A recent paper in the New England Journal of Medicine called “The Emerging Threat of Untreatable Gonococcal Infection” suggests that gonorrhea is set to join the superbugs, the elite circle of nightmarish infections (MRSA, XDR-tuberculosis, NDM-1) that some fear will sweep civilization off its pins. The new breed of sexually-transmitted infection, first spotted in Japan, is resistant to the cephalosporin class of antibiotics, which puts it in position to run the table on available treatments and knock us back into a Fred Flintstone, pre-antibiotic world.
As an infectious disease specialist, I am sort of flattered by the attention my homeboys are getting. After all, I have been thinking about, worrying about, and dreading these microbes for a long time and have limitless respect for their heartless lethality.
But I have to ask, people, why all the excitement? As a looming public-health calamity for John Q Citizen as he walks down Maple Street in Middletown USA, the threat is minuscule (particularly if John Q can remember to keep his pecker in his pants). As with the avian flu massacre that never was and the smallpox pandemic that never came, this Superbug fascination seems to be more about our peculiar love of fear itself (cf: Stephen King, Paranormal Activity, the Republican debates) than any sober consideration of the risk before us.
Beyond its fear-factor potential, the superbug story has legs because of something entirely different. The use and misuse of antibiotics has become one of the central morality tales of our time. All the key elements are there—our adolescent inability to control our appetites and the resultant waste of promising youth (alas, penicillin, I knew ye well); individual profligacy creating communal pain; and worst of all, scalding selfishness. Reading about superbugs has come to resemble John Bunyan following the Pilgrim in his progress more than a story of chemistry and microbiology and snippets of DNA that drift left rather than right.
Yet lost in the hurry to embrace this particular sky-is-falling medical story is an important and revealing fact: not all superbugs take the same path to ignominy. Gonorrhea, for example, hasn't moved to the front of the line on account of our pharmaceutical gluttony. There's another mortal sin at work: Lust. People like to have sex, and with each condom-free act, bacteria swarm from this body part to that again and again, yes, and one more time, yes yes. Yes. Simply put, the sheer velocity of people hooking up has overwhelmed our flimsy antibiotic defense.
In contrast, the superbugs that have been long-term headliners earned their stripes (the story goes) through a toxic mix of uncaring doctors, grasping patients, dim-witted public health officials, greedy drug companies, people who don’t wash their hands, and tons of antibiotics shoveled into the mouths of farm animals. In this godless world, available antibiotics are systematically misapplied, too much for some, not enough for others, until, at the far end of the bug-drug wrestling match, the only one left standing is super-whatever. John Bunyan, meet the mother lode: A world where everyone is guilty.
But our dramatic self-flagellation—alas, if only the trustees of medicine’s covenant had been more restrained, more mature, more caring about the real things that matter, then perhaps none of this would have happened—is just so much posturing and mugging for the camera. After all, antibiotic resistance has been with us from the day antibiotics were hatched in Fleming’s moldy lab; it’s an immutable part of the program. Antibiotic activity and antibiotic resistance are like credit and debt—you can’t have one without the other. And, as we learned from highly active antiviral agents against HIV, the more potent the compound, the faster resistance emerges.
In this long-running superbug drama, we humans are giving ourselves far too much credit for making the mess. This is about the power of bacteria, not the weakness of man. Yes, we can do a better job shepherding our patrimony, using common sense and restraint to maintain antibiotics’ fresh edge. But we will lose—always—and not because we are a fat, lazy society that, through indolence, inattention to detail, and blatant disregard of those around us, has created a dark and dangerous world.
Rather we are pawns in a game between bits of microbial DNA, crude chemical structures, and a human body with more bacteria in and on it than that person’s number of normal human cells. Our insistence that we are the ones driving this enormous complex over the cliff disregards the basic facts. More disturbingly it reveals an all-too-familiar Master of the Universe insistence that we are the cause of everything on the planet, good and bad. It's too bad there is no biological phenomenon like drug resistance to undo the suffocating certainty of the narcissist.