What's fascinating here is that the problems he finds have less to do with animal abuse (Maryn McKenna reports that Conover was surprised to find himself in a clean, safe, humane facility) and more to do with the abuse of antibiotics — a trend that is a major contributor to antibiotic resistance.
You can't read the full story for free, unfortunately. Such is the way of Harpers. But Maryn McKenna has a summary, Conover has a blog post on agribusiness gag laws, and you can buy access to the full story with a Harper's subscription.
Scientists are only now beginning to get answers to those questions. In a paper just published online in the journal Gut, Andres Moya of the University of Valencia and his colleagues took an unprecedented look at a microbiome weathering a storm of antibiotics. The microbiome belonged to a 68-year-old man who had developed an infection in his pacemaker. A two-week course of antbiotics cleared it up nicely. Over the course of his treatment, Moya and his colleagues collected stool samples from the man every few days, and then six weeks afterwards. They identified the species in the stool, as well as the genes that the bacteria switched on and off.
What’s most striking about Moya’s study is how the entire microbiome responded to the antibiotics as if it was under a biochemical mortar attack. The bacteria started producing defenses to keep the deadly molecules from getting inside them. To get rid of the drugs that did get inside them, they produced pumps to blast them back out. Meanwhile, the entire microbiome powered down its metabolism. This is probably a good strategy for enduring antibiotics, which typically attack the molecules that bacteria use to grow. As the bacteria shut down, they had a direct effect on their host: they stopped making vitamins and carrying out other metabolic tasks.
Today, we are desperately trying to figure out how to combat and keep up with antibiotic resistance — the frustrating tendency for bacteria to evolve defenses against the drugs we depend on to kill them. Seventy years ago, researchers were faced with a very different problem — how to take penicillin, the antibiotic derived from mold, and turn it into something that could be produced in large quantities.
At The Body Horrors blog, Rebecca Kreston writes about this quest and how a single moldy cantaloupe helped launch the (unfortunately) brief era of antibiotic supremacy.
For something that grows so carelessly and freely on our fruits and breads, mass producing the white mold and its hidden wonder drug penicillin was devilishly difficult. After Alexander Fleming’s accidental discovery of a bacteria-killing mold contaminating his cultures of Staphylococcus aureus, it languished as a laboratory parlor trick until World War II and the desperate need for treatments to fight bacterial infections became quickly apparent
It would be another fluke – the discovery of a moldy cantaloupe - that would yield a particular strain of mold that could produce prodigious amounts of this “magic bullet” antibiotic. Factories with the expert know-how on man-handling yeast and fungi into yielding their strange fruits - alcohol distilleries and mushroom factories – were then tasked with the production of penicillin
I particularly dig this video she posted with the story, showing a behind-the-scenes look at how large quantities of penicillin were made during World War II.
More than 700,000 people in the United States probably get gonorrhea each year. I say "probably" because the Centers for Disease Control doesn't know for sure. It's an estimate, because a lot of those cases go untested, unreported, and untreated.
The good news is that, since the 1940s, getting people to get themselves tested has been the hard part. Once you know the gonorrhea is there, antibiotics have made it both easy and cheap to treat. The (more) bad news: That's changing.
At her Superbug blog, Maryn McKenna talks about the threat of antibiotic-resistant gonorrhea—it's not just an issue of health, it's also an issue of how much health costs. So far, there's not been gonorrhea reported that's immune to all the drugs we can throw at it. Just the inexpensive drugs. Anticipating big problems when treating gonorrhea becomes a pricy proposition, the World Health Organization has put together a plan for improving treatment today.
The plan specifically calls out an aspect of the growing resistance problem that we highlighted at SciAm: Community control now depends on rapid molecular tests that identify the gonorrhea organism (Neisseria gonorrhaea) but cannot distinguish between drug-susceptible and antibiotic-resistant organisms. Hence, patients who were treated, and then went back to their doctors with the same symptoms, were assumed to have been cured and then reinfected. Physicians have not had the tools to identify ongoing infections that never responded to treatment — and patients who had those resistant, not-responding infections then went on to unknowingly infect others.
In order to address that problem, the plan calls specifically for improvements in lab capacity, diagnosis and surveillance, as well as asking for things that apply to the greater problem of antibiotic resistance: improved awareness, bigger efforts at prescribing antibiotics appropriately and better drugs. One thing that it particularly calls for — as the CDC did in the New England Journal last February — is for physicians to start applying a “test of cure,” actually checking microbiologically to see whether a patient who was prescribed an antibiotic for gonorrhea is clear of infection, or harboring a resistant strain.
Of course, that's expensive, too. The cheapest option is still to not get gonorrhea at all. Get tested. Make sure your partners are tested. And use protection. In the future, we're not going to be able to afford treating some STDs as "no big deal".
A key component of antibiotic resistance is the over-use of antibiotics. We talk about this a lot in the context of over-the-counter antibacterial cleansers, but there's a doctor's office side to this story, as well.
When sick people come into a doctor's office, part of what they are looking for is psychological wellness. They want to feel like somebody has listened to them and is doing something to treat their illness. Sometimes, that means they ask their doctor for antibiotics, even if antibiotics aren't the right thing to treat what they have.
In the past, and sometimes still today, doctors go ahead and prescribe antibiotics almost like a placebo. It's hard to say no to something a patient really wants, especially when it's likely to make them feel better—just because taking anything, and treating the problem, will make them feel better. But that is definitely not a good thing in the long term.
At KevinMD, family physician Dike Drummond offers some really nice advice for doctors who are struggling with how to make a patient feel better, but also want to avoid contributing to the growing antibiotic resistance problem. What I like best about Drummond's advice: It starts with empathy.
If you have a major challenge working up some empathy one of two things is happening.
You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.
You are not fully present with the patient and their experience. In many cases this can be addressed by taking a big relaxing, releasing breath between each patient and consciously coming back into the present before opening the door.
This came out while I was traveling, but I wanted to post it here in case you missed it. It is very cool, in that "maybe cool isn't the right word" sort of way. Our modern antibiotics are really just purified and pumped-up versions of naturally occurring compounds, right? So, it makes sense that, long before we started using them as antibiotics, bacteria had already started building defenses against the natural compounds. In other words: Antibiotic resistance is older than the use of antibiotics.