Act Now or Pay Later

The science community is begging us to understand that the standard risk assessments coming out of Washington about what really threatens to harm us are not just wrong, but that if we don’t heed what really matters, the DC consensus will also prove to be tragically wrong. The latest evidence in support of this view comes to us in a recently-released book and in an upcoming documentary film.

Deadliest Enemy 2In “Deadliest Enemy: Our War Against Killer Germs,” Dr. Michael Osterholm, founding director of the Infectious Disease Center for Research & Policy at the University of Minnesota, says that “infectious disease is the deadliest enemy faced by all of human kind,” because it has “the potential to alter the day to day functioning of society, halt travel, trade, and industry, or foster political instability.

In Osterholm’s view “there are only two microbial threats that … fit this description” for pandemic potential. One is “antimicrobial resistance and the very real threat of moving ever closer to a ‘post-antibiotic era’ … a world more like that of our great-grandparents where deaths due to infectious diseases we now consider treatable are once again commonplace.”

The other is influenza, “the one respiratory-transmitted infection that can spread around the world in short order and strike with lethal force.” Some variant of the bird flu, for example.

The pandemic potential of infectious disease is also the subject of the documentary “Unseen Enemy” whose global broadcast on CNN is April 7 in the US & Canada. The film is endorsed by the prestigious National Academy of Medicine who are holding an advance screening in Washington on April 3, which will include a panel discussion of experts moderated by Dr. Sanjay Gupta. Presumably it will be available on CNN at a later date.

It’s important to understand that what’s driving this pandemic potential is us. The filmmakers sum it up nicely: “Population growth, mass urbanization, deforestation, climate change and increased travel have dramatically increased the risk that familiar diseases will spread and mutate, and new ones will emerge. As people enter new spheres of biodiversity, they come into closer contact with other species, allowing viruses to jump from animals to humans and then spread more widely.”

One more thing. Pandemics are about more than just numbers or the disease itself. They’re also about how they scar our psyche with fear, suspicion, and even panic; for example, the Ebola scare of 2014. Take a look at this CBS report that came out at the time, “Ebola Panic Spreading Much Faster than Disease in U.S.,” which reads, in part, “The threat of Ebola is generating a considerable amount of fear and misinformation across the country, not to mention a growing number of false alarms. Fears about Ebola have reached a fever pitch in recent days.”

Here’s the thing: all that countrywide fear – yet there was only one case of Ebola that ever arose within the borders of the United States.

The films must-see trailer says we either get on board with this issue now or we’re gonna pay for it later.

(Dr. Osterholm’s book deserves fuller treatment & will be the subject of a future column.)

Medical Self-Defense: Your GP probably shouldn’t be allowed to prescribe antibiotics as they’re not the drug we thought they were. This means you have to learn about them.

Interesting perspective, as always (e.g. here & here), from Brad Spellberg, MD, Chief Medical Officer of the Los Angeles County-USC Medical Center, on how to fix the overprescription problem of handing out antibiotics like candy “just-in-case“: only allow the infectious disease specialist to prescribe them.

In an interview with Open Forum Infectious Diseases, the impeccably qualified Dr. Spellberg put it this way:

 

Oncologists don’t let non-oncologists prescribe chemotherapy. The single biggest mistake that our specialty made over decades and decades is that we’ve allowed anyone to prescribe these drugs, and the perception has been that they’re so safe and so effective you don’t need to be an expert in them. The result of that is a complete lack of control of use.

And you know as well as I Paul when you’re rounding on ID and you get consults and you go, “I can’t believe the drugs these folks are using.” Well, if we had the ability to say, “No you don’t get to use those drugs, only we can authorize the use of those drugs,” we would have a much better ability to protect these drugs.

 

Here’s the problem Spellberg’s addressing: Around a third of all antibiotic prescriptions handed out in the U.S. are done so in error. It’s either the wrong drug, the wrong duration, the wrong dosage, or the antibiotic shouldn’t have been given out in the first place, typically because the illness is viral, not bacterial. As a consequence, we’re losing our antibiotics. And since they’re wedded to the everyday practice of medicine – e.g. to prevent infections in surgeries, burn patients, & cancer patients undergoing chemo – the loss of them would mean a serious decline in health care, and perhaps something worse than that.

Spellberg concedes that “the cat is out of the bag,” that we’re not going to be able to take away the antibiotic prescription privilege from the family doctor. Therefore, Spellberg implies, we need to practice medical self-defense. In the same way that we learn good health habits, basic first aid & CPR, we simply have to learn when and when not to use antibiotics. It’s actually not very hard, and it’s interesting stuff. Here’s the short version, from the CDC. But the best messaging out there – this is interesting – remains this eye-opening public forum put on by the Harvard School of Public Health. Don’t be intimidated because it’s Harvard. The discussion is for everyone. And it’s got it all. Our take on it is here.

 

The W.H.O. Issues a Plea to Governments Across the World to Target 12 Superbugs

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Yesterday, the World Health Organization published its first ever list (below) of antibiotic-resistant “priority pathogens” – a catalogue of 12 families of bacteria that pose the greatest threat to human health.

The 12 bugs on the list are classified as critical, high and medium priority, based on their level of resistance to treatment, their mortality rates, their prevalence in the community, and the burden on the health system they cause.

MRSA is listed as a high priority, i.e. those bacteria that cause a large number of deaths and infections in otherwise healthy people. The US Centers for Disease Control said the same thing in 2013 when it ranked superbugs having the most impact on human health. The CDC Threat Report also used 3 categories – Urgent, Serious, and Concerning – and ranked MRSA’s threat level as “Serious” on the basis that (1) it alone is responsible for about half of the 23,000 deaths caused each year in the US by antibiotic-resistant bacteria, and (2) it causes more than 80,000 serious infections each year.

However, there’s a crucial difference between the WHO and CDC reports: The WHO’s intent is to “spur governments to put in place policies that incentivize basic science and advanced research and development.” Dr. Marie-Paule Kieny, WHO’s Assistant Director-General explains:

Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.

The science community believes that because antibiotic-resistant bacteria are a global issue, that the solution has to be global too; namely, a coordinated game plan that’s bought into by world governments, especially the major players on the global stage.

Which brings us to our problem – the United States, and whether or not they’re willing to play ball.

In 2015 the Obama administration rolled out its National Action Plan for Combating Antibiotic-Resistant Bacteria, a 5-year strategy to address what the president called “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.” The plan was quarterbacked by the president’s science advisor, John Holdren, PhD, and the President’s Council of Advisors on Science and Technology (PCAST).

As of today, however, there’s still no presidential science advisor. The Action Plan and PCAST are in limbo. For this and other reasons, US scientists are livid and in an unprecedented move will march on Washington on April 22 to publicly air their concerns.

All of this matters because according to a highly-regarded UK government report, antibiotic-resistant disease will cause more deaths than cancer by 2050.

Yesterday’s report by the WHO was a call to action to prevent that from happening. It was also an admission that it will take a village – a global government village – to address the problem. And that if someone doesn’t want to do their fair share, it will hurt all of us.

The WHO list:

Priority 1: Critical
1. Acinetobacter baumannii, carbapenem-resistant
2. Pseudomonas aeruginosa, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: High
4. Enterococcus faecium, vancomycin-resistant
5. Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
6. Helicobacter pylori, clarithromycin-resistant
7. Campylobacter spp., fluoroquinolone-resistant
8. Salmonellae, fluoroquinolone-resistant
9. Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: Medium
10. Streptococcus pneumoniae, penicillin-non-susceptible
11. Haemophilus influenzae, ampicillin-resistant
12. Shigella spp., fluoroquinolone-resistant

 

 

Minority Report 2: “Pre-Disease”

ISS

 

KENNEDY SPACE CENTER — This coming Saturday morning at ten o’clock, our friend Staphylococcus aureus will find itself buckled up inside a Dragon Spacecraft about to be launched some 250 miles into space so it can dock at the International Space Station (ISS), shown above.

The U.S.- Russian-manned ISS, which orbits the Earth 15 times a day at a speed of 17,000 mph, serves as a cutting-edge science lab because of its near zero gravity environment — the one where you see astronauts floating around the spacecraft like it’s a Disney ride.

As it turns out this microgravity environment is thought to have a pronounced effect on microbes: that it accelerates their rate of growth and reproduction, and therefore their (genetic) mutation rate. Accelerating an organism’s growth rate is a way of fast forwarding into the future, as if you were aging, say, a human, 20 years in just 365 days.

The idea is to place the Staph into that environment, under experimental conditions, and watch what it does. Specifically, to record all the different ways that Staph becomes resistant to an antibiotic as it morphs into Methicillin-resistant staphylococcus aureus (MRSA). You keep at it until you’ve mapped all of the various pathways Staph bacteria take on their road to resistance, in all its forms.

What the finished resistance map gets you is the ability to predict the future. It goes like this. Imagine, for example, that Big Louis comes to town to stick up a bank. He holes up at a local dive from which he cases the joint, decides when to strike, chooses a weapon, a disguise, a getaway car, and plans his escape route. The day of the robbery everything goes according to plan; the cops are called in and begin to work “backwards,” assembling the clues one by one, day by day, hoping they’ll lead to the guy whodunit before he gets away.

But what if, instead, the instant Big Louis hits town the cops know he’s there. They run his M.O. and learn everything within minutes: where he’s holed up, the crime he’s planning, his disguise, weapon, getaway plan, whether he has an accomplice, and so on, thus allowing them to scoop Big Louis at any point prior to the planned bank job.

 

MR 4

 

Where do the cops get all this information? This is the futuristic part: From having recorded not just every crime Big Louis has ever committed, but from having also recorded every crime he will commit over his lifetime. As if an experimenter had placed Big Louis in a time machine, pressed fast forward and recorded all of his future criminal behavior.

That, of course, is science fiction. But putting Staph aureus into a microgravity environment and accelerating its rate of growth and reproduction, recording each genetic change, plugging those changes into a data base, creating algorithms from that data that allow you to predict what Staph will do based on any given presenting genetic profile, and ultimately developing an antibiotic that targets that genetic profile, isn’t science fiction – as of this novel space experiment.

The project is led by Harvard’s Dr. Anita Goel, MD, PhD, whose one-of-a-kind resume is worth taking a look at. She admits that the space bug experiment is proof of concept. For example, they’re experimenting on 2 strains of Staph, yet there are hundreds, not to mention all the other different species of bad bugs that are out there. It’s as if, back to our crime analogy, they’re experimenting on Big Louis and his frequent accomplice, Little Ronnie Dinsdale, but leaving out the rest of the criminal underworld — Tony Soprano, Don Corleone, and so on — each with their own unique M.O.’s.

But here’s the thing. If the experiment works with either strain of Staph, then it means it will work with other disease microbes as well. And then … what about cancer cells?

Just 15 years ago we were introduced to the concept of “Pre-Crime” in the Tom Cruise film Minority Report. Pre-Crime was the name of the specialized police unit that arrested criminals based on foreknowledge of future crimes provided by psychics called “precogs.” Now replace psychics with scientists, have your foreknowledge based on microgravity enhanced “fast-forwarded” observations of the genomic changes in a superbug, and replace Pre-Crime with “Pre-Disease,” and we have Dr. Goel’s current work.

She chose to study Staph because MRSA kills more Americans every year than the combined total of emphysema, HIV/AIDS, Parkinson’s disease, and homicide. Worldwide, drug-resistant infections kill more than 500,000 people each year and by 2050 that number will exceed 10 million.

But if this notion of “Pre-Disease” intervention works we’ll have a different world. In fact, that’s what Dr. Goel said, with characteristic dry wit, in her 2010 TEDMED Talk: “Our aim with this is humble: We want to do nothing less than to revolutionize healthcare globally by enabling real time point of care diagnosis.”

Stay tuned.

 

 

 

 

 

 

Bugs on steroids: the antibiotic effect

Imagine prescribing steroids to people so we could build stronger antibiotic-resistant germs – “superbugs” – that grow and reproduce quicker than they otherwise would. Ridiculous, right?

Well, a study reported this week in the American Academy for the Advancement of Science tells us that’s exactly what we’re doing when we take antibiotics, i.e. they have a pronounced steroid-like effect, not on us, but on the bad bugs we harbor.

In the study, researchers exposed E. coli bacteria to 8 rounds of doxycycline treatment over four days and found that the bug – which can cause severe stomach pain, diarrhea and kidney failure in humans – had “increased antibiotic resistance with each treatment.” The E. coli also “reproduced faster than before encountering the drugs and formed populations that were three times larger [and] … [t]his was only seen in bacteria exposed to antibiotics.”

Therefore, say the researchers,”[b]acteria have a remarkable ability to rearrange their DNA and this can stop drugs working, sometimes in a matter of days” (my emphasis). And further: “It’s often said that Darwinian evolution is slow, but nothing could be further from the truth, particularly when bacteria are exposed to antibiotics.”

In fact, we can now literally watch this rapid evolution and spread of mutant superbugs thanks to a first-of-its-kind video produced by Harvard scientists that went viral on YouTube with some 25 million views. Here it is, with a nice voice-over explanation:

Here’s the takeaway. No one disputes that antibiotics are necessary and even lifesaving – but only when appropriately prescribed by a physician. The inconvenient truth, however, is that we horribly misuse and overuse them. For example, antibiotics cannot cure the common cold, are almost never needed for bronchitis, are not recommended to treat many ear infections, and are typically not needed to treat a sinus infection (sinusitis).

As Roy Kishony, one of the Harvard scientists involved in the video reminded us in an interview with STAT last December, “Every single antibiotic that has been introduced medically so far, bacteria found ways to evade it … every single one.”

So why help out the bugs even further by giving them “steroids”?

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.”

 

 

 

 

 

Butch Cassidy’s Question

Butch to Sundance: "Who are those guys?"

Butch to Sundance: “Who are those guys?”

In the 1969 Western classic Butch Cassidy and the Sundance Kid, our two outlaws and their Hole in the Wall Gang rob a Union Pacific train on both its eastward and westward runs, thinking that the second robbery would be unexpected and likely reap even more money than the first.

Problem was, the second robbery wasn’t so unexpected: Union Pacific, tired of being robbed, hired a six man Superposse to follow the train. It included renowned Indian tracker Lord Baltimore and relentless lawman Joe Lefors, who tore after Butch and Sundance in hot pursuit, night and day, without pause, “like a machine.” After using every trick in the book to elude the Superposse, and failing to do so, an exhausted Butch peers out from behind mountain rocks at the advancing trackers below and says to Sundance, “Who are those guys?”, a refrain repeated throughout the chase.

Misjudging an opponent is something the medical community is currently reckoning with when it comes to microbes and their increasing resistance to the antibiotics we use on them. Exactly, Who are those guys? — i.e. microbes — is a central question addressed by Brad Spellberg, MD, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, in his book Rising Plague: The global threat from deadly bacteria and our dwindling arsenal to fight them. Like Butch & Sundance’s Superposse, Spellberg and other leaders in the field of infectious disease have learned that bacteria and Superbacteria are not what we thought they were either. In essence, we underestimate them, too.

For example, Spellberg points out in his book that:

1. Microbes have existed for a thousand times longer than our species, outnumber us by a factor of 1022, outweigh us by a factor of 108, and represent 60 percent of the mass of life on the planet.

2. They reproduce “almost impossibly quickly.” E. coli bacterium, for instance, can create 69 billion progeny in just twelve hours of growth. “Now that’s an enemy for you,” says Spellberg. “Kill one and as many as 69 billion more can pop up within twelve hours.”

3. About 1.5 million of the 69 billion offspring can have mutations that enhance their ability to survive in hostile environments, such as the presence of antibiotics that would otherwise be lethal to the bacteria.

4. This “astounding replication and mutation rate,” i.e. the evolution in bacteria of resistance to antibiotics, is the method by which bacteria create new weapons and defense mechanisms within generations.

Here’s the neat part: the video below, developed at Harvard Medical School, allows us to watch the evolution of Superbacteria in action. It shows billions of bacteria breaking through ever stronger barriers of antibiotics inside a really big petri dish, or mega-plate. As the bacteria move towards the middle of the plate from both ends they are eating, growing, and multiplying. Along the way, they’re also mutating and evolving. As the bacteria move inwards, mutants evolve that are resistant to increasing doses of antibiotics that would otherwise — but for the mutations — kill the bugs.

Crucially, the evolution of bugs on the mega-plate mirrors real life, says Harvard’s Roy Kishony in an interview with STAT: “Every single antibiotic that we have introduced medically so far, the bacteria found ways to evade it … every single one.”

In other words, just like the Superposse chasing Butch & Sundance, nothing – no amount or kind of antibiotic – can stop the advance of the Superbacteria either.

Check it out:

In Praise of Vaccines: They also help fight the spread of antibiotic resistance

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We knew vaccines were good stuff. For example, according to a 2014 editorial in Science, “Vaccines are one of the safest and most cost-effective medical interventions in history. By immunizing infants, children, and teenagers, vaccines protect the entire community.”

And then just a few weeks ago we learned of yet another benefit. According to the World Health Organization vaccines can help fight the spread of antibiotic resistance, which the United Nations just called “the greatest and most urgent global risk.”

For example, as we enter the height of cold and flu season — December through March — the WHO says that vaccines not only protect us from those ills, they can also confer an added health benefit: “Vaccines against viruses, such as the flu, also have a role to play, because people often take antibiotics unnecessarily when they have symptoms such as fever that can be caused by a virus.”

The unnecessary use of antibiotics – i.e. overuse (e.g. in our food animals) and misuse (e.g. they don’t work on colds) – drives the resistance problem. Therefore, according to the WHO, “Vaccinating humans and animals is a very effective way to stop them from getting infected and thereby preventing the need for antibiotics.”

We tend to overlook the massive dosing of our food animals with antibiotics. One reason we give healthy animals antibiotics is to prevent them from getting sick — but you should no more give a healthy animal an antibiotic than you should a healthy person. As we noted this past April, the problem is vast:

“Over 8 tons of antibiotics are fed every year to the more than 8 billion food animals in the US alone, resulting in a ‘massive selection’ for resistant bacteria, writes Stuart Levy, MD, in his book The Antibiotic Paradox: How the misuse of antibiotics destroys their curative powers. With the upshot, Levy says, that resistant bacteria will develop in an animal within 2 – 3 days; from there it will spread to the other animals, then to the farm workers and their families, continuing outward to nearby communities, states, and even globally.”

Finally, the WHO also recommends expanding the use of existing vaccines in people. For example, they say that “if every child in the world received a vaccine to protect them from infection with Streptococcus pneumoniae bacteria (which can cause pneumonia, meningitis and middle ear infections), this would prevent an estimated 11 million days of antibiotic use each year.”

As we begin to tap in to this potential for vaccines — which includes the development of new ones — perhaps it will also help prevent one of the more dire scenarios that worries leading health authorities: that by the year 2050 antibiotic resistant disease will kill more people each  year than cancer.

Noam Chomsky Weighs in on Antibiotic Resistance: “We May Be Destroying Ourselves in That Way Too”

“Judged in terms of the power, range, novelty and influence of his thought, Noam Chomsky is arguably the most important intellectual alive today,” wrote the New York Times back in 1979. Since then, the polymath Professor Emeritus of Linguistics at MIT went on to prove the paper correct as he became the eighth most cited source in the history of the humanities: Marx was first, then Lenin, Shakespeare, Aristotle, the Bible, Plato, Freud, Chomsky, Hegel and Cicero. “What it means is that he is very widely read across disciplines and that his work is used by researchers across disciplines,” said the Humanities Librarian who checked the numbers.

 

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Many of us have been waiting for him to weigh in on antibiotic resistance because, for example, a heads-of-state meeting of the United Nations last month called it “the greatest and most urgent global risk.” And finally, just this month, from his office at MIT, he addressed it in an interview whose theme can be summed up in this question and answer:

Interviewer: If we don’t fix our problems, will the 21st Century be the last century of humanity?

Chomsky: Probably not of humanity but of organized human life on Earth.

In other words, says Chomsky, the question we face is: “Are we going to survive?” which he calls “The most serious problem that has ever arisen in human history.”

Two main drivers of our existential crisis are the ones we would suspect: “environmental catastrophe” and “the threat of nuclear war today [which] is greater than it was during the Cold War,” he says.

But after he made his case on those counts came the following surprise:

“I mentioned two [problems] which are enormous but there’s more than that. Another major problem is the threat of pandemics — diseases that can’t be controlled. That’s already happening, and it’s happening for important reasons. One reason that we haven’t mentioned … is industrial meat production. Industrial meat production is a huge contributor to global warming. It’s an enormous producer of carbon dioxide and methane.”

Then focusing on the resistance issue, he continued:

But it also has another feature. Corporations pour antibiotics into these systems. Animals are crowded together in horrible conditions and to prevent disease and to maintain growth there’s an extensive use of antibiotics. An enormous part of antibiotic production is for this. Use of antibiotics leads to mutations which make bacteria antibiotic resistant. We’re now … the rate of antibiotic resistance is growing faster than the techniques for dealing with them. So we may be destroying ourselves in that way too.

 

There’s something else about these issues that concerns Chomsky, as well: “If you watch something like the current electoral campaign … [you’ll] notice a very curious fact: None of this is being discussed.” “What strange form of intelligence,” he asks, “is it that enables great accomplishment to be achieved but is unable to ask the question, will we survive and how can we ensure our survival?

 

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