Exploring antibiotic resistance
2015; Elsevier BV; Volume: 3; Issue: 7 Linguagem: Inglês
10.1016/s2213-2600(15)00226-x
ISSN2213-2619
Autores Tópico(s)Antibiotic Use and Resistance
ResumoIt is partly the US Army's fault. They distributed penicillin during World War 2, in a decision quietly approved by Winston Churchill, to forestall Allied soldiers becoming casualties of their libidos. Later in the century, in Indochina, they handed out antibiotics to Vietnamese sex workers; a prophylactic measure to protect GIs unwilling to take prophylactic measures of their own. It worked, at least for the most part, but a subset of soldiers returned home with drug-resistant gonorrhoea. By 2011, reports were emerging of untreatable strains of the disease. Of course, the armed forces cannot shoulder all the blame. They might have been early adopters of mass antibiotic distribution, but their efforts pale into insignificance compared with meat farmers and primary care physicians.“It is a classic example of the tragedy of the commons”, points out one of the interviewees in Michael Graziano's stylish documentary film Resistance. The self-interest of the individual working in opposition to the interests of the community. But with antibiotics, opposing the interests of the community chips away at the foundations of public health. The documentary begins with a few facts about bacteria (none of which will come as a surprise to readers of The Lancet Respiratory Medicine). But it soon turns its attention to a likeable teenager named Jesse, who was diagnosed with antibiotic-resistant pneumonia in his right lung. “I kinda gave up, I guess”, he admits in a throaty Kentucky accent. His temperature soared, and he was pushed into a coma. Even today, the effects continue to trouble him. His lung is shrunken and sutured, and his body fixed with plates and screws. His parents fret that he might sustain injuries that cannot heal.The narrative flits back and forth between compelling personal tales of the toll of resistance and an exploration of how it came to be this way. Antibiotics have been smuggled into a startling array of products, including air filters, yoga mats, and calculators. Graziano is clear that the onset of resistance is a biological inevitability, but adeptly outlines the part over-prescription has played in exacerbating the problem.Much of the film is focussed on American agricultural practices. The country raises 9 billion animals for meat, dosing them with antibiotics, 80% of which are used non-therapeutically. “It makes about as much sense as sprinkling antibiotics on your children's cereal every day”, sighs Congresswoman Louise Slaughter. Farmers discovered that antibiotics worked as growth agents, as well as protecting animals from sickness. This protective effect meant that the unfortunate creatures could be crammed into industrial facilities—nearly all American meat is raised in such places. By 2011, 80% of antibiotics sold in the USA were used in farms.We learn that batches of ground turkey now bear traces of antibiotic-resistant salmonella. (“I will miss treating my ear infections with the Buffalo Ranch McChicken”, quipped comedian and television presenter Jon Stewart after McDonalds' announcement in March that it planned to cease using antibiotic-treated poultry). Statistics from Iowa, America's biggest pork-producing state, flesh out the story. From 1982 to 2007, the number of pork farms fell from 50 000 to 8000, and the price of a hog fell from US$240 to $109. Farmers were cornered, their margins were contracting every year. Antibiotics were a cheap way to help them scale-up production.Resistance is less assured when exploring the reasons why the US political establishment has failed to take action. It talks darkly of lobbying and powerful private interests, but there is little effort to come to grips with exactly how the food industry wields influence—a list of campaign donations, and an interview or two with politicians or industry executives would have made welcome additions to the film. Graziano lambasts the US Food and Drug Administration for assigning voluntary standards, but a passage examining Denmark's response to antimicrobial resistance notes that the farming industry stopped using antibiotics of their own volition.Perhaps the most telling moment occurs when one of the interviewees reveals that no single US agency is tasked with overseeing the use of antibiotics. He hastily adds that he is not advocating the creation of such an agency, and in doing so gives voice to a cultural wariness of state overreach. Couple this outlook to the way in which farming is bound up with American identity—“support your local farmer”, reads a rather cynical sign outside what looks far more like a chemical plant than a homestead—and it becomes apparent that this is an issue that has sprawled beyond the realms of public health and business. “The future of humanity and microbes likely will unfold as episodes of a suspense thriller that could be titled Our Wits versus Their Genes”, affirmed microbiologist and Nobel laureate Joshua Lederberg in 2000. This might only be the first act, but their genes have the upper hand.Resistance Michael Graziano 2015, USA, 72 minFor more about antibiotic resistance see Editorial Lancet Respir Med 2014; 2: 775 It is partly the US Army's fault. They distributed penicillin during World War 2, in a decision quietly approved by Winston Churchill, to forestall Allied soldiers becoming casualties of their libidos. Later in the century, in Indochina, they handed out antibiotics to Vietnamese sex workers; a prophylactic measure to protect GIs unwilling to take prophylactic measures of their own. It worked, at least for the most part, but a subset of soldiers returned home with drug-resistant gonorrhoea. By 2011, reports were emerging of untreatable strains of the disease. Of course, the armed forces cannot shoulder all the blame. They might have been early adopters of mass antibiotic distribution, but their efforts pale into insignificance compared with meat farmers and primary care physicians. “It is a classic example of the tragedy of the commons”, points out one of the interviewees in Michael Graziano's stylish documentary film Resistance. The self-interest of the individual working in opposition to the interests of the community. But with antibiotics, opposing the interests of the community chips away at the foundations of public health. The documentary begins with a few facts about bacteria (none of which will come as a surprise to readers of The Lancet Respiratory Medicine). But it soon turns its attention to a likeable teenager named Jesse, who was diagnosed with antibiotic-resistant pneumonia in his right lung. “I kinda gave up, I guess”, he admits in a throaty Kentucky accent. His temperature soared, and he was pushed into a coma. Even today, the effects continue to trouble him. His lung is shrunken and sutured, and his body fixed with plates and screws. His parents fret that he might sustain injuries that cannot heal. The narrative flits back and forth between compelling personal tales of the toll of resistance and an exploration of how it came to be this way. Antibiotics have been smuggled into a startling array of products, including air filters, yoga mats, and calculators. Graziano is clear that the onset of resistance is a biological inevitability, but adeptly outlines the part over-prescription has played in exacerbating the problem. Much of the film is focussed on American agricultural practices. The country raises 9 billion animals for meat, dosing them with antibiotics, 80% of which are used non-therapeutically. “It makes about as much sense as sprinkling antibiotics on your children's cereal every day”, sighs Congresswoman Louise Slaughter. Farmers discovered that antibiotics worked as growth agents, as well as protecting animals from sickness. This protective effect meant that the unfortunate creatures could be crammed into industrial facilities—nearly all American meat is raised in such places. By 2011, 80% of antibiotics sold in the USA were used in farms. We learn that batches of ground turkey now bear traces of antibiotic-resistant salmonella. (“I will miss treating my ear infections with the Buffalo Ranch McChicken”, quipped comedian and television presenter Jon Stewart after McDonalds' announcement in March that it planned to cease using antibiotic-treated poultry). Statistics from Iowa, America's biggest pork-producing state, flesh out the story. From 1982 to 2007, the number of pork farms fell from 50 000 to 8000, and the price of a hog fell from US$240 to $109. Farmers were cornered, their margins were contracting every year. Antibiotics were a cheap way to help them scale-up production. Resistance is less assured when exploring the reasons why the US political establishment has failed to take action. It talks darkly of lobbying and powerful private interests, but there is little effort to come to grips with exactly how the food industry wields influence—a list of campaign donations, and an interview or two with politicians or industry executives would have made welcome additions to the film. Graziano lambasts the US Food and Drug Administration for assigning voluntary standards, but a passage examining Denmark's response to antimicrobial resistance notes that the farming industry stopped using antibiotics of their own volition. Perhaps the most telling moment occurs when one of the interviewees reveals that no single US agency is tasked with overseeing the use of antibiotics. He hastily adds that he is not advocating the creation of such an agency, and in doing so gives voice to a cultural wariness of state overreach. Couple this outlook to the way in which farming is bound up with American identity—“support your local farmer”, reads a rather cynical sign outside what looks far more like a chemical plant than a homestead—and it becomes apparent that this is an issue that has sprawled beyond the realms of public health and business. “The future of humanity and microbes likely will unfold as episodes of a suspense thriller that could be titled Our Wits versus Their Genes”, affirmed microbiologist and Nobel laureate Joshua Lederberg in 2000. This might only be the first act, but their genes have the upper hand. Resistance Michael Graziano 2015, USA, 72 minFor more about antibiotic resistance see Editorial Lancet Respir Med 2014; 2: 775 Resistance Michael Graziano 2015, USA, 72 minFor more about antibiotic resistance see Editorial Lancet Respir Med 2014; 2: 775 Resistance Michael Graziano 2015, USA, 72 min For more about antibiotic resistance see Editorial Lancet Respir Med 2014; 2: 775
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