Granite Geek: Broader response from health community on microbes is needed

Monitor staff
Published: 3/25/2019 3:10:55 PM

You know a problem is serious when your physicians, veterinarians, dentists, laboratory staff, medical technicians and even the occasional reporter crowd into a single room to talk about it. Resistance to antibiotics, as a Concord symposium last week demonstrated, is definitely serious.

“This was impressive,” said Laura Kahn, a medical doctor who helps run a program called the One Health Initiative, about the fact that 270 medical professionals of all stripes came to the symposium, where she gave a keynote talk. “I would like to see a lot more like that.”

You might think Dr. Kahn was being polite to her hosts but I got the feeling she wouldn’t hold back if she had been unimpressed. Consider her take on the trendy practice of owning wild animals as pets.

“It’s a health risk to own an exotic animal,” she told the crowd, practically shaking her fist at the idea. “We’re talking about disease control, and people are importing all these furry bioterrorists into our homes!”

Furry bioterrorists – ha! I can’t wait to work that phrase into a story.

But Kahn didn’t come to New Hampshire just to regale us with stories of cute Africa rodents bringing a disease called monkeypox to America. The message of One Health is that health problems which that seem unconnected – in people, pets, wildlife, and the environment as a whole – can only be solved by considering how all of them interact.

Nowhere is that more obvious than with antibiotic resistance, which is rivaled only by climate change in terms of being a problem that is global, deadly, and difficult to solve because it’s the diffuse byproduct of useful specific actions.

As you probably know, an increasing number of microbes can no longer be killed with any of our many antibiotics. They have evolved resistance because of humanity’s overuse of these drugs in human medicine, animal health and even agriculture (we’re going to start spraying them all over Florida citrus groves, for crying out loud).

This is leaving wide open to disease. Some people fear we’re entering a post-antibiotic era, going back to the days when infections and diseases were an everyday lethal threat.

The medical world is well aware of this and is trying to limit the damage. One small example: Concord Hospital’s glossy annual report spends as much space talking about its program to fight antibiotic resistance as it does to the new ambulatory surgery center.

The New Hampshire medical community has a large working group on the issue, which sponsored last week’s Antimicrobial Stewardship Symposium at the Grappone Center in Concord. This is the second year they’ve held such a gathering.

(A terminology note: I think of “antibiotic” as meaning anti-bacteria but it actually refers to medicines that attack all sorts of single- and multi-celled microbes including fungi, algae and protozoas, all of which are seeing various levels of evolved resistance. Perhaps because of such confusion the health community tends to use “antimoicrobial” rather than antibiotic.)

The symposium made it clear how hard it is to tackle this problem. The day featured separate breakout sessions for doctors, for nurses, for dentists, for veterinarians, for pharmacists and for health administrators, all of them trying to figure out ways to take advantage of the benefits of antibiotics without contributing to their overuse.

But as the One Health Initiative made clear, the problem exists between fields as well as within them.

Dr. Kahn gave one startling example – startling to me, at least: There is evidence that pets are more likely to carry antibiotic-resistant microbes if their owners work in human health care.

In other words, when you collect sick people into one building like a hospital or a nursing home, it increases the chance that employees will encounter somebody who has resistant microbes inside them, which increases the chance that they’ll pick up such microbes and bring them home to their cat or dog or African rodent. Makes sense, yet I have to wonder how many veterinarians adjust their antibiotic treatment depending on whether the owner works with sick people.

By the way, because the symposium was geared to health professionals the symposium didn’t talk much about a big part of the problem – patients like you and me.

I grew up with the idea of antibiotics as “miracle drugs” and my default response to being sick or hurt is to want some of them. I need to stop that. It’s much harder for health workers to behave responsibly with antibiotics when patients keep demanding them.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek.)



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