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Peak medicine

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One of the central themes of The Consciousness of Sheep is that systems fail at their weakest point.  When they do, there is often a cascading knock-on effect in which things that had been taken for granted suddenly become impossible.  For example, during the UK fuel crisis in September 2000, while hospital managers were looking at obvious threats such as not being able to run ambulances or having back-up generators run out of diesel, several hospitals were unable to operate because of a shortage of surgical suture (the material used to stitch up wounds).  The absence of a common item that is used in almost all surgical procedures, and that was routinely taken for granted was sufficient to all but close a hospital facility.

For the moment, surgical suture is in plentiful supply.  However, there is another common item that is taken for granted in medicine.  And while it is not in short supply, it may soon be rendered almost useless for a different reason.  England’s chief medical officer, Professor Dame Sally Davies warns that we face a global “post-antibiotic apocalypse” unless there is global action to manage the use of antibiotics and to stimulate research into a new generation of drugs to combat a rising tide of antibiotic-resistant bacterial infections.  According to Davies:

“Around 700,000 people around the world die annually due to drug-resistant infections including tuberculosis (TB), HIV and malaria.  If no action is taken, it has been estimated that drug-resistant infections will kill 10 million people a year by 2050.”

While many medical treatments would still be possible without antibiotics, they would be far more dangerous than they are today.  This could spell the end of modern medicine:

“Without the drugs used to fight infections, common medical interventions such as caesarean sections, cancer treatments and hip replacements would become incredibly risky, and transplant medicine would be a thing of the past.”

Mainstream media coverage in the UK has focused on the myth of doctors handing out too many unnecessary prescriptions for viral infections (which cannot be treated with antibiotics); together with patients who do not follow treatment instructions.  However, these are far smaller problems compared to the vast quantities of antibiotics used in the global livestock industry.  Moreover, the UK – where antibiotics are only available on prescription – has successfully reduced use.  Unfortunately, elsewhere in the world antibiotics are still available for sale on the open market… and drug-resistant diseases don’t need passports.

The latest edition of the UK government’s National Risk Register (which serves as public guidance) puts the risk of pandemics second only to terrorism.  However, while terrorism tends to be localised and limited, pandemics are expected to have the most severe impact.  The report raises a particular concern with what it refers to as “antimicrobial resistance” (AMR):

“AMR is a term to describe the process where drugs are no longer effective in treating infections caused by micro-organisms such as bacteria, viruses or parasites. Without effective antibiotics even minor surgery and routine operations could become high-risk procedures, leading to prolonged illnesses and higher numbers of deaths. The number of antibiotic-resistant infections is expected to increase markedly over the next 20 years.”

The exact impact of antibiotic resistance is unknown.  Certainly a pandemic would be obviously devastating.  As an example, the UK government expects a death toll of up to 750,000 people from an influenza pandemic.  A life-threatening antibiotic resistant bacteria might be at least as devastating.  However, the wider – if less obvious – risk comes from the increased mortality rate from routine treatments.  People who today routinely survive accidents or complications with surgery or childbirth will become infected and will eventually die.  Those who survive will be maimed.  This, in turn, impacts the wider community and economy – people who were doing important work are simply not there anymore.

Take away the antibiotics and we will return to the kind of medicine that prevailed in the early twentieth century, when infant death was to be expected, and relatively few adults survived into old age.  However, we continue to consume antibiotics as if they will go on working forever.  Meanwhile, a profit-driven pharmaceutical industry that sees little value in researching new antibiotics that will only be used when all else fails, has invested its efforts elsewhere instead.

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