Superbugs

“Jaded Julie, a couple of weeks ago Mrs. Curmudgeon had some minor surgery, and I was really concerned.”

“Why should you be concerned, Curmudge? It was performed by an experienced surgeon, in a hospital that you respect, and the three little incisions were less than an inch long.”

“Perhaps I’m just an old worry-wart, but I was concerned that my wife might contract a nosocomial infection. I read a lot about infections a couple of years ago, and we talked about them on January 29 and February 5, 2009. It’s still a hot topic in the literature, and I read some newer stuff last month. When it comes to nosocomial infections, one may be either concerned or clueless; there’s no middle ground.”

“Despite your advanced age, Curmudge, you are rarely clueless. That makes me concerned as well. So what did you read that put the pepper in your Metamucil?”

“Dr. David Shlaes, MD, PhD has spent his career in the development of antibiotics, and he recently published a book, Antibiotics-the Perfect Storm. The book’s price as around $150, so I’ve had to be satisfied with reading his blog by the same name.”

“So what is the good doctor’s thesis, Curmudge? It must be mighty serious if he calls it a perfect storm.”

“Despite the appearance of new drug-resistant bacteria almost every day, the major pharmaceutical companies in the U.S. are abandoning the development of new antibiotics. If this continues, we’ll soon be as defenseless against these new ‘superbugs’ as we were against their predecessors 100 years ago.”

“I now appreciate your concern. But why are the drug companies getting away from antibiotics?”

“It’s a matter of economics, Julie. When a new drug is developed for a chronic illness, a patient might take it (buy it) for the rest of his life. Contrast that against a new antibiotic; the patient will take it for perhaps two weeks or until the infection is cured. With the latter scenario it’s very hard for the company to sell enough of the drug at a reasonable price to recoup its multi-million dollar development cost.”

“As I understand it, Curmudge, clinical trials are an essential and expensive part of new drug development. We talked about trials just a few weeks ago, on September 30. They are required to prove the drug’s safety and effectiveness.”

“The drug people call that efficacy, Julie. Recruiting participants for the traditional clinical trial of an antibiotic is especially difficult. People with a potentially deadly infection would be reluctant to join a trial in which they had only a 50% probability of receiving the medication. Those in the control group might die before the trial’s conclusion.”

“So what’s the answer? Or to use a term you brought from industry, what’s the path forward?”

“Approaches to this problem involve definitions of safety and efficacy, trial design, ethics, and controversy. Any one of these puts their discussion beyond the scope of this blog. I invite you to read Dr. Shlaes’ blog, or if your rich uncle just died, his book. If you need some grisly statistics to catalyze your concern, consider these from the Centers for Disease Control: ‘As many as 90,000 people die in the nation’s hospitals every year from bacterial infections. About 70,000 of these deaths are from drug-resistant bacteria—well above the 58,000 U.S. soldiers who died during the Vietnam War era.’”

“Okay, Curmudge, you’ve really got my attention.”

“Here’s another statistic that I’ve been thinking about in recent weeks: ‘Of all the complications that occur in the 30 days after surgery, such as infection and blood clots, almost half will surface after the patient leaves the hospital.’(1) That’s why I scrubbed my hands thoroughly before I changed the dressings on Mrs. Curmudgeon’s incisions.”

Affinity’s Kaizen Curmudgeon

(1) Landro, L. Patient, Heal Thyself. Wall Street Journal, October 26, 2010.