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9 of 10 people found the following review helpful:
5.0 out of 5 stars
Is an era ending?, December 22, 2009
This review is from: Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them (Hardcover)
My parents lived in the time when antibiotics won out over bacterial infection. My very real fear is that they will live to see bacteria win again. Dr. Spellberg describes what that time was like, when capricious infections would strike at healthy adults and cripple or kill them in just a few days. More to the point, he describes what this time is like, when he sees drug-resistant infections doing the same, now, even in the most advanced of western hospitals. Antibiotic resistance follows inevitably from antibiotic use. Every time a new antibiotic appears, billions of bacteria take on the evolutionary problem of dealing with it. Sooner or later, somewhere, one does - and that's all it takes. That one's progeny thrive in the presence of that drug, to the exclusion of all others. Spellberg omits, almost completely, a technical point that makes the problem even worse, though. "Horizontal gene transfer" means that one bacterium can pass its resistance on to others, not just its descendants, and not just within its bacterial species. In particular, one resistant bug can pass resistance on to a bug already resistant to something else, creating a superbug with multi-drug resistance. In rare cases, some pathogen resists all known medications. That's when the infectious disease specialist has to say something that hasn't been said since the dawn of the antibiotic era, "We've tried everything. There is nothing left to try." Acquired resistance is not just a problem. It must be considered a basic fact of life. All the best policy in the world regarding hand-washing, infection control, and the rest can not change that fact. Instead, the problem must be addressed on the human side, by coming up with new drugs and new ways of using them. That is where Spellberg's story takes its most appalling turn: We are doing nothing. In fact, many companies have already shut down development of new antibiotics. Step by dismal step, Spellberg describes how this has occurred. Part of the problem lies in misuse of the drugs, in ways that very nearly ensure the rise of resistant bacteria. Another part lies in governmental blunders that fail to reward, or seem actively to punish creation of new drugs. For example, drug patents last for some fixed number of years, as does any patent on anything else. Legalities require that the patent be submitted before the drug goes into testing, however, and legally mandated tests can go on for years. During all of those years, the developer keeps adding to the cost of development, which often exceeds a billion dollars. Only when the drug is approved can the company begin to recoup development costs - when as much as a third of the patent's lifetime has already expired. Even if successful, any one patient uses antibiotics for only a few days. It makes obvious economic sense to market drugs that a patient will take for a lifetime: things like Lipitor, Viagra, or diabetes medication. Pursuing uneconomic drug development could even put a company at risk of lawsuits from its shareholders. Oddly, Spellberg does not mention phages as potential therapeutic agents. Phages are viruses that attack bacteria but not people, and are already used in the US to prevent food-borne disease. Since phages occur naturally, however, they can't be patented. The company that funds development of phage therapy has no realistic way to recover development and testing costs. Once a phage hits the market, competitors can culture it and sell it immediately - at a price that doesn't need to recover expenditures already invested. Until some business model arises to make phage therapy profitable, there is no economic reason for a company to pursue it. Spellberg notes that solving the problem has so many interlocking parts that assigning blame is impossible, in addition to being a positive hindrance to creating solutions. Many solutions just can not work. Spellberg cites a lawyer's proposal for better hospital procedures to block the spread of resistant germs, very nearly a proposal to sue drug resistance out of existence. Spellberg gently points out the many fallacies that underlie this, as well as those underlying other seemingly meaningful proposals. In his final chapter, he goes even farther. In addition to 'stewardship' activities designed to preserve a drug's useful lifetime, he offer suggestions that create incentives for antibiotic development. Instead of radical new proposals, his are based on existing legislation with a proven record of motivating the drug companies. But, as Spellberg points out, any eventual solution must follow public recognition that a problem even exists. Then, a period of discussion will inevitably follow. As has already happened, educated people will enter that discussion with no idea - worse, with wrong ideas about the nature of the problem. Spellberg addresses these fundamentals. He shows that there is a problem, he states it in clear, understandable language, and shows how people can use that knowledge to fight back against drug resistance. And we'd better start fighting soon. The bacteria outnumber us by billions to one, and they're pulling ahead. -- wiredweird
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7 of 8 people found the following review helpful:
5.0 out of 5 stars
A chilling warning, September 9, 2009
This review is from: Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them (Hardcover)
As a fan of TV's medical drama "House," I've been amazed at the range of diseases and adverse medical conditions of humans, as well as the swiftness of their effects, but I wasn't prepared for the alarming descriptions by Dr. Brad Spellberg in his engrossing book Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them about antibiotic-resistant bacteria and the scary increase in infections and deaths because new antibiotics aren't being developed. If this book doesn't send a chill up your spine, you're probably spineless. But Spellberg is at the same time hopeful that we can turn things around, and I think his book will be that alarm bell calling attention to this problem. What's more, his moving descriptions of those helped by antibiotics throughout the years, such as the four-year-old girl near death from a staph infection (with photos of her before and after the infection), remind all of us not to be complacent about the future. I had the privilege of hearing a compelling talk he gave at the Center for Inquiry-L.A. about his book, and readers interested in understanding how antibiotics work on bacteria, which are examples of how fast evolution works, and how to combat this rising plague should not miss this book.
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16 of 22 people found the following review helpful:
3.0 out of 5 stars
The Brief Golden Age of Antibiotics, June 4, 2010
This review is from: Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them (Hardcover)
Rising Plague was written by Brad Spellberg, MD, a professor of medicine at UCLA. It's about the rise in drug-resistant microbes, and the fact that the drug industry has waning interest in developing new antibiotics. Where he explains the problem, the book is great, as far as it goes. He is good at discussing highly complex subjects in an understandable manner. I learned a lot. But the important subject of antibiotic use in animals is discussed in just two sentences. In fact, 70% of antibiotics are given to livestock, poultry, fish, shellfish, and pets. He doesn't mention that excrement contains active antibiotics. Plants absorb active antibiotics when the soil is treated with manure. Antibiotics are accumulating in groundwater. Every day, we are receiving small doses of active antibiotics in our water, milk, meat, vegetables, fruit. Some antibiotic molecules are remarkably stable, and can remain active even after being cooked at 273 degrees Fahrenheit. He does not mention these issues. This daily low-dose exposure certainly hastens the development of drug-resistant microbes. Antibiotics make animals grow faster and larger, so they are very popular among producers of industrial meat. Eliminating or sharply reducing antibiotic use on animals is not mentioned in the book. The meat industry has vast political power. If we ignore the animal issue, then it makes no sense to spend billions to develop new antibiotics. Spellberg devotes a single paragraph to the notion that, in the world of antibiotic research, the low-hanging fruit has already been picked. Developing new antibiotics is going to be far more difficult, expensive, and time-consuming. We'll have to discover new, radically different bug-killing paradigms, according to Dr. Alfonso J. Alanis at Lily Research Laboratories. The portion of the book where Spellberg recommends solutions to the problem failed to get me to leap on his bandwagon. This is a book with an agenda -- inform the ignorant hordes, put pressure on government to put pressure on the drug industry. Coincidentally, this solution corresponds to the way he makes a lot of money: securing research grant money. Everyone agrees that the problem of antibiotic-resistant disease pathogens will never be cured. The microbes will inevitably develop resistance to any and all new pharmaceutical weapons. The microbes will inevitably blindside modern medicine. It's only a matter of time. No amount of money or magic can fix this. Nature will not be controlled. Weeds develop resistance to herbicides. Plant diseases develop resistance to fungicides. Insects develop resistance to insecticides. Pathogenic microbes develop resistance to antibiotics. By the 17th century, humans developed resistance to the bubonic plague. Looking at the world from the mountaintop of ecological history, I can envision that in the 20th century, the four horsemen of the apocalypse are: (1) The Haber Bosch process for producing ammonia fertilizer, which likely added two billion to the herd. (2) The Green Revolution, which sharply increased the productivity of corn, wheat, and rice -- more food, more people. (3) The antibiotic era, which sharply reduced the death rate. (4) The era of cheap and abundant energy: more everything. What will benefit the generations yet-to-be-born -- a multi-billion dollar campaign to discover new drugs, in order to provide a temporary delay in a lost cause? Infectious diseases were not a major problem before humans began living in high density. Paleoanthropologists report that nomadic foragers left behind remarkably healthy skeletons. Thinking outside the humanist box, it's almost possible to see this as a self-solving crisis. Overpopulation is the pathogen, and infectious disease is the powerful curative antibiotic. We should never think outside the box. Spellberg is an MD, committed to saving every human life possible, no matter the cost. Make drugs, not war! But healthy people can't live in a sick ecosystem. We are in an icky predicament. The history of civilization is one of countless human attempts to dominate and control nature. Sooner or later, all of them fail. Nature will not be controlled. This gives Dr. Spellberg nightmares: horrific visions of the ultimate impotence of our magnificent technology. He does not want to lose control. But he will.
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