Germ Warfare

Last month came the unwelcome if not downright chilling news that the antibiotic of last resort -- the most powerful infection fighter in the medical arsenal -- is now ineffective against some new bacterial strains. If, like me, you heard that much and decided your nerves were not up to learning a lot more, then this might be a good time to click over to see what else looks interesting in the Views section menu. There’s something to be said for deliberate obliviousness on matters that you can’t control anyway.

Hugh Pennington’s Have Bacteria Won? (Polity) is aimed straight at the heart of a public anxiety that has grown over the past couple of decades. The author, an emeritus professor of bacteriology at the University of Aberdeen, is clearly a busy public figure in the United Kingdom, where he writes and comments frequently on medical news for the media. A number of recent articles in British newspapers call him a “leading food-poisoning expert,” but that is just one of Pennington’s areas of expertise. Besides contributing to the professional literature, he has served on commissions investigating disease outbreaks and writes “medico-legal expert witness reports” (he says in the new book) on a regular basis.

The fear resonating in Pennington’s title dates back to the mid-1990s. Coverage of the Ebola outbreak in Zaire in 1995 seemed to compete for attention with reports of necrotizing fasciitis (better known as “that flesh-eating disease”), which inspired such thought-provoking headlines as “Killer Bug Ate My Face.”

Pennington refers to earlier cases of food contamination that generated much press coverage -- and fair enough. But it was the ghastly pair of hypervirulent infections in the news 20 years ago that really raised the stakes of something else that medical researchers were warning us about: the widespread overuse of antibiotics. It was killing off all but the most resilient disease germs. An inadvertent process of man-made natural selection was underway, and the long-term consequences were potentially catastrophic.

But now for the good news, or the nonapocalyptic news, anyway: Pennington makes a calm assessment of the balance of forces between humanity and bacteria and, without being too Pollyannaish about it, suggests that unpanicked sobriety would be a good attitude for the public to cultivate, as well.

The history of medical advances in the industrialized world has, he argues, had unexpected and easily overlooked side effects. Now we live, on average, longer than our ancestors. But we also die for different reasons, with mortality from infection no longer being high on the list. The website of the Centers for Disease Control and Prevention makes the point sharply with a couple of charts: apart from a spike during the influenza pandemic following the First World War, death from infectious disease fell in the United States throughout most of the 20th century. Pennington’s point is that we find this trend throughout the modernized world, wherever life expectancy increased. Medical advances, including the development of antibiotics, played a role, but not in isolation. Improved sanitation and increased agricultural output were also part of it.

“There is a pattern common to rich countries,” Pennington notes. “The clinical effects of an infection become much less severe long before specific control measures or successful treatments become available. Their introduction then speeds up the decline, but from a low base. An adequate diet brings this about.”

So death from infectious disease went from being a terrible fate to something practically anomalous within two or three generations. (To repeat, we’re talking about the developed world here: both prosperity and progress impose blinders.) And when serious infectious disease become rare, it also becomes news. “From time to time,” Pennington says, “the media behave like a chief refracting telescope, focusing on an object of interest but magnifying it with a good deal of aberration and fuzziness at the edges because of the poor quality of their lenses.”

Lest anyone think that the competitive shamelessness of the British tabloid press has excessively distorted Pennington’s outlook, keep in mind that CNN once had a banner headline reading, “Ebola: ‘The ISIS of Biological Agents?’” Nor does he demonize the mass media, as such. “Sometimes the journalistic telescope finds hidden things that should be public,” he writes -- giving as an example how a local newspaper identified and publicized an outbreak of infectious colitis at an understaffed and poorly run hospital in Scotland.

Have Bacteria Won? is packed with case histories of outbreaks from the past 60 or 70 years. Each is awful enough in its own right to keep the reader from feeling much comfort at their relative infrequency, and Pennington’s message certainly isn’t that disease can be eradicated. Powerful and usually quite effective techniques exist to prevent or minimize bacterial contamination of food and water, and we now have systematic ways to recognize and treat a wider range of infections than would have been imaginable not that long ago. But systems fail (he mentions several cases of defective pasteurization equipment causing large-scale outbreaks) and bacteria mutate without warning. “Each microbe has its own rules,” Pennington writes. “Evolution has seen to that.”

We enjoy some advantage, given our great big brains, especially now that we have the tools of DNA sequencing and ever-increasing computational power. "This means," Pennington writes, "that tracking microbes, understanding their evolution and finding their weaknesses gets easier, faster and cheaper every day." Given reports that the MCR-1 gene found in antibiotic-impervious bacteria can move easily between micro-organisms, any encouraging word is welcome right about now.

But Pennington's analysis also implies that the world's incredible and even obscene disparities in wealth are another vulnerability. "An adequate diet" for those who don't have it seems like something all that computational power might also be directed toward. Consider it a form of preventative medicine.