The Antibiotics Problem

When Sally Davies, the chief medical officer for England, said that antibiotic resistance is a ‘ticking time-bomb’, that it could mean a return to 19th-century treatments for infection, and that as a threat it ranks alongside terrorism, she made sure her message was heeded and that Volume Two of her Annual Report would be noticed.

Her saying that a hip replacement operation could be lethal helped propel the issue to the top of the news. But it was unfair to orthopaedic surgeons. Ever since the surgery was developed they have been obsessed with preventing infection. They count an infection rate greater than 1 per cent as a failure; and antibiotics on their own don’t work at all well when metalwork is there.

But it is easy to guess why Davies used this example. She was speaking to politicians and Treasury officials, many of whom will need new hips and knees fairly soon. By scaring them she hopes to avoid the fate of the first chief medical officer, John Simon, who in 1871 wanted to appoint half a dozen new inspectors, increase the gratuities paid to public vaccinators and raise the number of clerical staff to three. He was castigated in a Treasury minute:

The Health Department is proclaiming the same sort of unlimited missionary activity as has inflamed the estimates of the Science and Art Department, which now alarm the Chancellor of the Exchequer.

Davies’s report is full of good stuff. It points out that while targets and political attention to MRSA and Clostridium difficile have paid off, bigger problems are being caused by gram negative organisms. They live in our guts, where they exchange antibiotic resistance genes with abandon. Even worse, all the obvious weaknesses in bacteria that can be attacked by antibiotics have already been targeted. So the development of new drugs is very difficult. And antibiotics are not good business for Big Pharma, because they cure patients quickly, unlike blood pressure pills and all the other drugs that are taken for life.

Davies’s recommendation that antibiotic resistance should be put in the national risk register is very reasonable. It could even be said that there is a better case for it to be there than an influenza pandemic, which tops the current list, because our ability to prevent flu by vaccines and antivirals, and the outcomes of treatment, are improving all the time, whereas for antibiotic resistance a pessimistic policy is the only prudent one.