My thoughts on the antibiotic crisis

For any budding student slightly interested in medicine, science and any interested in current affairs the antibiotic resistance crisis would no doubt have found its way into your thought process at some point. I know it is often on my mind.

The crisis of antibiotic resistance is one that is often documented in the media, and it is in my opinion one of the biggest challenges that modern medicine faces. In 2013 alone, there were about 480 000 new cases of multidrug-resistant tuberculosis according to WHO, this to me is slightly terrifying as without antibiotics we return to the pre antibiotic era, where whether you survived tuberculosis or not was down to sheer luck.

It’s a situation where I am not sure what the answer is, and I don’t expect to know the answer quite frankly, I’m not sure anyone really does. There is of course things we can do as a society to prevent the situation escalating more than it already has, by not overprescribing or overusing antibiotics, having a general understanding of antibiotics and antibiotic resistant. However, I personally fear that it is a situation where antibiotic resistance will occur regardless of our efforts to prevent it, in fact thanks to Darwin and the theory of evolution we know this to be true. The selection pressure that is antibiotics will naturally cause bacteria to evolve to become resistant to them.

So what is the solution?

To me, with what many may call naïve optimism, due to my age, I would say let’s find an alternative to antibiotics. If you ask me what that is, I will tell you this; at the moment I do not know. Yet, I do have ideas and one of them is thanks to my EPQ project, it is called phage therapy, and I will not delve into the technicalities of it at this moment, for I want to keep my posts as short and snappy as possible, but I will say if you are intrigued or rightfully concerned by this global crisis, I say do a bit of research. Phage therapy is highly under researched and doesn’t have the best reputation due to past research and trials, but it is if anything a fascinating idea, and even if it isn’t a possible solution to this crisis it’s worth a look up either way.

India vs UK healthcare

India has the ninth-largest economy in the world by nominal GDP and the third-largest by purchasing power parity (PPP) [1] and despite this much of India still remains as a third world country. Over October half term I had the experience of visiting Goa, India for two weeks, the trip was predominantly to visit family. However, whilst I was there I was able to witness the huge cultural  difference of India compared to the UK, not only in attitudes towards lifestyle and people, but also a particular difference in attitude and approach to healthcare.

Unlike the UK healthcare is not free at point of use in India (i.e. there is no NHS), and as a consequence of this the attitudes to healthcare are very different, below I will outline some key observations I witnessed whilst in India:

·       I noticed that many of the people who were begging and living on the streets often had a limb missing or some form of disability. I believe that this shows how many of the poorest in India  are unable to afford healthcare, and often they are those who are most in need.

·       One huge contrast to me, which actually shocked me significantly, was the ease of buying medicines from a pharmacist that would require a prescription from a healthcare professional in the UK. I also say pharmacist very loosely, since the pharmacies themselves were normally a shack on the side of the road, and upon entering you would tell the pharmacist your symptoms, and they would return with an antibiotic or other medicine, at an extremely cheap price. For example, whilst in India I contracted the ‘delhi belly’ and my mum was able to buy medication for me at 30 rupies, which is about 30p. Whether the ease of gaining prescription medication is a good thing or not is up for debate. It certainly helps fuel the misuse of antibiotics and hence the antibiotic crisis. However, having said that I know that the day I woke up feeling extremely ill, I was very thankful of the ease of access to medication.

·       The final contrast I noticed was the public health campaigns, in particular the appeal regarding smoking. I would spend much of my afternoon, when the heat was unbearable, watching a movie, and I noticed that if within that movie a character was smoking, then a banner would come across the screen declaring that smoking was dangerous. I cannot remember the exact wording, but the banner in short explained how it can lead to serious health complications and even death.

Overall it is quite easy to say that the healthcare in India is extremely different to the UK, and it made me appreciate how fortunate I am to have a solid healthcare system in the UK. The NHS allows society to gain healthcare whatever your income, and to me it the fact that it is free at point of use is extremely important and extremely beneficial. I also think that the fact in India one can obtain any medication over the counter at such ease is a problem, as it gives rise to misuse, and of course resistance, which is becoming a huge issue in global healthcare. The trip itself was enlightening, and showed me just how different the approach to healthcare is for different countries.

[1] http://www.rediff.com/business/slide-show/slide-show-1-special-25-interesting-facts-you-must-know-about-the-indian-economy-/20130808.htm

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Soon we'll cure diseases with a cell, not a pill - TED talk

"We've thought about illness and treatment in terms of a profoundly simple model. In fact, the model is so simple that you could summarize it in six words: have disease, take pill, kill something." - Siddhartha Mukherjee. 

TED talks are notoriously thought provoking, and I always find that after watching one my perception on the world is radically altered. However, this talk in particular by Siddhartha Mukerjee named 'Soon we'll cure diseases with a cell, not a pill' really infulenced and inspired me, to the point that I even caught myself thinking about it whilst I should have been integrating a trigonometric function in my maths lesson. With my understanding of the looming issue of antibiotic resistance growing, due to my EPQ on phage therapy, which is also providing an alternative to antibiotics, I have found myself intruiged at learning about alternatives to antiobiotics, and this TED talk covered the topic in a refreshing way. Instead of focusing on the problem of antibiotic resistance, Mukherjee focuses on the use of stem cells to create a new model of treatment and a new view on thinking about illness. Suggesting an alternative to the lock and key model, Mukherjee introudces the idea that we as a society need to revaluate our ideas on medicine; medicine no longer needs to be a pill. Today we can utilise our environment, holistic approaches, cells, and of course the classic 'pills' as forms of treatment. 
Mukherjee suggests the new model of cell, organ, environment to treat a disease and goes into great depth in his talk about how this model was devised. 

I truely believe that in order to avoid a huge health catastrophe we need to find an alternative to anitiobiotics. We should not eradicate them completely, as they are indeniable extremely useful drugs. However, due to antibiotic resistance, we must consider other treatment options and Mukherjee's use of stem cells and a new model for medicine just may be an answer. 
I highly recommend watching this TED talk, the link is below: 
Link to TED talk - soon we'll cure diseases with a cell, not a pill by Siddhartha Mukherjee