The Antibiotic Dilemma

to take some antibiotics? Sure? Yes, And so these antibiotics are meant to be medicine that makes us feel better and everything's cool and awesome, and so these I don't even know why we're doing an episode really honestly, because I mean they're like tic TACs, right, you just give them to everyone and then for everything exactly. Yeah, yeah, you're no longer able to see the color red. Here's some antibiotics. Yeah, okay, So antibiotics are specific types of

medication to fight off bacteria. So before we get into anything about antibiotics, I thought all quick refresher on what bacteria are would be in order, right, So bacteria right there, Germs dirt. That's okay, Let's want to be a little more specific. Bacteria are micro organisms. Bacteria is the plural. A single bacteria would be a bacterium. So if you ever say, like if you're ever using it in the singular,

you should be using bacterium instead of bacteria. Although most of the time you're not going to run into a singular bacterium. If you if you do run into a bacterium, the odds are in your favor because you are much larger. Because we're talking about single celled organisms, organisms that don't even have a nucleus. And when I say organism that I'm not talking about some form of plant life or

animal life. Actually bacteria. It's its own classification, right right, and in fact are what we assume we're the very first forms of life on our planet. And there are a lot of different types of bacteria. So bacteria range from everything from a helpful bacteria that we have in our bodies, and by helpful I mean either it's completely neutral so it doesn't harm us, or it actually does

help us in some way. We have a bacteria in our gut that help us break down complex sugars, for example, that's just one version, right, I think just by sheer number, your body cells are out numbered by bacteria cells. Oh yeah, inside your body. Yeah, there's more of them than there are a few. I've got some interesting little stats here.

For example, a single gram of soil typically contains about forty million bacterial cells, and a milli liter of fresh water just one millilter has about one million of them, and scientists estimate that the bacterial population of the entire Earth is somewhere in the neighborhood of five no nillion bacteria. You made that number, Uh yeah, what's a million? Okay, so I have to be more specific. Actually that's a great question because no nillion means two different things depending

upon which definition you're looking at. Now, they're using the American definition, which means a one, Like if you're talking about one nillion, it'd be a one followed by thirty zeros. If you're talking about the British definition, it would be a one followed by fifty four zeros. So while a British nonillion is bigger than American nonillion, I guess there's some weird u uh you know, competition thing going on here. Yeah,

we're talking about the American version. Oh yeah, that distinction was actually made in the Declaration of Independence, right, like we here red million, like we were dropping twenty four zeros from no nillion. Guys, it's the twenty first century. We all love Sherlock. Let's let's let's solve this problem. Let's get it together. Well, I think it was one of those. It was like, there were two main reasons

for the American Revolution. There was the taxation without representation and they're just way too many zeros and a nonillion. So anyway, five no nillion bacteria on Earth. It's a huge number. I mean, that's a lot of this stuff. They are, you know, they dominate. Really, it's just that they're dominating on a scale that's too small for us to see without the use of a microscope, because these

things are just a few micrometers in size. Now, still a bacteria or bacterium I should say a bacterium will dwarf a virus. Viruses are on the nanoscale, they're even tinier, and there are big differences between bacteria and a virus.

You have to take that into account, and that's important when we talk about antibiotics because one of the problems with antibiotics is that sometimes, either through carelessness or an honest mistake or just lack of education, people will end up getting prescribed antibiotics to treat a viral infection, which don't work, y'all, because antibiotics aren't designed to fight viruses.

They're designed to fight bacteria. Right, Depending on the kind of antibiotic that you're working with, it's going to be attacking a bacterium, I mean a single bacterium in this case, although a whole group of them at the same time, in one of a few different ways. Yeah. Yeah, there's

actually a couple of different major ways. So if you were to look at the Earth, you would not find any place on the Earth that is absent of bacteria, apart from something that had been specifically sterilized so that

you're specifically killing all bacteria in that area. Because bacteria are really resilient, right they have You can find them like deep under the ocean in areas where magma from the inside of the earth is starting to leak in, and you'll find bacteria that exists through chemosynthesis in those areas. They're really resilient. They're actually bacteria that thrive in the hot springs of yellowstones like this scalding water. Well sure, I mean there are bacteria that can thrive in totally

different environments from other bacteria. Oh sure, Yeah, It's not as though you can probably drop the bacteria in your gut into a hot spring and expect it to survive. But yeah, no, it would probably be very upset in its own bacterial way for a very short amount of time, and then no longer be bacteria, like a little bacterial angel comes down and takes it off. Yeah. But yeah, we also, by the way, use bacteria in lots of ways to create certain types of food things like yogurt

or cheese or vinegar pickles. So it's not like bacteria are all bad. You know, there are a lot of reasons why we want bacteria around. We depend upon them. In fact, the oxygen we're breathing a lot that was

generated by bacteria billions of years ago. So they also help break down, breakdown, potentially disease causing bits of decaying matter, which is terrific, right right, And they also can take the place like helpful bacteria can actually physically take the place that harmful bacteria would otherwise occupy in your body. So it's essentially saying like the club is full, you're gonna have to leave you you can't come in, and the bad bacteria is like, oh, well shucks. Well, meanwhile

the club is hopping with all the good backscia. So that's what the way you want it to happen, which is one of the reasons, by the way, that you don't want to overuse antibiotics, because eventually you will start clearing out the good bacteria along with the bad, which leaves room for bad bacteria to come in. Anyway, So we have the good bacteria and then we have what we call pathogenic bacteria, and all these are the bacteria that cause illnesses. And here's the thing. You can't just

say that a bacteria is pathogenic or nonpathogenic. Those properties actually depend upon multiple variables, not just what type of bacteria and what type of host, but the condition of both the bacteria and the host at any given time. Right for example, the bacteria that cause something terrible like cholera aren't always going to cause cholera in a given person. So, yeah, you know, we're talking about how our bodies are essentially these kind of these kind of cauldrons of various types

of bacteria. We have all these different populations living within us. They have a balance, right, It's kind of like the force. They're balanced in our bodies. So when the host has a well balanced microbiota going on, then things are cool. But if something were to tip that balance one way or the other, then some bacteria that normally would either be neutral or even helpful to us can in turn

become harmful opportunistic. Yeah. So, and really, when you think about all bacteria are opportunistic, it's just a question of whether they're also pathogenic. But some bacteria are just just plain You don't want to come into contact with them right there. You don't want to get an infection because it can lead to some really serious outcomes. Right. For example, I've possibly talked a lot about Clustridium baculinum because I'm really obsessed with botulism. I mean not having it personally,

but I just think it's a really fascinating pathogen. And you know, these critters, as a byproduct, create something that is toxic on the nanoscale to human people, right, which is I mean really cool in a science way, but also completely terrifying. Right. And so some of the diseases you've probably heard about that are caused by bacteria include cholera, dysentery, pneumonia, typhoid, tuberculosis, and the plague good times. But then, of course there

are viral diseases too, right. The flu is a virus, for example, so flu is not bacteria related, it's a virus. Uh. And then there's also small pox and malaria, very serious diseases that are viral, not bacterial in nature. So it's important to make that distinction. And again with this the fact that the pathogenic mechanism isn't fully understood by doctors right now, I mean, we don't always know exactly what it is, what the mechanism is for a bacterium to

cause illness to a host. Oh right, what sets off specifically a colony of bacteria in an organism from toggling that dormancy and how virulent they are? Right right? We don't have all the information on all of those factors, so it may treating these diseases somewhat of an inexact science,

which leads us to antibiotics. That's one of the big ways that we treat bacterial infections and antibiotics essentially, that's talking about medication that's designed to either limit bacterial growth in some way or to actually kill off bacteria, and so it's kind of a you know again, it's it's not a very precise way of going in and treating something. It's effective, at least at first, but it's not it's not something that's based upon a deep understanding of what's

going on on the bacteria level. Yeah, we don't want to demonize antibiotics since we're going to talk about the dangers and the need to move past them in some situations, because antibiotics are kind of amazing. They have done amazing things. Oh sure, humanity, there's a pretty there's a pretty good chance that the people in this room would not exist because our parents or grandparents would not have lived if penicillin had not been not invented but discovered in nineteen

twenty eight. Yeah, yeah, that was Flemming, right, who discovered that. So, yeah, Alexander Fleming in nineteen twenty eight discovered the antibacterial effects of penicillin. Penicillin itself had been discovered about a century before, but no one understood really bacteria at that point, so there wasn't a real deep understanding what was going on? Oh right, they realized that this fung guy was creating

this byproduct that happened to make other stuff die around it. Yeah, but they didn't know why, right, And as it turns out, penicillin will prevent a bacterium from replenishing its own cell walls. It's like if you prevented skin from regrowing around your body, and so eventually the bacterium will burst and die, right right, Yeah, so that was you know, that's actually a fairly common technique for the types of antibotics that are designed to

actually kill bacteria. Those are you know, called bacteriaicidyl antibiotics. And then you have the type that are meant to just slow down growth, which are bacteria static antibiotics. Right. Those might prevent bacteria from multiplying or interfere with the formation of other subcellular structures. Right. So, antibiotics saved lives in the past, still saving lives today? Really useful? Is so? Are they? The answer? Is there nothing to worry about? Well,

there are two problems here. One is that over time, no matter how you use antibiotics, some strains of bacteria start to develop resistance to those antibiotics. You know, growing sturdy or cell walls. And in the case of those bacterial cytyle right right, they or they might have some sort of they'll start to generate some other form of chemical that will help fight off the antibiotics and thus

keep them more safe from those kind of things. And they can actually spread this across an entire population, oh sure, because they survive and multiply, right, so, and multiply real quickly exactly So in one hand, On one hand, you're eventually going to see various strains of bacteria develop resistance to different types of antibiotics over time, no matter what

you do. However, if you poorly use antibiotics, as in you overuse, or you are improperly taking the antibiotics, like you don't take an entire course of antibiotics when you are prescribed one, like maybe you start feeling better and you think, oh well, I don't need to take any more medicine, so you stop these sort of tech These sort of behaviors lead to bacteria gaining that resistance much more quickly, and it's spreading much more across multiple populations

of bacteria, thus creating a larger problem for us as a whole. Because now we've got strains of bacteria that we can't treat with the same antibiotics that we would have used maybe ten years ago, because they are naturally resistant to it. And so the more we use antibiotics poorly, the worse we make the problem. And it's a serious problem. I mean, this isn't a case of a couple people

getting sicker than they otherwise would. The CDC estimates that every year, more than twenty three thousand people in the US alone die as a result of infection by resistant bacteria, right, And I mean, there's you really can't, you know, exaggerate how bad this problem could potentially become. So essentially, like, let's say that I, you know, I was saying earlier, like I was sick, and then I started feeling better,

so I stopped taking my antibiotics. I'm feeling pretty good, and I'm thinking, Wow, there's no need for me to keep taking this. It's a hassle. I'm feeling fine, everything's good.

The reason why your course of antibiotics would possibly extend further than the symptoms you're feeling is that those antibiotics are meant to try and kill off that population of bacteria as much as possible, and if you stop early, so you know you no longer are feeling the physical effects of being sick, but you've stopped before the baia antibiotics has run its course, uh to be a little repetitive.

Then that population there may be some surviving members of it, and this is bacteria that has come into contact with that antibiotic and thus is more likely to form a resistance to that antibiotic in the future. So you didn't you didn't do the full job. You didn't kill off all the bad guys, and so the bad guys that are left are now stronger because they figured out what your your method of attack is, and then when they start making more bad guys, they all have this feature,

this resistance. So that's that's one issue. Another issue, of course, like we said before, is if you were prescribed antibiotics for something that wasn't a bacterial infection, had no infection related problems there, uh, then that could also end up creating problems where it creates an imbalance in your system, thus giving the opportunity for bacterial infection to paradoxically attack you later, or it actually helps develop that resistance we

were talking about where the bacteria in your body come into contact with this and start to develop that resistance. Meanwhile, you are still sick because a viral infection is totally different and is it going to be affected by antibiotics. So that's a double negative there, not in the grammatical sense, but in the sense that two bad things are happening.

You're not getting better, and you're making your body more susceptible to future infection and ultimately possibly bringing other people into danger because the bacteria in your body that developed this resistance could eventually start spreading to other people. And then, yeah, they have a habit of not staying neatly in one place right now. Neat and bacteria are two things that rarely go together. So yeah, this is a big concern.

And this isn't just something that we're concerned about. I mean, there are major organizations all around the world that are studying this and trying to come up with strategies to deal with it, and some of them get pretty scary, including the Center for Disease Control, which is located here

in Atlanta or we are. And the CDC has identified a list a big list of various types of bacterial strains that are demonstrating resistance to antibiotics that we should be concerned about, and they categorize them into different levels of concern. So you want to hear the top three. Okay, Okay, So there's different levels. Some of them are like serious or concerning. And this is on the urgent list. Yeah, this is the top of the list, the most urgent.

So urgent does not necessarily mean that these particular strains of bacteria are more deadly than another. It means that they may be more resistant to a larger array of antibiotics than other strains. Also, they may just be more prevalent. And a lot of these are prevalent in places you seriously do not want bacterial infections to go haywire, like hospitals,

you know. I mean you're talking about people who may be coming out of surgery and they're very susceptible to various types of infection, right, their immune system has already been a topper compromised. Yeah. Yeah, And you know, if you've got any place where you're healing from something already,

you're you're probably more susceptible to more damage. And you know, you're around all these other people who are sick, and people who could be accidentally transferring that sickness across the entire population within a hospital, other places that you would expect to see the sour stuff. Really, it's pretty much anywhere where a lot of people are going to be gathered together for long periods of time, particularly things like

elder care facilities. And again that's extra dangerous because the people in those facilities tend to not be in the best health already, so it's a you know, it's really an actual danger. So here are the three that they identified, and I apologize ahead of time for the butchering of pronunciation I'm going to have for these various types of bacteria. So there's Clostridium difficile or CDF, which they this is one of those that in health care facilities is a

real problem. It causes flu like symptoms and also abdominal pain, bloating, diary, and other really unpleasant stuff, and it can be life threatening, particularly if you're already trying to recover from something else. So that's a big one. Uh. Then we have anterio bacteria SIA, which is actually a broad classification of different types of bacteria, and it includes some that are completely harmless to people. You know, it's just they belong to

the classification, but they don't cause pathogenic Yeah. But then there are pathogenic ones and they're big ones like salmonella or E. Coli. Those can be really nasty. And then there's nay syria gonorrhea, so that's that's gonerreea sexually transmitted disease. Those are the three that have developed the most, the most numerous strains of antibiotic resistant bacteria in popular reporting. You've probably heard about other diseases though, that come from

antibiotic resistance bacteria. One of the ones that is uh most talked about is mrs A Right. Yeah, it's a methicillin resistant Staphylococcus arius. Yes, yep, I said it. Yeah, you did it really well. First try. Well, that's not that much of a victory because that is actually the name of a horrible antibiotic resistant bacteria that manifests most often in nature. If you get this in the wild,

it's going to be a skin infection, uh huh. But in hospitals, where a lot of these infections take place, that can show up as blood stream infections or something going wrong with the surgical incision. It's really nasty. Stuff, and it can be very dangerous. It can lead to to pneumonia, which is again very very serious for someone who is already in a compromised situation. Right, right, So we've got all the doom and gloom here the scary world where the drugs we're using to treat the disease

or making these diseases stronger. I mean, that's kind of the layman version of what we're talking about. But let's earn a page and take a look. What are some of our options for either coming up with alternate ways of dealing with bacterial infections and bacterial populations, or to kind of guide us in our use of antibiotics in a more strategic and controlled way. We need better strategy, we do need. Yes, strategy is an all time low.

We have to make that high. Yeah, we need to outsmart these brainless, single celled organisms, Lauren, What is the best strategory? Some researchers are working on this, and it's several years off yet. This is in relatively preliminary research, but they think that we can use something called quorum sense inhibition. Okay, So a quorum is when you get enough bacteria there to hold a vote, right, exactly, so if we can stop them from voting, We're okay, I

think it kind of is like that. Actually, it kind of is. I'm making a joke, but in a way,

that's kind of what we're talking about. It turns out that bacteria can communicate with one another through this quorum sensing thing, which means that they're producing and releasing these little bits of chemicals that are then absorbed by other bacteria, and therefore across a colony and across colonies of different kinds of bacteria can coordinate the way that they behave that that is, whether or not they decide to be dormant,

whether or not they decide to be pathogenic. Right. They can actually express genes this way, right, Right, So it's fascinating and kind of completely terrifying because we had never thought we had classically thought that bacteria are just these completely senseless, brainless things that are just doing their thing individually.

But it turns out that they work together really pretty effectively. Right. So, if you end up having one strain of bacteria start to develop resistance, then at least there's the potential for that resistance to spread to entirely different populations of bacteria through this kind of complex communication, or at the very least for a bacteria party to kind of form in a place where it otherwise wouldn't have because someone kind

of rings the dinner bell, gotcha. So one thing that we might be able to do is disrupt this communication in some way. If we can figure out how to affect that communication, then we might be able to prevent a dormant bacterial strain from going pathogenic within a host, right by either preventing that communication by sending out false signals or by blocking the reception of those signals and other bacteria. Right. And as you were saying, this is

very early in the research phase. We're talking about people doing tests on cultures in a dish in a lab, right. Oh yeah, and they're still not sure how that how that's working an additional lab let alone. I mean, we've got years of research yet to go before we're going to be able to introduce this into especially a human host, and have any kind of predictability of how it's going to go. Right. So, but it's a promising potential method that we might use to deal with a bacterial infection.

But it is certainly one that would be in the future, not something that we're going to see happen within this year or something along those lines. In the more near term, there are some some like I said, some organizations working on creating real strategies we can follow right now that will increase our ability to deal with bacterial infections and decrease the impact we make on creating antibiotic resistant strains of bacteria. The Center for Disease Control has a big

report that details these sort of these source strategies. Yeah, they just put it out I think near the end of twenty thirteen, So this is really new, fresh, recent research. And the four main I guess pathways that they suggest are pretty common sense oriented, right. I mean, it's not like you read something and think, oh, yeah, that's deep.

That's deep. But these are the day basic things that if we follow these basic things, and by we, I mean human population as a whole, If we follow these basic, these basic strategies, then we can really reduce the impact

of antibiotic resistance strains of bacteria really wreaking havoc. So those four things are number one, prevent infections and the spread of disease in the first place through immunization and promoting safe food handling practices as well as hand washing, and you know those basic hygiene and cleanliness standards that you need, particularly in places where you're preparing food or you're in a hospital, that kind of stuff to really help minimize the chance of infection in the first place.

So if you don't have to treat an infection, that's the best type absolutely so. Then the second one is to create systems for tracking antibiotic resistant infections so that experts can develop strategies to limit or eliminate those strains, so, in other words, to identify when these are popping up and to really track their progress so that the people who our best at working in that particular strain can

really concentrate on it. And the CDC is doing this already, sure, but it's really difficult to coordinate that kind of effort across countries, and especially in less developed countries than say the US or Britain, where we've got pretty robust organizations that help us do this. So it has to be a global effort, right. Then we have the third strategy, which is to improve the general use of antibiotics through

education and practice. Now, this is what I was talking about before about over using antibotics and prescribing them for the wrong kinds of treatments. In some cases, you may not need an anabiotic to fight off a bacterial infection. Our bodies actually do have an immune system that can fight off bacteria. It's just sometimes those infections can get so strong that our bodies would have trouble doing it

on their own, and that's when antibiotics are really important. Sure, but it doesn't mean that every time you get a bacterial infection you absolutely must have antibiotics. This is something that obviously you would have to come to a decision

with your doctor. The doctor is going to be the expert on this, and you know, you just have to have that conversation and express a concern about the use of antibotics if it's something that you know, ask just an honest opinion, like in your medical opinion, is this the best course of action? Do I need this? Or am I going to recover without any undue discomfort to myself?

I mean, because we're certainly not recommending that that people suffer through illness unnecessarily or just stop taking antibotics, because in some cases it is absolutely necessary. The trick here is to try and make sure that it's it's necessary or needed in whatever case you are in. So well, you know, I mean, the whole point is preserving their effectiveness for when they are necessary, right or right right right.

And you know, there's some doctors who essentially have been you know, put through this, this this kind of difficult situation where their patients are demanding that they have some sort of treatment so that their symptoms go away because you know, they don't want to be sick. That's perfectly understandable. And then the doctors are saying, well, antibiotics will knock it out. And you know, on a case by case basis,

it seems like it's perfectly harmless. It's when you take it all into the collective that you really start seeing this problem growing. Right right, I want to add a little separate addendum to this point, which is anti bacterial soap. Oh my goodness, we should really reconsider our use of antibacterial soap. And that's not like an idea coming from me. This is something that health professionals have been saying for

a long time. Yeah, And actually finally in December of twenty thirteen, so just a few months ago, the FDA finally announced that manufacturers have to demonstrate that their products are both one better than plain soap and water, yep, which scientific research seems to indicate that they are not.

I've never seen a trial that has said that antibacterial soap, with the exception of like in a hospital environment where it is very important where you're using like industrial strengths in the first place, sure has any benefit over regular sip and water. No, Yeah, so far's the science seems to suggest that plants open water is just as good, right, But also it's it has to be safe for human use and demonstrated to be safe for human use. So there's the big One of the big culprits is an

antibacterial called trickles san or triclessan. So why why wouldn't these things be safe? Well, of course, one of the things is they could potentially be causing antibiotic resistant bacteria. We don't know that they are a cause of that,

but I think that there it is highly suspected. And then the other thing is that they can potentially cause totally separate health problems like messing with hormone regulation and test animals, and the idea as well, if they're doing this to rats, and frogs and stuff, then there's very likely doing it to us. This also leads to just tangentially, but it's still within the same realm the idea of

using antibiotics on animals like livestock. All right, and this is part of the argument that a lot of the more of more militant vegans and vegetarians, but also lots of people who are concerned about the treatment of animals in the farming industry are are concerned over because when you're keeping animals in a condition that necessitates the use of antibiotics in order to keep them healthy, A, that's not really good for the animals, and b's it's probably

not good for us, so it's probably not good for anybody. Yeah, they're a lot of different concerns, some of which are based on misinformation about using antibiotics with animals. In some cases, it's absolutely necessary if you want to try and save

the life of an animal. But there are a lot of I'll say, there are some entities out there, whether they are landowners or large corporations or whatever, that use this broad spectrum approach to giving antibiotics to all the animals in order to make the best case for the animals never to get sick, so it's not even that they're treating of specific they're trying to prevent it from ever happening. So it's almost like they're using antibiotics as

an immunization approach, which is not really they do. It's not a vaccine, it's not the same sort of thing. So, uh, that kind of issue is really serious, and it's not necessarily necessarily true that you're going to end up consuming

antibiotics and get those antibiotics in your system. If you were to have, you know, to eat animals that had been treated that way, that's a possibility, but that's not the issue that I'm specifically talking about is that this actually helps create exactly, So, even if there is no chance that you are going to get these antibiotic components into your body, and even if they do not actually cause hormone changes in animals, it's still creating antibacterial resistant

strains of bacteria. So no matter what, it's not good. Okay. So anyway, those those are three of the four strategies. The fourth one is to develop new drugs and diagnostic tests to both battle and measure antibiotic resistant bacteria. So this is just This is that medicine side of things. Where you have a bacterial strain that resists some antibiotics, perhaps the answer is to start to develop new antibiotics

or combinations of antibiotics to use against that strain. Some study shows that using combinations of antibiotics decreases the chance that a bacterial strain will become resistant. Right, that's too complex. A lot of the terrific research that's kind of on the forefront, right. Yeah, So these are the things that we're really focusing on now. So it's not to abandon antibiotics entirely, because they are very important. It's just finding the best way the stewardship of antibiotics that is going

to preserve their efficacy for as long as possible. So, yeah, it's kind of a scary topic, but it's an important one and it's one we really wanted to tackle because, I mean, it's been in the news and like I said, there's a lot of information out there too, and it's important for people to to get active, to look into this sort of stuff, to have those conversations with their healthcare providers. Yeah, make those personal choices that over population

can absolutely make a difference. Yeah, And you know, I realized that when it comes to health we all want the best health care we can possibly get. And in a lot of cases, some of well, I'll say some of us have probably in the past fallen victim to the more is better approach. That's not always the case. That's kind of the little u moral of the story I think here. But anyway, now that we kind of wrapped up that discussion, I just want to invite all

of you guys out there listening to join in. Let us know what you think, tell us your thoughts on this, or give us suggestions for things that you want to hear about. Stuff you know that's the future oriented that you're really excited about and we've never talked about. Let us know, we'll totally tackle that topic. You can email us. Our address is FW thinking at the Discovery dot com, or you can drop us a line on one of the many social networking sites that we get about on

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