LESS IS MORE

it is not often that the conclusions of an important report are prefaced by
the words: "This inquiry has been an alarming experienceŠ", especially when
those responsible are the members of the House of Lords Select Committee on
Science and Technology.

But these peers--who include many renowned scientists and doctors among
their number--have every reason to be alarmed. They have confronted the
dreadful prospect that resistance to antibiotics is spreading widely, that
some poorer parts of the world have already been plunged back into the era
before antibiotics, and that early next century there may come a time when
resistant bacteria appear faster than the drugs to treat them.

Some degree of resistance is inevitable. But, as the report explains, the
West has made the spread of resistance worse through careless
overprescribing by doctors, perhaps by the use of antibiotics to speed the
growth of farm animals, and in Britain, by cuts in the National Health
Service that have helped some hospitals become reservoirs of
antibiotic-resistant bacteria.

This news will not surprise many scientists who have been invited to
conference after conference on the subject over the past few years. But it
will be a profound shock for a public that takes antibiotics so completely
for granted that they cannot imagine what life would be like without them.

Perhaps they should ask those who can remember the 1920s. Then,
tuberculosis meant isolation in a sanatorium until you died or cured
yourself, simple hospital operations could mean death by infection, cuts
and scratches might result in fatal septicaemia and syphilis often ended in
insanity.

If we want to keep antibiotics effective, national and global action will
be necessary. First, we must accept that there are good reasons for
reducing the use of antibiotics to a minimum. The inquiry heard that
doctors often prescribe antibiotics because patients ask for them and that
explaining why it might be better not to use them just takes too much time.
Doctors themselves have often been too long out of college to fully
understand the risks of the spread of resistance. The cures are obvious:
media campaigns, posters in every doctor's waiting room and re-education
courses for doctors themselves.

Secondly, the use of antibiotics in farm animals needs to be controlled
much more tightly. At the very least, animals and humans should not be
given related antibiotics (New Scientist print edition 25 April p 4). But
in the longer term, the regular use of antibiotics as "growth promoters"
will probably have to end, as it already has in Sweden. The evidence that
resistance has spread from animals to humans is limited. But there is a
terrifying possibility that bacteria in animals being fed antibiotics could
evolve some very general resistance mechanism, such as the ability to pump
antibiotic out of themselves. Resistance to whole classes of antibiotics
might thus appear, spread to humans and wipe out established disease
treatments.

Thirdly, hospitals in Britain and elsewhere need to relearn old hygiene
skills and reduce dependence on antibiotics. Conditions described in the
report would make Florence Nightingale turn in her grave. Cost-cutting in
Britain means that hospitals are not properly cleaned, beds are too close
together, and "hot bedding"--where patients move around the hospital as
beds become free--spreads infections everywhere. Isolation wards have
vanished to save money and basic standards, such as washing hands between
patients, have slipped.

With an educated public and tighter control of usage, could antibiotic
resistance be not just controlled but reduced? Optimists suggest when a
bacterium acquires genes to provide resistance it does so at a cost, so
that resistant bacteria would once again be replaced by non-resistant ones
if the use of a particular antibiotic was stopped. That would mean we could
stay ahead of disease by carefully revolving the use of different
antibiotics. Unfortunately, the latest evidence suggests that some bacteria
can simply acquire other mutations that allow them to keep resistance at
little cost.

If that is generally true, then the future looks grim. Some bits of the
world are already experiencing the horrors that result when drugs fail. In
Tadzhikistan, a strain of typhoid fever has emerged that is resistant to
every known antibiotic. One drugs company told the inquiry that between
2000 and 2007, multiresistant organisms will emerge "without parallel
progress in the introduction of new antibiotic classes". We have been
warned.