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Article Review: "Imagining the Post-Antibiotics Future" by Maryn McKenna

While I’ve enjoyed every article in this book up to this point and have been nearly unfailing in my praise, I think I’ve finally hit a stinker here. The topic is antibiotic resistance, something that is enormously scary and lurking—if not looming—in the background as we speak. It is real and it is not going away. It is part of the nature of what antibiotics are and how they work, how we human behave and how microbes reproduce and evolve.

Author Maryn McKenna begins by describing how she found the story of a distant relative, a firefighter, who died in 1938 at the age of 30 from an infected cut he received when a brass hose nozzle fell on him. McKenna is saddened to think how easily such a cut could have been treated and her relative’s life presumably saved with penicillin, which was available only a few years later.

What she doesn’t mention is sulfa, an antimicrobial available in the 1930s that could possibly have saved his life. Was he treated with it? Or was the drug unavailable in light of the 1937 poisoning tragedy when sulfa mixed with diethylene glycol led to the deaths of at least 100 people (and, at least in part, to the passing of the 1938 Federal Food, Drug, and Cosmetic Act)? None of this gets a nod in McKenna’s article. Not that she has to discuss it, of course, but a discussion of sulfa drugs in addition to penicillin would shed light on her relative’s seemingly unnecessary and certainly untimely death.

McKenna writes of antibiotic resistance:

Health authorities have struggled to convince the public that this is a crisis. In September [2013], Dr. Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention, issued a blunt warning: “If we’re not careful, we will soon be in post-antibiotic era. For some patients and some microbes, we are already there.” The chief medical officer of the United Kingdom, Dame Sally Davies—who calls antibiotic resistance as serious a threat as terrorism—recently published a book in which she imagines what might come next. She sketches a world in which she imagines a world in which infection is so dangerous that anyone with even minor symptoms would be locked in confinement until they recover or die. (p. 190)

Resistance is caused by several mechanisms. First, by the antibiotic not killing the whole colony either by not being strong enough or by therapy ending before it’s killed off. This has the result of the stronger members living and producing stronger offspring. Because bacteria reproduce so much more quickly than humans, this effect can take place in observable time. It’s similar to breeding animals for a certain trait, only with a much shorter turnaround time.

Second, it can take place by overuse of antibiotics. If everyone is taking antibiotics, then the organisms that survive are those that have been through a baptism of fire for many, many generations. Bringing out bigger and bigger guns is the only way to get rid of them.

And McKenna points the finger a farm use of antibiotics. She cites the case of one 54-year-old inline skater with occasional diverticulosis problems. Diverticulosis is when bulges develop in the digestive tract. He had the misfortune of having one of his rupture and the contents spilling into his abdomen. What should have been normal E. coli bacteria were instead drug resistant E. coli.

[He] believes, though he has no evidence, that the bacteria in his gut became drug resistant because he ate meat from animals raised with routine antibiotic use. (p. 194)

The distinction that he has no evidence is an important one, because McKenna’s appeal is pretty much to the emotions. Her information is anecdotal, though true. At worst, I thought she was trying to arouse outrage as oppose to educate.

She paints the world of drug-resistance in black and white, as if all of a sudden, no antibiotic anywhere would be of effect against any disease. That is silly. Long before her bleak world of deciding: In a post-antibiotic era, would you mess around with your power tools? Let your kid climb a tree? Have another child? (p. 193), there will be new drugs and new combinations developed, new strategies developed such as the one used in Augmentin. Plus, it makes it sound as humans have no immune system at all.

There is little attempt to educate in this article, specifically, no attempt to describe the different between a virus and a bacterium, or to explain why antibiotics are useless to treat a viral infection. I’ve already noted the lack of mention of sulfa, or of its many uses aside from antimicrobial.

Granted, McKenna is free to write whatever kind of article she wants. The story of her relative is touching and sad—the death any 30-year man dying from an accident like this is regrettable at the very least. That he was a family man and a firefighter makes it all the more poignant and just a few years from a drug that could have saved his life…?

My contention is that to be included in The Best Science and Nature Writing of any year and it should contain for solid information and should not appeal so much to outrage. If anyone must take responsibility for anything it should be the reader to do his part. Just my humble opinion.

Forgive me for blathering so, and thank you to those who have made it this far.

Title: “Imagining the Post-Antibiotics Future”

Published in: The Best American Science and Nature Writing 2014

First Published: Medium Nov. 20, 2013

Author: Maryn McKenna



©2015 Denise Longrie

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Gossamer wrote on April 8, 2015, 5:53 PM

People look at me as if I'm lying or joking, or as if I have absolutely no idea what I'm talking about, when I tell them that antibiotics are useless against viruses. People in general are very uninformed and just want the (in their eyes) quick-fix solution to colds and flus (basically ANY illness, really) - go see the doctor, get a certificate for a few days off work, get a prescription for antibiotics. It's little wonder that things are headed the way they are.

msiduri wrote on April 8, 2015, 6:25 PM

My point exactly. Outrage is all well and good when there is reason to be outraged, but outrage without basic education is just lunacy. Because I worked in a pharmacy for so long (...too long... ) such distinctions were basic and I thought everybody was aware of them, but if the average Joe doesn't understand, then it's time he got an education. If this article is an example of the "best" science and nature writing, it's wonder Joe's in the dark.

AliCanary wrote on April 9, 2015, 12:21 AM

Although I also have worries about growing resistance to antibiotics due to zealous overuse and have actually written on the topic myself, I want to applaud you for bringing this writer to task--she is using emotionalism to spackle over her lack of facts, and in so doing, does a disservice to her aim of discouraging such overuse by sounding like an alarmist who uses exaggerated figures to whip up a panic. It's an important subject--TOO important to mess up by crying wolf.

AliCanary wrote on April 9, 2015, 12:25 AM

It blows my mind how few people grasp the solid fact that WE DON'T KNOW HOW TO KILL VIRUSES. Heck, we still aren't even sure they are actually alive, per se, as I understand it. That is why there is NO CURE for Ebola, AIDS, herpes, and the common cold. Doctors have to shoulder some of the blame, though, because they have allowed patients to bully them into prescribing unnecessary antibiotics on the thinking that "it won't hurt". I doubt they still think that--I hope not, anyway!

AliCanary wrote on April 9, 2015, 12:28 AM

PS - A minor aside, but is the title actually "Imaging..." and not "Imagining..."? I understand how both could work, but the latter seems more typical. I see you have it at the bottom, too, so that seems sure, but I just wondered.

msiduri wrote on April 9, 2015, 6:56 AM

Ah, curses. Thanks for the heads up.

msiduri wrote on April 9, 2015, 7:10 AM

Thanks for you kind words.

It strikes me that people don't realize that viruses and bacteria are two different animals, so to speak. A virus is, in short, a little bag of travelling DNA. One strategy that I heard one doctor use was that he wrote a prescriptions but asked the patient to fill is only if they showed signs of bacterial infection and listed them. That way, the patient didn't feel like the trip to the doctor was unnecessary, didn't spend money on a script unnecessarily and didn't take a/bs unnecessarily.

There are antiviral meds, i.e. Valtrex for herpes, Tamiflu for flu. These don't so much as cure, but control. They do prevent spread of the virus, however, and thus save people a lot of misery.

I've had problems with bronchitis in the past and have had pneumonia twice so I tend to be a little twitchy with nasty colds. I've been told by docs simply that what I have is a "viral infection," a politic way of saying "a cold." No one has offered me a/b, only cough syrup and advice to get rest.

Last Edited: April 9, 2015, 7:10 AM

Gossamer wrote on April 9, 2015, 9:32 AM

I tried to explain it to a colleague today. He kind of understood what I was saying, but gave his own case as an example. He had been (with a virus) to the doctor recently, who (quite rightly) prescribed paracetamol and rest. The next day he wasn't feeling any better, so he went back to the doctor and got a prescription for antibiotics. He says they worked. I didn't want to say it out loud to him, but I was thinking straight away "placebo effect!"

Last Edited: April 9, 2015, 9:34 AM

msiduri wrote on April 9, 2015, 9:42 AM

Or simply that the virus had run its course by then. *sigh* It's like the old joke about the guy who'd discovered the cure for the common cold. "Just give it 7-10 days to kick in..."