The Problem of Superbugs - Research Paper Example

26 July A Proposal for Civil Action: A Comprehensive Response to Super Bugs “It seems a medieval end for a very modern man” (McArdle 474). This is how Megan McArdle, one of the senior editors of The Atlantic, describes the death of British novelist and journalist George Orwell. He died from tuberculosis, which was already treatable during that time, but his disease showed resistance to several medicines he tried. His medieval end has been the modern end for many people dying from infectious diseases because of antimicrobial resistance. In 2007, Monina Klevens and her research team at Centers for Disease Control and Prevention informed the public that Methicillin-Resistant Staphylococcus Aureus (MRSA), a bacterium that resists the strongest antibiotics, lead to 19,000 deaths in America annually (Walsh and Fischbach 44). They emphasized that 20% of those who died from MRSA were young and healthy people who got infected while going through their daily routines. Furthermore, antimicrobial resistance is not only a national problem because it can soon develop into a global national health issue without immediate and long-term national and international collaboration. Doctor Anuj Sharma of the World Health Organization (WHO) stresses that without local and worldwide resolutions, diseases that used to be easily cured would soon be untreatable. Before resolutions to the problem of superbugs, or drug-resistant microbials, are discussed, the paper explores the history of MRSA first because it will help understand the justification for the proposal. Antimicrobial resistance (AMR) is not a new healthcare problem. Christopher T. Walsh, a Hamilton Kuhn professor of biological chemistry, and Michael A. Fischbach, a microbiologist at the University of California, describe the development of superbugs, which started in the late 1950s. Methicillin, a drug derived from penicillin, was used in 1959 to treat infections that were already resistant to penicillin, like S. aureus and Streptococcus pneumonia (Walsh and Fischbach 44). Two years after, European hospitals reported that they experienced methicillin-resistant strains of S. aureus, and since then, MRSA spread to other healthcare institutions across the globe (Walsh and Fischbach 44). By the 1990s, a new strain of MRSA infections developed in the community, as microbials learned to fight the drugs that aimed to kill them. The most effective antibiotic then was vancomycin, but soon, vancomycin-resistant bacteria developed. Walsh and Fischbach illustrate the reality of antibiotics, wherein “from the moment an antibiotic is introduced in the clinic, its useful lifetime begins to tick down,” and they note that natural selection is key to AMR because “the mere presence of an antibiotic creates an environment in which a bacterial strain that happens to be resistant will suddenly have a growth advantage over its competitors” (45). The growth of drug-resistant bacteria cannot easily be stopped because it is in their nature (which is common to all living things) to fight for survival. Despite the complexity of the problem, it can be resolved. The proposal lies on widespread civil action. Civil society should pressure the government to pass a federal law that encompasses diverse responses to resistant bacteria, particularly offering financial incentives for antibiotic research, monitoring and controlling how healthcare workers prescribe antibiotics, mandating screening for MRSA, banning the use of antibiotics for non-therapeutic applications in the agricultural sector, and prohibiting the sale of over-the-counter antibiotics for animals and humans. The specifics of the proposal seek to respond to every aspect of the problem. First, it must be recognized that AMR is not a healthcare issue alone, but one that affects the food supply chain and pharmaceutical industry too, and so the law must target all stakeholders. Second, sources showed that one of the reasons that research on AMR has decreased for the past thirty years is because drug firms are not reaping high profit from R&D on antibiotics. McArdle and Sharm show that pharmaceutical firms have no financial incentive to invest on stronger classes of antibiotics because of low volume of sales and short patents on antibiotic drugs. If the private sector cannot see any money to be gained from developing more potent antibiotics and in preserving its use, the government has to step in and to encourage research and conservation. Third, the government should consider how it can maximize the use of antibiotics for both humans and animals. It must monitor and control prescriptions and diverse healthcare uses of antibiotics to improve their efficacy. Betsy McCaughey of the Hudson Institute criticizes the Centers for Disease Control and Prevention for not mandating universal MRSA screening for all patients, so this concern must also be tackled. Universal screening is critical to identifying and controlling the spread of MRSA. Fourth, antibiotics are known to be added to the feeds of animals because they can keep them healthy, and this benefits farm owners (which are now composed mostly of large corporations) because healthy livestock are bigger and more profitable. David C. Love and colleagues who are affiliated with the Department of Environmental Health Sciences and the Center for a Livable Future at Johns Hopkins University and the Animal Welfare Approved, narrate the history of free-choice medicated feeds (FCMF) that are routinely used in American farms. They argue that antibiotics in feeds can produce AMR because of overdosing and underdosing problems. The Scientific American confirms the use of antibiotics in feeds, even when animals are not sick, and as a result, MRSA in animals are believed to infect humans too. With such widespread use of antibiotics for the wrong purposes, the government must again step in to ban the use of these antibiotics for non-therapeutic means. Thus, the specifics of the policy do not focus on human-centered actions alone, but national and local changes that can stop the spread of AMR from livestock to humans. The proposal does not have silent opponents, who offer solutions on their own. The first argument from opponents stress that banning the use of antibiotics for non-therapeutic purposes in the agricultural sector will result to decrease in net profits for the U.S. pork industry and higher pork prices for consumers, so it must not be applied at all. Dermot J. Hayes, Helen H. Jensen, and Jacinto F. Fabiosa studied the effect of banning over-the-counter feed antibiotics for the pork industry and the summary of their study was published in the Iowa Agricultural Review. They estimated the financial effects of the ban using the Swedish model because the Swedish already banned over-the-counter feed antibiotics in 1986. Their findings showed that without these antibiotics, the cost of raising pigs would be higher and would result to a potential loss of $1.039 billion in one decade, while consumers would pay for higher retail prices that could reach $748 million every year (Hayes et al. 10). They show that banning free-choice medicated feeds (FCMF) would be bad for pork producers and consumers alike. Whether their estimations are true or exaggerated, the study indicates that banning over-the-counter feed antibiotics would be tremendously harmful for the economy, but this concern is not valid because it would actually help the economy to be rid of these agricultural practices. First, one study showed that it would be beneficial for farms to shift from antibiotic dependence to organic farming. Amy R. Sapkota and colleagues, who are from different environmental, animal, and epidemiological departments, investigated the occurrence of antibiotic-resistant Enterococcus in conventional poultry farms that adopted organic practices in America. They collected poultry litter, feed, and water samples from two groups of farms: ten that practice conventional farming methods that depend on antibiotic-infused feeds and ten that have organic poultry practices. Their findings showed that farms with organic practices had lower incidence of antibiotic-resistant and MDR Enterococcus than the other group. Sapkota et al. demonstrate that the study of Hayes et al. emphasize only on the losses, but not on the gains, such as the benefits that would be acquired if farms used alternative livestock approaches. While losses cannot be entirely avoided, innovations in organic farming, among other alternatives, can result to higher profits in the long run. The second argument that opponents of the policy can state is that these policy efforts will be wasted because trade, travel and immigration opens the U.S. to the entry of people who have acquired superbugs, so it is better to address the R&D on antibiotics only, and not the control of antibiotic sales. Doctor Sharma underscores that the two main causes of the development of antimicrobial resistance are “overuse and misuse of antimicrobials” and the spread of resistant microbial between people, animals, communities, and nations (470). Travel, trade, and immigration can spoil the potential benefits of the policy. Moreover, governments do not always agree on what actions to take and what policies to adopt when it comes to antibiotics. One nation might be stricter with bans than others. The result can be a series of messy international processes that could delay the potential for sharing important information about AMR and applying practices that matter, such as universal screening for MRSA, for instance. Hence, a comprehensive policy is not a feasible solution. This thinking that because trade, travel, and immigration can undermine the policy is enough to reject the latter is invalid because as the case of AIDS showed, the international community, healthcare organizations and governments included, can agree on enough points to cause immediate and long-term solutions to AMR. Adrian Towse, Non-executive Director at Oxford Radcliffe Hospitals NHS Trust, and Priya Sharma, Health Economist at Office of Health Economics, determine the context of AMR and its drug-making pipeline, the economic issues of poor R&D on AMR, and proposals to enhance R&D. They underline the role of the government in encouraging R&D on drug-resistant microbials through financial incentives. Like Sharma, they understand and respond to the economic needs of pharmaceutical firms to make money for their shareholders. At the same time, these actions include international partnerships, so that governments will help one another in screening MRSA and other related infections and in finding suitable medical solutions. The history of determining what causes AIDS, for instance, showed that governments across the globe can work together through private and public partnerships. Thus, if it is possible to work together then, it is also possible and feasible for the same governments and healthcare agencies to work together again now. The third argument from opponents is that R&D is so poor for AMR that the discussion on incentives will only be lost in debates, especially when it results to “high prices” because of conservation effects. Conservation refers to the approach where doctors would not use first-class antibiotics yet because this would be their last weapon against superbugs. Because of conservation, lower volumes of the drug would be sold, which would result to low sales for drug firms, as McArdle explains (477). If the government intervenes, it may lead to increase in prices. McArdle talks about a potential solution, where firms would be paid more if a lower number of their drugs are sold (478). The conservation plan improves the effectiveness of drugs, but as an economic tradeoff, the prices of stronger antibiotics would rise to compensate for lower demand. Not all people are ready to pay high prices for more potent antibiotics and they would be the first to rally against high prices because of drug conservation. Human rights would complain too because the poor would lose access to precious life-saving drugs. If they cannot afford more expensive drugs, they are as good as dead. This argument is invalid because it focuses on only one kind of solution. McArdle proposes a scheme, where the government purchases all antibiotics to better regulate its use, where several billions of dollars can be used to buy a first-in-class antibiotic, half of that would be spent on a second-in-class antibiotic and so on (477). This solution can be considered because it allows the government to control the use and marketing of important antibiotics, which might as well be the last line of defense in the future, when once-treatable diseases are back with revenge. Instead of counting the billions of dollars lost now, people should also consider the billions that will be saved in the long run. At present, MRSA infections in American hospitals alone are causing $3 to $4 worth of healthcare expenses (Walsh and Fischbach 44) and billions more would be wasted without solutions that are applied now and without future resolutions. Going back to the policy, the solution presented is feasible because it concerns multisectoral partnerships. Taxpayers alone will not pay for the R&D costs of AMR. Brad Spellberg and peers presented policy recommendations to the Infectious Diseases Society of America (IDSA). One of their recommendations underlines the public-private partnerships that will enhance the feasibility of the proposal: New public-private partnerships (PPPs) should be established and existing government-supported collaborative programs (e.g., the Biomedical Advanced Research and Development Authority [BARDA] housed within the US Department of Health and Human Services’ [HHS] Office of the Assistant Secretary for Preparedness and Response [ASPR]) strengthened to supplement (but not replace) traditional industry R&D for critically needed antimicrobial drugs. (Spellberg et al.). The recommendation insists that the government is not the only investor, and instead, it encourages wide-scale investment on the health of the people. Collaboration between the public and private organizations can improve access to funds and provide more incentives for R&D. Aside from feasibility, the solution solves the problem because it addresses all aspects of the problem. Leclercq, a professor from the Department of Microbiology, CHU Coˆte de Nacre and EA 2128, University of Caen-Basse-Normandie, Caen, France, suggests the need for strict healthcare monitors and regulated use of antibiotics for animals and humans. His article is technical in its examination of the causes and effects of superbugs and society, which shows that only comprehensive solutions can resolve this problem. Sharma and McArdle agree that diverse solutions are needed because AMR is a complex problem. Because the problem of superbugs affects different people and industries, the solution must respond to different interests too. Finally, the policy is the best solution because the government has yet to respond to this issue and only civil action can bring the problem to the priorities of the government, where their solution has immediate and long-term benefits. Paul Rubin’s article criticizes the Food and Drug Administration’s (FDA) lack of support for R&D on antibiotic resistance. He cannot understand why the FDA has not passed any meaningful resolution to control antibiotic use in the agricultural industry. Ariele Lessing, Executive Editor of the Boston College Environmental Affairs Law Review from 2009 to 2010, argues that the FDA lacks political will in banning non-therapeutic antibiotic use in the agricultural sector. After reviewing the many times that the FDA failed to pass the necessary policies to control the use of antibiotics in farms, Lessing says: Neither the FDA nor Congress has proven itself capable of effectively dealing with growing antibiotic resistance through sub-therapeutic animal dosing; it is time for a citizens’ group to petition the FDA to withdraw approval for animal use of important human drugs and, if necessary, accomplish the same outcome through an action for judicial review. (Lessing 481). Instead of waiting for the government to act on this problem, civil society must act on it with urgency and determination. If the government sees the large number of people calling for greater control over antibiotics use and increased R&D on AMR, the former can be effectively persuaded to support the policy. The immediate effects are greater R&D for AMR and the long-run effects are multisectoral partnerships and billions of dollars saved because saved human and animal lives. In order to fight superbugs, a comprehensive policy is needed- one that encompasses the diverse uses of antibiotics and R&D concerns. First, the people must pressure the government to pass a law that will provide incentive to antibiotic research and development, monitor and control the use of antibiotics in healthcare and agricultural settings, and ban its uses for non-therapeutic purposes for animals and non-microbial illnesses for humans. Second, the society can handle opponents of the bill through understanding their legitimate aims and providing various alternative solutions. Third, the policy is feasible because it is a product of concerted efforts from the government and other sectors. Fourth, the policy solves the problem because it addresses its numerous dimensions. Finally, it is the best solution because it offers immediate and long-run responses. If the people will not act now, they might soon find themselves or their loved ones dying from medieval diseases. Orwell’s death should not be part of future deaths at all, not if people could help it. Works Cited Hayes, Dermot J., Jensen, Helen H., and Jacinto F. Fabiosa. “What Would Happen if Over-the-Counter Antibiotics Were Banned (in Swine Rations)?” Iowa Agricultural Review 6.3 (2000): 9-10. Web. 16 July 2013. Leclercq, R. “Epidemiological and Resistance Issues in Multidrug-Resistant Staphylococci and Enterococci.” Clinical Microbiology & Infection 15.3 (2009): 224-231. Lessing, Ariele. “Killing Us Softly: How Sub-Therapeutic Dosing of Livestock Causes Drug-Resistant Bacteria in Humans.” Boston College Environmental Affairs Law Review 37.2 (2010): 463-491. Academic Search Premier. Web. 13 July 2013. Love, David C., Davis, Meghan F., Bassett, Anna, Gunther, Andrew, and Keeve E. Nachman. “[Commentary on] Dose Imprecision and Resistance: Free-Choice Medicated Feeds in Industrial Food Animal Production in the United States.” Environmental Health Perspectives 119.3 (2011): 279-283. Academic Search Premier. Web. 13 July 2013. McArdle, Megan. “Resistance is Futile.” Global Issues, Local Arguments. Ed. June Johnson. Pearson Education, Inc, 2010. 474-479. Print. McCaughey, Betsy. “To Catch a Deadly Germ.” Hudson Institute, 14 Nov. 2006. Web. 13 July 2013. Rubin, Paul H. “The FDA’s Antibiotic Resistance.” Regulation 27.4 (2004): 34-37. Web. 13 July 2013. Sapkota, Amy R., Hulet, R. Michael, Zhang, Guangyu, McDermott, Patrick, Kinney, Erinna L., Schwab, Kellogg J., and Sam W. Joseph. “Lower Prevalence of Antibiotic-Resistant Enterococci on U.S. Conventional Poultry Farms that Transitioned to Organic Practices.” Environmental Health Perspectives 119.11 (1 Nov. 2011): 1622-1628. Academic Search Premier. Web. 13 July 2013. Scientific American, The. “Healthy Growth for U.S. Farms.” Global Issues, Local Arguments. Ed. June Johnson. Pearson Education, Inc, 2010. 472-473. Print. Sharma, Anuj. “Antimicrobial Resistance: No Action Today, No Cure Tomorrow.” Global Issues, Local Arguments. Ed. June Johnson. Pearson Education, Inc, 2010. 469-471. Print. Spellberg, Brad, Blaser, Martin, Guidos, Robert J., Boucher, Helen W., Bradley, John S., Eisenstein, Barry I., Gerding, Dale, Lynfield, Ruth, Reller, L. Barth, Rex, John, Schwartz, David, Septimus, Edward, Tenover, Fred C., and David N. Gilbert. “Combating Antimicrobial Resistance: Policy Recommendations to Save Lives.” Clinical Infectious Diseases 52.S5 (2011): S397–S428. Web. 15 July 2013. Towse, Adrian, and Priya Sharma. “Incentives for R&D for New Antimicrobial Drugs.” International Journal of the Economics of Business 18.2 (2011): 331-350. Academic Search Premier. Web. 13 July 2013. Walsh, Christopher T., and Michael A. Fischbach, “New Ways to Squash Superbugs.” Scientific American 301.1 (2009): 44-51. Academic Search Premier. Web. 13 July 2013. Read More