Trends by Martin Khor
Monday 19 March 2012
An end to modern medicine?
A warning by the head of the WHO that antibiotic resistance is so
serious it may lead to an end to modern medicine should alert health
authorities to contain this most serious health crisis.
Last week the head of the World Health Organisation sounded a large
alarm bell on how antibiotics may in future not work anymore, due
to resistance of bacteria to the medicines.
Antibiotic resistance has been a growing problem for some time now.
From time to time, there will be news reports of the outbreak of diseases,
old and new, that cannot be treated because the bacteria have grown
more powerful than the antibiotics used against them.
And experts have been warning about how the wrong use of antibiotics
has given the bacteria the opportunity to develop resistance, enabling
them to become immune to the medicines.
What is needed, of course, is a multi-prong strategy to prevent the
abuse and wrongful use of antibiotics. Drug companies should not
over-market their products. Doctors should not over-prescribe. And
antibiotics should not be used for animals that are not sick but to
fatten them and thus enable higher profits.
Now, the Director General of the WHO has given a big warning that
the growing threat of resistance may mean an end to modern medicine,
and the entry of the world into a post-antibiotic era.
Speaking at a meeting of infectious disease experts in Copenhagen
last week, Dr Margaret Chan said there is a global crisis in antibiotics
caused by rapidly evolving resistance among microbes responsible for
common infections that threaten to turn them into untreatable diseases.
Every antibiotic ever developed was at risk of becoming useless.
“A post-antibiotic era means in effect an end to modern medicine as
we know it. Things as common as strep throat or a child’s scratched
knee could once again kill. For patients infected with some drug
resistant pathogens, mortality has been shown to increase by around
“Some sophisticated interventions, like hip replacement, organ transplants,
cancer chemotherapy and care of pre-term infants, would become far
more difficult or even too dangerous to undertake.”
Dr Chan called for action to restrict the use of antibiotics in food
production. “Worldwide the fact that greater quantities of antibiotics
are used in healthy animals than in unhealthy humans is a cause for
great concern,” she said.
She called for measures including doctors prescribing antibiotics
appropriately, patients following their treatment and restrictions
on the use of antibiotics in animals.
These actions have in fact been suggested already for many years,
including by the health group REACT, based in Sweden, by health networks
such as Health Action International, and locally by the Consumers’
Association of Penang.
The WHO itself has the scope to do much more in alerting health authorities
and in building the capacity especially of developing countries to
There are forms of TB that have become untreatable because of multi-drug
resistance. The TB pathogen has become immune to many antibiotics.
This has resulted in a resurgence of the deadly disease. The story
is the same for many other pathogens causing other diseases.
As Global Trends reported in June 2011, a worrying development is
the discovery of a gene, known as NDM-1 that has the ability to alter
bacteria and make them highly resistant to all known drugs, including
the most potent antibiotics.
In 2010, there were reports of many cases in India and Pakistan and
in European countries. At the time, only two types of bacteria were
found to be hosting the NDM-1 gene – E Coli and Klebsiella pneumonia.
But it was then feared that the gene would transfer to other bacteria
as well, since it was found to easily jump from one type of bacteria
to another. If this happened, antibiotic resistance would spread rapidly,
making it difficult to treat many diseases.
These concerns have been proven to be justified. In May 2011, the
Times of India published an article based on interviews with British
scientists from Cardiff University who had first reported on NDM-1’s
The scientists found that the NDM-1 gene has been jumping among various
species of bacteria at a “superfast speed" and that it “has a
special quality to jump between species without much of a problem”.
While the gene was found only in E Coli when it was initially detected
in 2006, now the scientists had found NDM-1 in more than 20 different
species of bacteria. NDM1 can move at an unprecedented speed making
more and more species of bacteria drug-resistant.
there are very few new antibiotics in the pipeline, when the resistance
grows among the whole range of bacteria to the existing drugs, human
beings will be more and more at the mercy of the increasingly deadly
May 2011, there was an outbreak of a deadly disease caused by a new
strain of the E-Coli bacteria that killed more than 20 people and
affected another 2,000 in Germany.
They were affected by a new strain of the already rare 0104 type of
E-Coli. There are other common types of E Coli which normally cause
only a mild ailment. The WHO said the variant had “never been seen
in an outbreak situation before.”
Although the “normal” E-coli usually produces mild sickness in the
stomach, the new strain of E-Coli 0104 causes bloody diarrhoea and
severe stomach cramps, while in some of the more serious cases so
far it also causes haemolytic-uraemic syndrome (HUS), which damages
blood cells and the kidneys.
A major problem is that the bacterium is resistant to antibiotics.
Eradication of these kinds of bacteria is impractical partly because
they are able to evolve so rapidly, according to medical experts.
Now that the WHO chief has sounded the alarm bell, health authorities
should redouble their efforts to contain the crisis. An “end to modern
medicine” and a “post-antibiotic era” are predictions too horrible