Saturday, February 27, 2010

Antibiotic Resistance, A Risk We Don't Worry About Enough

We fret a lot about all sorts of things, but sometimes the real threats are the ones we don’t fret about enough. A HUGE risk that most people know nothing of is antibiotic resistance, the ability of bacteria to mutate and develop traits that resist our drugs, faster than we are coming up with new and better drugs.

A current story on this is at, about a whole new class of germs call gram negative bacteria that are developing the ability to fight the arsenal of drugs we rely on to control them. But this is just one small additional chapter in a truly frightening story that’s really about two things. First, it speaks to the arrogance of the human belief that we are smart enough to control nature, since nature in this case definitely has the upper hand. Second, this issue is a clarion example of the peril of The Perception Gap, the gap between our fears and the facts. Sometimes when we worry too much we make decisions that are dangerous. But in this case, the problem is not worrying enough.

So it’s important to understand why the huge threat of antibiotic resistance does not evoke more concern. First, as catastrophic as the numbers already are (tens of thousands of deaths per year in the U.S., 19,000 just from methicillin-resistant Staphylococcus aureus or MRSA, the one antibiotic resistant germ getting a bunch of media attention), the risk of antibiotic resistance doesn’t feel like a catastrophe, a large a single high profile event. Catastrophic risks scare us more. Chronic risks scare us less. This helps explain why many of the major killers, like heart disease, stroke, diabetes, even accidents, don’t raise as much concern or get as much attention as risks that kill far fewer people but do so in catastrophic ways, like plane crashes or mass murders.

Second, when we get sick we think we can just go to the doctor and get a pill. We have some control. That is DANGEROUSLY naively wrong. Many of the germs our pills used to kill can now resist them. We are losing our ability to control bacterial infections like pneumonia and staph. But we still think we have that control, and that feeling of control makes us less afraid. Actually, this feeling of control over illness is making the problem worse. Patients often demand a pill from the doctor for a viral infection that antibiotics can’t fight (they only fight bacterial infections). This kills off the weak bacteria in our system, but the ones that can resist that drug thrive and proliferate and spread, and gradually the drug works less and less.

Finally, there is a general lack of awareness. This matters more than just that we don’t know about the problem. The brain uses a set of subconscious cues to judge how dangerous something is, and the more readily it can summon up information on a risk, the more emphasis that risk gets. A risk that doesn’t immediately ring alarm bells, won’t ring those bells as loudly, even when they do finally go off.

We can fight back against that last component of the Perception Gap. We can learn more about this immense problem. There are few risks out there where learning more can help as much. Here are some links that tell you a lot of what you need to know to keep yourself safer. (The first is another post on this blog, but it’s actually Chapter 38 of my book, RISK! A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You.)

1 comment:

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