In examining the pressing issue of antibiotic resistance, it becomes apparent that the root causes are often oversimplified or overlooked. This book review, along with the book it discusses, raises concerns about the reckless overuse of antibiotics, which could have been postponed had medical professionals exercised more caution. While the article addresses the aggressive marketing strategies employed by major pharmaceutical companies, it sometimes portrays doctors as mere victims rather than active participants in the prescription process. This view risks exonerating physicians and healthcare institutions from their role in this growing crisis.
Numerous individuals have shared stories of visiting their doctors with flu-like symptoms, only to leave with prescriptions for antibiotics. Although correlation does not imply causation, the recent increase in sepsis-related deaths—a condition stemming from bacterial, viral, or fungal infections—can, at least in part, be attributed to antibiotic-resistant bacteria. According to the AAMC, the situation remains critical:
From 2000 to 2019, deaths related to sepsis declined, thanks in part to the Surviving Sepsis Campaign guidelines. However, the mortality rates have risen in the senior population from 277 per 100,000 in 2019 to 331 per 100,000 in 2021, as reported by the CDC.
The agricultural sector has witnessed an even greater excess in the use of antibiotics, a point the book may not emphasize enough. According to a 2015 study:
Approximately 80% of all antibiotics sold in the United States are intended for livestock, with about 70% considered “medically important” for human health. Antibiotics are administered to animals not only to prevent infections but also to boost growth rates, a practice expected to escalate globally in the next 15 years. Evidence suggests that the excessive use of nontherapeutic antibiotics in animals contributes to antibiotic resistance in humans, which can occur through direct contact, consumption of undercooked meat, and exposure to contaminated surfaces.
The implications of ineffective antibiotics would be dire for both the practice of medicine and public healthcare. Healthcare providers are increasingly urged to refrain from unnecessary prescriptions as part of antimicrobial stewardship programs. Yet, the rampant overuse of antibiotics in agriculture is equally significant in the landscape of antibiotic resistance. This misuse not only exacerbates resistance issues but also elevates healthcare costs associated with treating resistant infections. According to the Infectious Diseases Society of America, antibiotic resistance leads to extended hospital stays and an estimated annual cost of $21 to $34 billion in the U.S. healthcare system.
Countries like Australia demonstrate the feasibility of reducing antibiotic use in farming. For example, the use of hormones in chicken production has been banned since 1973. Antibiotics are only permitted for sick birds. During my time in Sydney (2002-2004), these regulations were already in effect, and Australian chicken proved to be both affordable and superior in taste compared to its American counterpart.
By Lola Butcher, a healthcare business and policy writer based in Portugal. Originally published at Undark
BOOK REVIEW — “Dangerous Miracle: The Astonishing Rise and Looming Disaster of Antibiotics,” by Liam Shaw (PSimon & Schuster, 352 pages).
The Sackler family, known for their role in the opioid crisis through Purdue Pharmaceuticals, has a historical connection to the antibiotic industry as well. Arthur Sackler, the oldest brother, was a pioneer in the advertising of antibiotics, crafting campaigns that misrepresented their benefits and thereby laying the groundwork for the current healthcare crisis surrounding these drugs.
These insights are unveiled in “Dangerous Miracle: The Astonishing Rise and Looming Disaster of Antibiotics,” authored by Liam Shaw, a British biologist who focuses on bacterial evolution. Shaw explores the intricate crisis brought on by antibiotic resistance, which now places patients in dire situations, with some bacteria becoming resistant to previously effective treatments. He emphasizes that as the world runs out of effective antibiotics, new solutions have yet to materialize.
Bacteria exist in countless environments—soil, air, water, and our bodies. While most are harmless, some notorious pathogens like staph and E. coli pose serious threats. In fact, bacterial infections accounted for at least 10% of deaths worldwide as of 2019.
Antibiotics, the solutions that either kill or incapacitate bacteria, are one of the 20th century’s monumental medical advancements. “Although we describe antibiotics as magic or miracles, they operate within the powers of nature—not beyond them,” Shaw explains.
Some bacteria are inherently resistant, while others acquire resistance over time. This phenomenon occurs due to evolution; bacteria that survive an antibiotic treatment are often those with resistance genes. This allows them to thrive and spread among populations, complicating the fight against infections.
The escalating levels of antibiotic resistance have led the United Nations General Assembly to label it a significant global health threat. Shaw details the highs and lows of antibiotics over the years, highlighting both the scientific hurdles and the detrimental influence of profit motives within healthcare.
Historically, antibiotics are natural substances not discovered until relatively recently. The understanding of germ theory in the 19th century revealed that bacteria and other pathogens could trigger diseases in living organisms.
Although molds with antibiotic properties were used earlier for wound treatment, the development of antibiotics into concentrated medicines happened in the last century. Alexander Fleming’s accidental discovery of penicillin in 1928 marked a pivotal moment, followed by the synthetic antibiotic Prontosil in 1935, which acted against streptococcal infections. By 1945, when Fleming and his colleagues received the Nobel Prize, antibiotics had already begun their transformative role in healthcare.
During the mid-20th century, commonly referred to as the “golden age” of antibiotics, these drugs effectively treated various infectious diseases such as gonorrhea, syphilis, tuberculosis, and meningitis. This innovation also made surgeries safer, and cancer patients became more likely to survive chemotherapy. “Antibiotics did more than eliminate diseases; they provided the foundation for modern medicine,” Shaw highlights.
Today’s antibiotics vary; some are synthetic while others originate from natural sources, such as microbes discovered in soil. Pfizer, for instance, located its most effective antibiotic after collecting 135,000 soil samples from diverse locations.
This breakthrough antibiotic, Terramycin, was celebrated for its ability to combat numerous bacterial strains, drawing the attention of Arthur Sackler. As a physician and copywriter, Sackler designed a campaign promoting Terramycin as a universal remedy, suggesting doctors simply prescribe it without diagnosing the underlying condition.
Following Pfizer’s lead, other pharmaceutical companies began to employ similar marketing strategies. “As antibiotics became prevalent, there grew a notion that they could be used for even minor issues like ear aches,” Shaw notes, underscoring the profit-driven motives that led to increased antibiotic prescriptions across the board.
The surging demand led to the incorporation of antibiotics into household products like mouthwash and toothpaste, as well as livestock feed, permitting faster growth in animals. “Antibiotics, once regarded as precious resources reserved for severe ailments, became widely available, leading to an unprecedented rise in resistant bacterial strains,” Shaw concludes.
Today, antibiotic resistance claims the lives of more than one million people annually, and projections indicate that this figure could nearly double by 2050. “Despite the rising threat of antibiotic resistance, the pace of new antibiotic development has stagnated,” Shaw emphasizes.
The dwindling interest from the pharmaceutical industry since the 1980s has significantly hampered progress in antibiotic development. Stricter FDA approval processes and the high costs of clinical trials have made it less appealing for companies to invest in antibiotics, compared to long-term medications that promise greater profits.
Consequently, only 15% of essential antibiotics defined by the World Health Organization have been developed in the past 30 years, and a concerningly low number are currently in the works. As of 2023, only 32 antibiotics were under development to tackle infections highlighted by the WHO.
Compounding this issue is the inaccessibility of long-standing antibiotics to those in need. For instance, penicillin, a cost-effective treatment, remains out of reach for millions in Africa and Latin America, despite still being recommended for many infections, such as congenital syphilis.
“Dangerous Miracles” is filled with historical insights, discussions around patent law, and biographical details, which at times may overwhelm the central narrative. Readers seeking a more accessible overview of antibiotic resistance may prefer Maryn McKenna’s “Superbug: The Fatal Menace of MRSA,” published in 2010. Shaw’s intent, however, is to provide historical context to inform future solutions: “To understand the crisis, we must examine the origins of antibiotics and how we exhausted them.”
The proposed solutions remain murky. Shaw points to the need for global collaboration among governments to finance antibiotic development—a suggestion widely supported by experts. “Multiple analyses indicate that pooled investments in new antibiotics would prove advantageous economically, much like vaccine preparedness for potential pandemics,” he argues.
Yet during a recent international conference on antimicrobial resistance, many experts deemed the idea unrealistic. This uncertainty leaves Shaw—and his audience—yearning for a breakthrough: “Perhaps we can only truly appreciate the value of antibiotics once we face a world devoid of them.”
