Deadly Rise of Drug Resistant Bacteria [Hardcover]

Mark J. Plotkin (Author), Michael Shnayerson (Author)

Book Description

ISBN-10: 0316713317 | ISBN-13: 978-0316713313 | Publication Date: September 3, 2002 | Edition: 1

It wasn't too long ago that modern antibiotics seemed to have conquered bacteria. Threatening bacteria, doctors proclaimed, were on their way out.

Not exactly. In THE KILLERS WITHIN, Michael Shnayerson and Mark Plotkin reveal the terrifying truth: that bacteria have evolved, have outwitted doctors, and are now on the ascendancy. Quietly, a medical crisis has been brewing, as laboratories and doctors frantically race to develop new drugs and new means to combat bacteria that, via aggressive evolution, have zigged when medicine zagged. Bacteria that disintegrate your skin; bacteria that clog your lungs; bacteria that result in golf-ball-size abscesses-all these and more make appearances in THE KILLERS WITHIN.

We meet the scientists desperately racing to stay one step ahead. We learn the creepy science of how bacteria work, and why they may be winning. And we see how, ironically, we've created the problem by misusing antibiotics. A book that will be compared to Laurie Garrett's bestselling "The Coming Plague," THE KILLERS WITHIN is a horror story that just happens to be true.

Editorial Reviews

From Publishers Weekly

Bacteria preceded human life by millions of years but will they also outlive us? Shnayerson, a staff writer at Vanity Fair magazine, and Plotkin, an ethnobotanist, paint an alarming picture of the crisis posed by antibiotic-resistant bacteria. They focus on the three most common types: enterococci, streptococci and staphylococci. They tell of the deadly S. aureus a particularly virulent strain of staph that has shown up in deadly resistant strains and the infamous "flesh-eating bacteria" (necrotizing fascitis), whose incidence has been on the rise. They explain the myriad factors that have contributed to antibiotic-resistant bacteria and disease, most important among them the overprescription and misuse of the drugs, including the antibiotics fed to livestock to promote growth. Sharing the latest research, the authors suggest that future antibiotics are in the most unlikely places, from shark-bellies and silkmoths to the saliva of the Indonesian Komodo dragon. Shnayerson and Plotkin write in a lively, journalistic style and spotlight many victims, microbiologists and other "faces" behind the statistics, going far to make the copious scientific information accessible to general readers (though some may still be daunted). Yet their alarmist tone may strike many readers as overly sensationalistic and grating. Moreover, many of the facts about antibiotics abuse and drug-resistant bacteria are simply old news, and this book may not drum up much interest in spite of its informative analysis.
Copyright 2002 Cahners Business Information, Inc.

From Library Journal

At first glance, Shnayerson, a Vanity Fair staff writer, and noted ethnobotanist Plotkin (Tales of a Shaman's Apprentice) seem an unlikely pair to be writing a book about antibiotic resistance. Yet the reader quickly becomes engrossed in their tale. The authors provide an extremely readable look at the overuse of antibiotics, the methods bacteria use to develop resistance, the role of antibiotics as animal growth promoters, and the outlook for antibiotics. Drawing on a vast number of interviews with key people in the field, Shnayerson and Plotkin have managed to demonstrate their concern over the future of antibiotics while keeping the scientific background manageable for lay readers. A brief, annotated bibliography and list of web sites adds to the work. An interesting complement to Gerald Grob's The Deadly Truth, which discusses the inevitability of disease, this work also offers readers a riveting update to the section on antibiotics in Laurie Garrett's The Coming Plague. Recommended for public and academic collections.
Tina Neville, Univ. of South Florida at St. Petersburg Lib.
Copyright 2002 Reed Business Information, Inc.

See all Editorial Reviews

Product Details

• Hardcover: 320 pages
• Publisher: Little, Brown; 1 edition (September 3, 2002)
• Language: English
• ISBN-10: 0316713317
• ISBN-13: 978-0316713313
• Product Dimensions: 9.4 x 6.1 x 1.1 inches
• Shipping Weight: 1.2 pounds
• Average Customer Review: 4.7 out of 5 stars  See all reviews (16 customer reviews)
• Amazon Best Sellers Rank: #882,268 in Books (See Top 100 in Books)

Customer Reviews

Most Helpful Customer Reviews

13 of 13 people found the following review helpful:

5.0 out of 5 stars The frightening return of infectious disease, November 25, 2002

By 

Dennis Littrell (SoCal) - See all my reviews
(VINE VOICE)    (COMMUNITY FORUM 04)    (HALL OF FAME REVIEWER)    (TOP 500 REVIEWER)    (REAL NAME)   

This review is from: The Killers Within: The Deadly Rise of Drug Resistant Bacteria (Hardcover)

This book is scary. According to ethnobotanist Mark J. Plotkin and longtime Vanity Fair contributing editor Michael Shnayerson, the golden age of antibiotics that began with penicillin, a time when it was generally thought that infectious diseases were under control and largely a menace of the past, is over. Our naivete and our arrogance in imagining that we had just about defeated the bugs and could move on to other more pressing public health concerns came to an end in the nineties as one after another of the major human borne bacteria became resistant to our drugs. Through the exchange of DNA, that immunity has been transferred to other bacteria so that, as this book went to press just a few months ago, infectious diseases caused by bacteria are once again a major threat to humans everywhere in the world.

What happened? As the authors explain there are three main problems, (1) the overuse of antibiotics by the medical profession, (2) the misuse of antibiotics as growth enhancers in the meat and poultry industry, and (3) the failure of hospital personnel to follow CDC guidelines on hygiene, especially simply washing their hands.

(1) Too many doctors, either through ignorance or a desire to please their demanding patients, have over-prescribed antibiotics for routine infections, and in some cases actually prescribed antibiotics for viral infections (for which they are useless) "just in case" the patient also gets a bacterial infection. The result of this massive overuse of antibiotics is to give the bugs countless trillions of generational opportunities to evolve defenses against the antibiotic, leading to the antibiotic becoming useless.

(2) Tons of antibiotics--"24.6 million pounds a year," see p. 123--are routinely added to animal feed by the meat and poultry industry to promote growth so that their products will get fatter faster. What has happened is that the bugs have grown resistant to the antibiotics while transferring that immunity to bacteria living in, on and around humans. Even the use of an "analogue" antibiotic such as growth promoter virginiamycin can promote changes in bacteria that make them resistant to the antibiotic Synercid (e.g., see pages 115, 119 and 285). As the authors chronicle, this is a serious problem fraught with angry political battles as the meat and poultry people fight to maintain their profit margins while the disease control people fight to restrict the use of growth promoters.

(3) Surprisingly enough the authors report (see page 282 and elsewhere) that there is cynicism among some hospital personnel about the effectiveness of washing their hands and a belief that hygiene won't stop the proliferation of the bugs. The result is that hospitals have become very dangerous places. Most of the drug-resistant bacteria developed their resistance in hospitals. Most (or all) of them are endemic to the hospital environment. If you have to go to a hospital for any reason you are taking a chance of contacting a drug-resistant bug. Heaven help you if you have a compromised immune system, or if you are an infant or an elderly person.

How bad is the situation? According to the authors on pages 278-279 the high cost of developing new drugs (average "$802 million") and the fact that "return on investment from producing an antibiotic that might be used by a patient for less than a week versus return from a drug for a chronic condition that a patient might take daily for fifty years" is persuading big pharma to downsize the antibiotic end of the business. (See also page 94.) The authors ask the question, where are new drugs coming from? and answer that the "great glittering prospect was genomics." But "reality" has "sunk in." (p. 280) Drugs to fight bacteria developed from DNA manipulation "might take even longer to reach the market" than those previously developed. (p. 281)

The authors also touch on the possible use of drug-resistant bacteria as a bioterrorist weapon.

What does all this mean for you and me? It means that should we or our loved ones get a life-threatening bacterial infection, it's possible there won't be an antibiotic around that works. In effect, we might find ourselves back in the days before penicillin (the first really effective antibiotic, and one of the greatest of all medical miracles) when millions of people routinely died from staph, strep, TB and other bacterial infections. As Shnayerson and Plotkin report, right now there are strains of bacteria, including Staphylococcus aureus (the golden-globed bacteria pictured on the cover), Streptococcus pneumoniae, and the Mycobacterium that causes tuberculosis, that are immune to almost every antibiotic in use. There is even a strain of Enterococcus that is resistant to every antibiotic in use.

The authors do offer some hope. They report on the promising use of bacteriophages (viruses that invade and destroy bacteria)--see the very interesting Chapter 14, "Bacteria Busters." They present the idea of a more vigorously controlled use of antibiotics. If we prohibit their use as growth promoters and use them sparingly in an ordered sequence, perhaps bacteria would not have time to gain immunity and/or would lose it after the antibiotic is no longer in use. As pointed out on e.g., page 183, resistant bacteria are "encumbered" by an "extra chunk of DNA" that gives their non-resistant brethren an "ecological advantage" in an environment that doesn't contain the antibiotic. Additionally, the authors report the theory of population biologist Richard Levins who believes that if antibiotics are "saved for the most severe cases...then natural selection would favor the pathogens that produced the milder symptoms." (Explained on page 287).

Bottom line: this is a fascinating, scary and state of the art report on the pathogen wars written in a readable manner sure to interest not only the general public at which it is aimed but professionals as well.

10 of 10 people found the following review helpful:

5.0 out of 5 stars Stephen King...stand aside! Reality is scarier..., November 17, 2002

By 

K. L Sadler "Dr. Karen L. Sadler" (Freedom, Pa. USA) - See all my reviews
(VINE VOICE)    (REAL NAME)   

This review is from: The Killers Within: The Deadly Rise of Drug Resistant Bacteria (Hardcover)

Excellent, excellent job done in research and writing by Shnayerson & Plotkin. If the reader is involved in science or public health, the 'news' in this book does not come as a surprise to anyone. It's been known for years among those in these communities that bacteria has been developing resistance to our antibiotics from day one. We get taught this if you work in a lab, because it becomes vitally important to keep everything absolutely sterile and clean. I know it is taught in medical school, but they don't emphasize this enough to medical students and doctors and nurses, because many doctors continue to dispense antibiotics like candy even though they have been warned and warned again by the Center for Disease Control and others.

For those who enjoy reading stuff like this to scare themselves...well, good luck. This is the stuff of nightmares, and if you spend a lot of your time worrying, I certainly wouldn't recommend you read this book. There is always hope, as the authors point out, that researchers will continue to find antibiotics that will temporarily restrain bacterial onslaught. However, be assured this hope has been relied upon in the past, and the bacteria always seem to find a way to mutate around medication, regardless of whether the antibiotics had an organic chemical basis or was a synthetic/man-made one, not seen in nature.

Most of the time, the people who pick up this type of book are already involved and concerned about this public health disaster-in-the-making. Yet these authors are trying to get this information out to the public, and write in such a way as to make this science knowledge understandable. The book starts out slowly, but picks up pace quickly. I had difficulty putting it down after the first couple of chapters. It is absolutely vital that the public be aware that responsibility for correct antibiotic use lies not just with the physicians, but with the patients and parents of patients who beg their doctors for antibiotics, when those antibiotics are not called for. As the authors bring up, most antibiotics given out by pediatricians are for ear infections (>60%). Yet often times those ear infections will go away on their own, with the antibiotics only minimalizing the length of time of the course of infection. Yet, all of us are guilty of expecting physicians to give us 'something' to make a cold or the flu 'go away'. Unfortunately, too often those illnesses are not caused by bacteria, but by viruses, and giving antibiotics in this manner just give bacteria an opportunity to switch genes around to build resistance. Same thing with not taking all of a prescription after the patient starts feeling better, or sharing medication not prescribed for others.

I hope this book is widely read. Maybe if enough consumers become concerned, we can put a stop to certain practices such as the use of antibiotics in animal feed as growth factors, regardless if they are known to be used for human consumption. The public needs to get more involved in their own medical care, and that means participating in governmental processes to fight against massive lobbying by pharmaceutical companies and livestock/meat companies and their lackeys, who often don't know and don't care about the possible consequences of their indiscriminate use of antibiotics.

Karen Sadler,
Science Education,
University of Pittsburgh

11 of 12 people found the following review helpful:

5.0 out of 5 stars Don't read this book!!, September 13, 2002

By A Customer

This review is from: The Killers Within: The Deadly Rise of Drug Resistant Bacteria (Hardcover)

If you think that modern medicine has all the answers, don't read this book! If you believe that science will save you, don't read this book! If you have faith in the wholesomeness of our food system, don't read this book! If you trust that industry has your best interests in mind, don't read this book! If you want sweet dreams at night, please, please, don't read this book!
The Killers Within weaves two very different emotional strands into a compelling narrative. One story is that of courage and curiosity, of those scientists who devote their lives to the pursuit of knowledge. These men and women toil for decades to understand the miniature worlds of bacterial organisms, enduring what (to me) seems like almost unbearable tedium in unravelling just one tiny aspect of these mysterious life forms. The book shines a lovely light on these Galahad figures, who seek their Holy Grails in dreary laboratories to keep the rest of us from harm. One wonders what these scientists feel about industry, which exploits the discoveries of science when it leads to profit, but ignores bedrock principles - such as evolution - if they threaten to inhibit corporate income in any way.
The other story woven into the book is that of evolving bacteria, and it's like looking into hell. Where only a few years ago doctors were crowing that we'd completely conquered infectious diseases, now it's the bacteria who are gaining the upper hand, and fast. There is a lot of medical and biological detail here; it takes some attention to follow but it's well-written and well-larded with colorful and helpful similies for the civilian. What makes the story especially disturbing is that much of the evolution of drug-resistant bacteria has been engineered by stupid or indifferent (worse!) humans. While the authors don't cast blame on any particular individuals, you don't have to be Perry Mason to figure out who the bad guys are here.

The main reason why you shouldn't read this book is that it presents a view that will forever demolish your belief that humans are the center of the universe. It's not exactly "Nature Red in Tooth and Claw", but it's ruthless. These bacteria will kill us if they can (we are just food sources for them, after all) and the next person dead in a heartbeat might be our child, our husband, our mother. After you have been sucked into the flourescent glare of this nightmarish book, read The Doomsday Book by Carol Willis, a novel that takes place during The Black Plague. I guarantee that you will never again forget to be grateful for your short and lucky life.