[.ca] The Killers Within: The Deadly Rise of Drug-Resistant ... (ISBN 0316735663)

This is an important book:
This is a serious book about a very serious subject--the escalating arms race between humans and disease-causing microbes. The bad news is that we're losing, making the emergence of resistant disease causing bacteria "one of the greatest threats to the survival of the human species." Co-written by Mark Plotkin, a leading ethnobotanist and Michael Schnayerson, a talented writer and editor, The Killers Within is a highly readable, often gripping narrative, full of stories, personalities and drama. At the same time, it presents a lot of the history, science and politics that surround the struggle of medical science to stay a step ahead of the deadly bugs that are proving remarkably adept at evolving ways to defeat our antibiotics. The authors have no trouble identifying the culprits in this losing battle--an agricultural industry pouring millions of pounds of antibiotics into poultry and livestock as "growth promoters," doctors and patients who overuse antibiotics, and the interaction of profits and politics that determine what kinds of drugs reach the market and when. But behind these lies our naive blindness to the bacterial world's incredible capacity to defeat our most powerful weapons. Bacteria have multiple ways to evolve and swap handy genetic information, such as how to cleave penicillin molecules or pump antibiotics out of their cells. All it takes is one bacteria that survives an antibiotic by evolving a new resistance mechanism; within a few years even unrelated bacteria thousands of miles away will know the trick. It's as easy for the bacteria, the authors write, "as collecting charms on a charm bracelet." The authors chillingly describe the costs of this war being fought out in our labs, hospitals and bodies--millions of illnesses, hundreds of thousands of deaths worldwide, and the risk to all of us of returning to a world where we are no longer protected by antibiotics. Most of the major pathogens have already evolved multiple drug resistance. The very young and the very old are already dying from untreatable infections, but any one of us is now at risk that a cut, an accident, a minor surgery or a bout of flu can lead on to a raging infection by bacteria resistant to most if not all antibiotics. The authors do hold out some hope. Perhaps phages, vaccines, or new generations of genetically engineered antimicrobial agents will once again tip the balance in our favor. But for now, expect to see more headlines about outbreaks of resistant strains of bacteria and to hear more horror stories from friends whose scratch or surgery turned into a life-threatening nightmare. This book will help you make sense of those events. Let's hope that the dedicated and farsighted researchers it depicts will eventually win the day. Robert Adler, author of Science Firsts: From the Creation of Science to the Science of Creation (Wiley, 2002).

The frightening return of infectious disease:
This book is scary. According to ethnobotanist Mark J. Plotkin and longtime Vanity Fair contributing editor Michael Shnayerson, the golden age of antibiotics that began with penicillin, a time when it was generally thought that infectious diseases were under control and largely a menace of the past, is over. Our naivete and our arrogance in imagining that we had just about defeated the bugs and could move on to other more pressing public health concerns came to an end in the nineties as one after another of the major human borne bacteria became resistant to our drugs. Through the exchange of DNA, that immunity has been transferred to other bacteria so that, as this book went to press just a few months ago, infectious diseases caused by bacteria are once again a major threat to humans everywhere in the world. What happened? As the authors explain there are three main problems, (1) the overuse of antibiotics by the medical profession, (2) the misuse of antibiotics as growth enhancers in the meat and poultry industry, and (3) the failure of hospital personnel to follow CDC guidelines on hygiene, especially simply washing their hands. (1) Too many doctors, either through ignorance or a desire to please their demanding patients, have over-prescribed antibiotics for routine infections, and in some cases actually prescribed antibiotics for viral infections (for which they are useless) "just in case" the patient also gets a bacterial infection. The result of this massive overuse of antibiotics is to give the bugs countless trillions of generational opportunities to evolve defenses against the antibiotic, leading to the antibiotic becoming useless. (2) Tons of antibiotics--"24.6 million pounds a year," see p. 123--are routinely added to animal feed by the meat and poultry industry to promote growth so that their products will get fatter faster. What has happened is that the bugs have grown resistant to the antibiotics while transferring that immunity to bacteria living in, on and around humans. Even the use of an "analogue" antibiotic such as growth promoter virginiamycin can promote changes in bacteria that make them resistant to the antibiotic Synercid (e.g., see pages 115, 119 and 285). As the authors chronicle, this is a serious problem fraught with angry political battles as the meat and poultry people fight to maintain their profit margins while the disease control people fight to restrict the use of growth promoters. (3) Surprisingly enough the authors report (see page 282 and elsewhere) that there is cynicism among some hospital personnel about the effectiveness of washing their hands and a belief that hygiene won't stop the proliferation of the bugs. The result is that hospitals have become very dangerous places. Most of the drug-resistant bacteria developed their resistance in hospitals. Most (or all) of them are endemic to the hospital environment. If you have to go to a hospital for any reason you are taking a chance of contacting a drug-resistant bug. Heaven help you if you have a compromised immune system, or if you are an infant or an elderly person. How bad is the situation? According to the authors on pages 278-279 the high cost of developing new drugs (average "$802 million") and the fact that "return on investment from producing an antibiotic that might be used by a patient for less than a week versus return from a drug for a chronic condition that a patient might take daily for fifty years" is persuading big pharma to downsize the antibiotic end of the business. (See also page 94.) The authors ask the question, where are new drugs coming from? and answer that the "great glittering prospect was genomics." But "reality" has "sunk in." (p. 280) Drugs to fight bacteria developed from DNA manipulation "might take even longer to reach the market" than those previously developed. (p. 281) The authors also touch on the possible use of drug-resistant bacteria as a bioterrorist weapon. What does all this mean for you and me? It means that should we or our loved ones get a life-threatening bacterial infection, it's possible there won't be an antibiotic around that works. In effect, we might find ourselves back in the days before penicillin (the first really effective antibiotic, and one of the greatest of all medical miracles) when millions of people routinely died from staph, strep, TB and other bacterial infections. As Shnayerson and Plotkin report, right now there are strains of bacteria, including Staphylococcus aureus (the golden-globed bacteria pictured on the cover), Streptococcus pneumoniae, and the Mycobacterium that causes tuberculosis, that are immune to almost every antibiotic in use. There is even a strain of Enterococcus that is resistant to every antibiotic in use. The authors do offer some hope. They report on the promising use of bacteriophages (viruses that invade and destroy bacteria)--see the very interesting Chapter 14, "Bacteria Busters." They present the idea of a more vigorously controlled use of antibiotics. If we prohibit their use as growth promoters and use them sparingly in an ordered sequence, perhaps bacteria would not have time to gain immunity and/or would lose it after the antibiotic is no longer in use. As pointed out on e.g., page 183, resistant bacteria are "encumbered" by an "extra chunk of DNA" that gives their non-resistant brethren an "ecological advantage" in an environment that doesn't contain the antibiotic. Additionally, the authors report the theory of population biologist Richard Levins who believes that if antibiotics are "saved for the most severe cases...then natural selection would favor the pathogens that produced the milder symptoms." (Explained on page 287). Bottom line: this is a fascinating, scary and state of the art report on the pathogen wars written in a readable manner sure to interest not only the general public at which it is aimed but professionals as well.

Excellent Book. Every one should read it.:
This book describes the problem of the bacteria developing resistance to the many antibiotics that humans are using to fight them and, the most important, that we are losing this battle. The book talks about the reasons behind this : overuse and abuse of antibiotics by us, use of antobiotics as "growth enhancers" and so on. I am already aware of this resistance problem but after reading this book I was thrilled and frightened. If we do not change our ways of using antibiotics soon then we will soon be unable to fight those drug resistant bacteria when they cause infections and a huge health problem will unfold. I for one strongly agree with the authors that antibiotics use as "growth enhancers" should be totally banned as soon as possible.

Big on bios, short on science.:
This is a reasonably good review of the problem, but there is just too much about the heroic docs and their saddest cases, and too little basic science. The book gets a little tedious and confusing because of this. It would profit from an introductory chapter devoted to the background science, and an appendix you can refer to with a table showing different kinds of antibiotics, possibly a figure explaining how antibiotic-resistance is evaluated (the MIC pops up everywhere, but is not explained well), a list of problem bugs and their acronyms, and another list of the principle mechanisms of resistance. There are web resources (listed) to go to for help-www.cdc.gov is a good place to start. The current research on nonantibiotic approaches to treating infections(principally antibacterial peptides from amphibians, and phage therapy) was very interesting to me: I have a good background in microbiology, and am probably being a little critical, but the science here was not explained very well.

An eye-opener to the real world:
This book was extremely interesting for me, but I wouldn't recommend it to just anyone. I would recommend it however to those interested in the Health/Science industry. The read isn't so hard but does require a basic understanding of some medical terminologies and you have to be able to pick things up and follow ideas easily. The book reads almost like a horror story, except its true. I wouldn't recommend reading this book if you get paranoid easy. I know I usually don't, but even I find myself thinking twice about alot of things now. This book gets a high rating from me because, as a studying pre-medical student, it has helped me to find my area of interest in the field.