As Good as it Gets

WASHINGTON, D.C.: In the spring of 2015 President Obama convened a news conference where he addressed, in his words, “an issue of great importance to the public health of America and the world … [i.e.] antibiotics becoming less effective … one of the most serious public health issues we face today.”

Seated to his immediate left was DHSS Secretary Sylvia Burwell, a fellow graduate of Harvard, and also of Oxford, where she attended as a Rhodes Scholar. Together, they unfurled his National Action Plan for Combating Antibiotic-Resistant Bacteria, “a product of extraordinary work,” Obama continued, “from some of our top scientists … that covers the next five years starting right now.”

Presciently noting that “this is a problem that doesn’t always rise to the top of people’s day-to-day concerns until somebody in their family is impacted,” just last week the CDC presented us with an uncomfortable truth: An elderly woman (her name wasn’t released) in Nevada died of a bacterial infection that defeated every antibiotic in our arsenal – 26 of them in all.

Speaking about this woman’s death to Stat News, Lance Price, head of the Antibiotic Resistance Action Center at George Washington University, said “If we’re waiting for some sort of major signal that we need to attack this internationally, we need an aggressive program, both domestically and internationally to attack this problem, here’s one more signal that we need to do that.”

Here’s the thing: As of tomorrow, a new U.S. president will be sworn in. And it’s the right of every incoming administration to set their own policy and priorities. We know, for example, that they want to dismantle the Affordable Care Act. However, we don’t yet know their attitude towards the problem of antibiotic resistance in general and Obama’s National Action Plan to combat it, in particular. We do know that the incoming administration has yet to appoint just 3 cabinet members, and the presidential science advisor — head of the group that developed the National Action Plan — is one of them.

Obama’s science and technology teams were filled with our best and brightest, just one reason why that community saw him as “setting the modern standard” when it came to science. Under him it was as good as it gets. And so for that reason and because it’s President Barack Obama’s final day in office he gets the last word:

“We take antibiotics for granted for a lot of illnesses that can be deadly or debilitating and we’re extraordinarily fortunate to have been living in a period where our antibiotics worked … [Antibiotic resistance] is something we have to take seriously now and invest in now. If we do, then I’m confident we’re going to be able to deal w this effectively. If we don’t, if we put this off, there’s going to be a major public health problem and it’ll be a lot harder to solve.”

 

The Political Page: Will President-Elect Trump Appoint a Science Advisor?

pcast

 

Last night, in President Obama’s moving farewell address, he said that “science and reason matter,” and using climate change as an example he outlined what happens when you operate without them: “… without bolder action, our children won’t have time to debate the existence of climate change. They’ll be busy dealing with its effects: more environmental disasters, more economic disruptions, waves of climate refugees seeking sanctuary.”

Climate change wasn’t the only science-related action that Obama took during his tenure. Less noticed was his unprecedented work on antibiotic resistance. Calling it “one of the most pressing public health issues facing the world today,” he developed a National Action Plan to Combat Antibiotic-Resistant Bacteria. To carry it out he proposed almost doubling the Department of Health and Human Services budget in FY 2016 to an unprecedented $1.2 billion.

Obama’s action on antibiotic resistance was driven by the President’s Council of Advisors on Science and Technology (PCAST), composed of, during Obama’s tenure, the nation’s best and brightest. For example, the co-chairs of PCAST are the president’s Science Advisor, John Holdren, PhD, who taught at Harvard prior to his appointment; and Eric Lander, PhD, of MIT and Harvard.

When Obama rolled out his National Action Plan on antibiotic resistance in 2015, Lander commented:

 

There is no permanent victory against microbes. If you use antibiotics, whether in human health care or in agriculture, you will over time see resistance. If we fail, if we fall behind in our stewardship, in our creation [of new antibiotics or equivalent therapies], or if we fail to surveil to understand what’s going on, it’s a very real risk to see a resurgence of what life looked like a century ago when we had bugs we could not treat. It’s a terrifying prospect. Now … it doesn’t help to do scare tactics around these things but it’s just plain scary.

 

But we have a problem: As of today, there are still three positions left unfilled in the incoming Administration and Science Advisor is one of them. And thus the question, where will we be without a Science Advisor and PCAST?

The online journal Science reports that more than two dozen U.S. scientific organizations have written the President-elect urging him to act quickly. They worry that a long delay on key appointments could mean science will take a back seat in policy deliberations by the new administration.

The reality is that superbugs are getting stronger, defeating our last resort antibiotics. More federal support is needed to develop new drugs and to carry out evidence-based programs that work in fighting antibiotic resistance — that’s the argument made in this informative year-end essay in Medscape News.

We either confront that reality — with a Science Advisor’s guiding hand — or the consequence will be, as the President warned the nation last night: “ … as my mother used to tell me, reality has a way of catching up with you.”

 

 

 

 

 

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