Blame the messenger

“She said, we’ve got to hold on to what we’ve got …” As Bon Jovi’s “Livin’ on a Prayer” came on in the bar, I joined in enthusiastically: “It doesn’t make a difference if we’re naked or not!” My friend burst out laughing. “It doesn’t make a difference if we make it or not,” she corrected me.

My head spun. For the past 20 years, my understanding of this song had been wrong. I hadn’t even questioned it, simply assuming that my interpretation was correct. And now, learning the true lyrics, my perspective shifted and it all made more sense.

I thought of this incident when I read a headline describing the findings of a recent survey: “Antibiotic resistance widely misunderstood by the British public.” How could this be misunderstood, I wondered, when it’s such a simple concept?

Survey researchers found that most people, if they had heard of antibiotic resistance at all, thought that it was their body that became resistant to antibiotics, rather than the bacteria. One person interviewed during the research said: “The more you take, the more your body becomes resistant to it. They stop working.”

This was another “a-ha!” moment for me. After all, our bodies do build up tolerance to certain drugs, thereby lessening their effectiveness.

The simple misunderstanding helps explain why many people who are prescribed antibiotics often fail to complete the course, believing that lessening their exposure will help prevent their bodies from developing resistance. In fact, failure to complete a course of antibiotics is a major factor in the development of drug-resistant infections, as it exposes germs to enough of the drug to promote resistance, but not enough to kill them.

It’s an easy mistake to make, but like me, clinicians and other health professionals too long remained unaware of the misconception, with potentially deadly consequences. Antibiotic resistance is perhaps the biggest health threat we face in the developed world. Imagine tuberculosis and pneumonia once again spreading through our cities. Imagine dying of appendicitis or a simple scratch on the leg that leads to untreatable cellulitis.

People in rich countries already die of drug resistant infections, which they usually acquire in the hospital. It would be nothing short of catastrophic if the constantly evolving bacteria that regularly infect us became resistant to our precious small arsenal of antibiotics. A major factor in drug resistance is the irresponsible use of antibiotics in cattle, but incorrect and excessive use by humans is a likewise a large part of the problem.

If people don’t understand how they are part of the problem, they can’t become part of the solution. The survey researchers suggest doctors talk about “drug-resistant infections” or “antibiotic resistant germs,” rather than “antibiotic resistance.” The simple phrase could open a window of perception.

This column first appeared at The American Scholar.

One thought

  1. It is not quite that simple. Our bodies are at war with much of our mictobiome (the bacteria in our guts, in the plaques in our arteries etc) and many of the microbiome are fighting each other. With? Antibiotics!. The toxins that some clostridia and some coli bacteria make are mostly directed at their foes. It is a complex war and as long as we live, there is mostly a balance. Nobody, not you, not any species of bacteria, is fully on top. A bigger problem with antibiotics is that they can kill “civilian bacteria” and commit genocide on them. This happens in the guts of Somali children who emigrate to the west. They have a different bacteria in the ascendancy and this bacteria has almost zero defenses against our antibiotics. These are almost wiped out, a clostridia moves in, it uses a strong toxin (an antibiotic) to keep these bacteria from coming back, unfortunately it is a neurotoxin in humans, and the children have the highest rates of autism in the world. And you can find this in Somali children in every western country. It might be solvable if Somali children were treated with different antibiotics.

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