Why health panics are so often wrong
Let nobody accuse professional healthcare officials of being unproductive. They diligently produce what they are good at producing -- dire warnings of disaster.
There have been Ebola virus, Lassa fever, swine flu, bird flu, swine flu again, SARS, the human form of mad cow disease, and many more such scares. Every single one proved exaggerated -- greatly, vastly so.
To add insult to injury, when each scare fails to materialise, officials close ranks and congratulate themselves on averting it. The latest example is Britain's insulting official review of the swine flu fiasco, as described by Michael Fitzpatrick in Spiked:
The independent review of the UK response to the 2009 pandemic carried out by the former Welsh chief medical officer, Dame Deirdre Hine, concludes that ‘overall the UK response was highly satisfactory’: ‘The planning for the pandemic was well developed, the personnel involved were fully prepared, the scientific advice provided was expert, communication was excellent, the NHS and public health services right across the UK and their suppliers responded splendidly and the public response was calm and collaborative.’ Splendid!
Remember this was after spending an estimated £1.2 billion of your and my money on something that lost of us thought would prove a non-event from the start. Such complacency is infuriating.
The latest scare is an antibiotic resistant strain of bacterium called `New Delhi Metallo-beta-lactamase 1-positive'. It is said to be spreading among ‘medical tourists’ travelling to India for cosmetic surgery, and it presages the end of civilisation, according to Tim Walsh in Lancet Infectious Diseases last week:
In many ways, this is it. This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing Enterobacteriaceae.
Antibiotic resistant strains of bacteria have been a threat for decades and these apocalyptic cries of wolf are getting tiresome. Resistance is an evolutionary phenomenon. We expose billions of bacteria to intensely strong selection pressure in a tempting environment (hospitals, with a procession of patients with open wounds in shared rooms) and -- behold -- we select for strains that thrive on our antibiotics. So we invent new antibioitics and the arms race continues.
Cvilisation does not end, for three reasons. First, we keep inventing new antibiotics. Second, we get better at hygiene. Remember, it was antiseptic practice that first made hospitals safe place to be ill, not drugs. So even if the supply of new antibioitcs does dry up, as we have been told for decades it will, we need not be back to medieval levels of disease, just early 20th century levels. Third -- and here is a fact no journalist ever, ever remembers to pass on to readers -- antibiotic resistance goes away if you stop using the antibiotic.
When you take the selection pressure that selected for a trait away, the trait gradually vanishes -- especially if the trait is energetically expensive, as antibiotic resistance is for bacetria. For example, here's a report from the literature:
Precipitous declines first in the numbers of isolates with high-level resistance (from 31% to 4%) and then in those with low-level resistance (from 26% to 10%) accompanied prescription control.
and here's the title of a paper published last month:
The Decline of Pneumococcal Resistance after Cessation of Mass Antibiotic Distributions for Trachoma
If you stop using an antibiotics, resistance will gradually decline. Surely we can recruit evolution to our cause in our arms race. That is to say, we can accelerate the decline by ingeniously setting up the selection pressure so that resistant strains die out. I don't know how -- we need to somehow reward bacteria for being susceptible. Have a secure place in each hospital where we breed the darned things and let them out to compete with their resistant conspecifics? Sounds weird, I admit, but we need more health professionals to start understanding evolution so they can think their way to solutions.
If health officials learned just a little about evolution they might also be less panicky and financially profligate when confronted with flu scares. In normal times and normal societies, flu strains MUST evolve towards low virulence, because in victims who are still leading normal lives, they will encounter more new victims. That is true of all casual contact diseases (hence the mildness of all colds), though not of insect-borne, sexually transmitted or water-borne diseases -- which often thrive when their victims are immobilised and moribund. The peculiar conditions of first-world-war field hospitals, with nurses moving between the injured and huge fresh supplies of injured people, undoubtedly selected for an unusually virulent strain on flu. In a strain spreading in normal society, that will not happen.
Comments (9)
The current Healthcare officials generate too much flues and un-remedy disease, expecially AIDS, many of them come from drugs, and I think our fight to drug is failed now.
The fee of having a medical treatment is so expensive, not all people can support, there are a lot of poor guies in the world are suffering the modern diseases, maybe learn some knowledge from tranditional medical system is a doable way.
Let's do some work help people on healthy!
Hageladuki
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Agreed. I had the same argument a week ago with a friend who posted this article from the Guardian:
http://www.guardian.co.uk/society/2010/aug/12/the-end-of-antibiotics-hea...
"Peak antibiotics" is as unlikely as "peak oil".
There is no incentives for these guys to behave sensibly. It's really up to everyone of us - the great unwashed - to exchange ideas laterally among ourselves without deferring to these sorry uninformed and biased gate-keepers. In other words, we need a bottom-up approach to public health care.
A good article again, after the silly last one http://www.rationaloptimist.com/blog/prosperity-friend-wildlife
If it wasn't for the lack of help for people who actually get such a "scare"-disease, one could actually make fun of all the hysteria. The problem is, that our governments are structured and expected to over-react to even the smallest problem, if the population sees it as a thread. The sad truth is that real problems, that are far more complex and outside the public's short attention span, don't enter into official problem-solving efforts as much as necessary.
Wait, does somebody mean traditional methods of medicine to be utilized in a doable way supposedly? At what cost to the patient? It will take some work on those methods in order to stay healthy. Is it really possible? Is it really effective against various diseases?
It is too much politicking that delays efforts of people in the medical profession and us ordinary people in preventing such diseases whenever there is trouble. So how come the promoters of traditional medicine want us to make magic out of plants or something else and look good to people's health? Are such methods truly effective?
The acrimonious debates have not been settled because of the junk scientific biases, and I personally predict that if some people continue to commit such mistakes in promoting traditional methods of medicine (eg. herbal medicine), they might as well pay the price for risk aversion, questionable practices, quackery, ripoffs, etc.
Obviously, the real problems LifeScienTology claims "don't enter into official problem-solving efforts as much as necessary". Are the claims true? More on this soon.
Looking back the path of life, one can see that conditions of the past was more difficut than now. In other words, we can say that the living standards have been improved since long ago.
Now, a home to shelter after work even at any time when we want to, abundant things in a refrigerator, a comfortable sofa in front of a big TV which has over 30 channels, cooling fans in winter, warm floor by centrally controlled heating system, meals with fresh foods, meats,soups, side dishes, drinks with wife and lastly favorate tobacco.
The last dream that African can enjoy their lives as much as American, can be come true by the progress of science which has made us live more luxuriously than Louix 16th.
This issue has been one of the "complaining points" among those of us in the medical field for years. Years ago it was common knowledge that if we could just put a few antibiotics on a sabbatical, the resistance to those antibiotics would drop by the mechanisms you described. Then when they are returned into rotation they would be more effective, almost as if they were a novel treatment. Penicillin was invented in 1928 and the bacteria have had since then (millions of generations) to develop their defenses.
The difficult part (especially here in the US), is convincing a capitalism loving drug company to stop making an antibiotic for several years for the greater good. My guess is that it will take some sort of subsidy to those companies. With the increasing globalization of our world, it will also need to be a coordinated effort to decrease the use of certain antibiotics for a pre-determined period.
I would love the irony of bringing penicillin back from a sabbatical 10 years from now and having it be the new "super drug" used to treat highly resistant infections, for pennies on the dollar!
I think you were right on track until your last sentence:
The peculiar conditions of first-world-war field hospitals, with nurses moving between the injured and huge fresh supplies of injured people, undoubtedly selected for an unusually virulent strain on flu. In a strain spreading in normal society, that will not happen.
You might want to do a little more homework on 1918 - especially now that we have the 1918 virus and will (optimistically) be able to determine why it was so virulent. Nurses moving between injured people is not on the list, and to think that another strain like 1918 H1 would not emerge 'in normal society' smacks at best of hubris and at worst of ignorance.
The pharmaceutical and medical industry often thrive in a climate of fear. There is a popular myth that these companies, together with media companies and the government, are spreading fear in order to encourage domestic spending to boost the economy. Whether this is true, I feel the research money could have better used for find the cures for other age old diseases like AIDS, Parkinsons and the like.