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The Verge of Extinction
We've all read the headlines about scary antibiotic-resistant organisms emerging around the globein far-flung locations like Japan and Vancouver, and not so far-flung ones like Florida. They are the kinds of stories people read with interest, shudder at the implications, and then file neatly away under the heading, "Couldn't Happen Here." Or could it?
According to Dr. Jorg Winterer, 58, the answer is a frightening affirmative. Winterer, 58, is the director of emergency services at Morristown's Lakeway Regional Medical Center, a position he arrived at after having been recruited several years ago to this area as director of the pediatric care unit at East Tennessee Children's Hospital and having, shall we say, issues with a certain controlling managed care firm he'd rather not name.
Something of a quietly outspoken gadfly, the impressively multi-degreed Winterer (bachelors in medical science from Dartmouth, M.D. from Harvard, masters in public health from Johns Hopkins, Ph.D. in clinical nutrition from MIT) explains the problem: "The incidence of resistant organisms has reached alarming proportions. Organisms are multiply resistant to different antibiotics. And even though new antibiotics are being developed, the organisms are developing resistance at alarming speedjust as quickly as we can think up new ones.
"We know that there are resistance factors (or R-factors), that bacteria can exchange. And when you expose a population of bacteria to an antibiotic, you kill all the susceptible ones, but the ones that are left are the ones that possess the resistance factor. They multiply, and spread the resistance factor. It's a almost like a perverse survival of the fittest kind of thing, a Darwinian mechanism."
So what, you might ask yourself. So this: "It just so happens that Knox County is one of the hotspots for resistant organisms in the country."
That's a dubious honor to be sure, one we've earned through our county-wide cultivation of penicillin resistant strains of streptococcus pneumoniae, a.k.a. pneumococcus. Pneumococcus serves as a sort of bellwether of antibiotic resistance. It was, after all, the bacterium upon which penicillin built its reputation, rendering this previously fatal bacteria harmless, thus ushering in the age of antibiotics and forever changing the face of modern medicine. A recent issue of Epidemiological Update, a publication of the state board of public health and the Knox County Health Department cited by Dr. Winterer, found that 35 percent of pneumococcus isolated in blood in Knox County is now penicillin resistant; and 100 percent of that cultured in the trachea and bronchia is resistant.
Scary stats, to be sure. But what does this mean in the larger scheme of things? Quite simply, says Winterer, "That the ante keeps going up. We started out with penicillin, which was the native molecule, and everything became resistant to penicillin. Then they tinkered with the penicillin molecule, and everything became resistant to that, and they've created new classes of antibiotics and everything became resistant to those. There are more and more people and more and more doctors, and the amount of antibiotics prescribed has increased. And the pace is picking up because the use of antibiotics is escalating.
"New classes of antibiotics are constantly being developed. But resistance is developing at an alarming rate. It seems like the organisms are responding to new antibiotic classes much fasterbut that's just an impression that I have. Because penicillin certainly had a long runand not just for four or five years, for decades. Now it's down to three or four years. Ciprofloxin is an antibiotic that's only three or four years old, and I see resistance to that all the time already. I think we carry around multiply resistant organisms that have learned the trick of becoming resistant to other antibiotics, and that maybe because they've done that, when they see a new class of antibiotics, they may be already partially resistant. The whole strategy with antibiotics is kill all the organisms, and not leave any survivors, but that's getting harder and harder to do."
For a doctorany doctorthat's a scary scenario. In order to combat potentially fatal diseaseslike, say, meningitisdoctors must be able to rely on the power of an antibiotic, because the stakes are high. "When you're dealing with meningitis, you need to know that the organism is sensitive before the cultures come back, because by the time the cultures come back, if you're treating meningitis with an ineffective drug, you'll have brain damage or death."
He charts the long march of antibiotic resistance. "It used to be ampicillin, but that hasn't been good enough for a long period of time. And then most recently was rocephinyou used to feel that if you put a child on rocephin, you had a good chance of affecting a cure, but the problem is that now the organism is rocephin-resistant, so you can't treat with rocephin anymore with the absolute knowledge that the disease is rocephin-resistant. The one drug reserved for that was vancomycin, so if you had one really bad case of meningitis, you could treat with vancomycin. It was the drug of last resort, and now we can't use it anymore with absolute certainty."
Vancomycin is the drug popularly known as "the silver bullet"the last, best hope for the hopelessly ill and dying. That it, too, is losing its effectiveness is a frightening prospect indeed, for right now at least there is no other line of defense.
What's the worst case scenario? Winterer lays it out clearly: "The worst case scenario is that infectious diseases which were thought to have been laid to rest are roaring back and becoming a problem again. I think that's a reality, particularly with tuberculosisthey had it licked, closed the sanitariums, and were thinking about the old days when TB was a problem. Well, TB has become a big problem again, and tuburculum strains are now becoming multiply resistant. It used to be one drug was good enough to kill TB, then it was two drugs, then three drugs, and now three drugs don't kill it. Put that together with the AIDS epidemic, and you have a nice little problempeople with no immune systems running around spreading TB in the inner city, they spread it much more effectively to people with good immune systems."
The solution, of course, is less reliance on antibiotics, more emphasis on immune system enhancement. Though he does not practice alternative medicine, Winterer is quick to acknowledge that he uses it himselfhe's a patient of local acupuncturist Susan Thompson. He's undergoing chelation therapy to rid his body of heavy metal toxicity. He supplements his diet with vitamins and amino acidsvitamin C, CoQ10, carnitine, omega-3 fatty acids. And maybe you should too.
"People need to realize that health and ultimately their life needs to be dependent on competent immune systems, more than on the ability of antibiotics," he concludes. "There are always people who survive plague. They're the ones with the good immune systemsthey're the ones who survive cancer as well."
Something to think about on sleepless nights.