Communicating about antibiotic resistance

Are we failing to educate? Or worse: misleading?


The problem of antibiotic resistance is as real as watching a tsunami gathering force while standing on the shore. It’s coming, and more people are becoming aware of that. Yet the oversimplification of this incredibly complicated topic results in the popular media has resulted in dramatic misunderstanding — leading to some very real physical consequences. The drumbeat to outright ban antibiotics by law from certain applications is growing steadily louder, as people regard any antibiotic with increasing dependence and suspicion. Our narrative about the problem has implicated arguably the wrong suspects, and in the process driving people to endorse rash actions that could lead to worse problems later on.

Creation and Superbugs

Perhaps the most pernicious and egregious is the phrase “creating superbugs”. This pop-science term is now taken for granted, parroted to the point of propaganda. Even at the NIH, who should know better. And it propagates a number of problems. “Superbugs” lack a proper scientific definition, but it does convey an image of malevolence given strength. They are mostly the same old microbes only now able to resist what we’ve been hammering them with. Nor do antibiotics actually create these bacteria — the capability has been there all along. All we are doing is wiping out those which lack the ability to resist the drug, thereby opening the field for the resistant descendants. The media fails to describe this as the exact same strategy that gives us the benefits of modern agriculture. It’s evolution, inevitable and inexorable.

False equivalences

False equivalence is an unfortunate side effect of oversimplification when describing scientific phenomena. In most stories meant for popular consumption, “antibiotics” is used as a blanket term, without taking into consideration the different classes, pathways affected, strategies employed, or specificities of developed drugs. As a matter a fact, writers seldom bother to define what antibiotics are, as if they emerge routinely from factories like Barbie dolls. Biochemically, the compounds we choose to develop as antibiotics are harvested from observed competitive warfare between microbes. The main advantage is that since humans are so genetically distant from the bacteria, our own physiology is less likely to encounter friendly fire. Unfortunately, if the invasive microbe is more closely related, like fungi, this strategy becomes constrained, which is why our repertoire of commercial antifungals is so much smaller.

Likewise, bacteria are at once maligned and praised, since the same terminology is used to describe both pathogen and commensal, but in reality, those circumstances are matters of opportunism. In many stories, I note that simplification results in a forced “good guys vs bad guys” metaphor. And that the primary players never change their roles.

Could this stem from the reluctance in invoking and educating the public on the basic principles of evolution? I can speculate that this is giving wide berth to the never-ending creationism “debate”. What happens here is that lay people cultivate a static view of microbiology. Moreover, this carries over to a sense of personal responsibility — how often have I encountered a mother who insists that antibacterial soaps and antibiotics are bad for her and her children, directly. But not realizing that the effect is aggregate for the population, and that it doesn’t immunize them from the consequences.

Evolution

So, I propose a change. We should properly bring in the concepts of evolution. Given the radically short generation times, the species concept is at best a guideline when applied to bacteria. And this is further muddled by the phenomenon of rampant horizontal gene transfer — a concept often omitted when discussing how antibiotic resistance spreads. I’ve used the metaphor that it’s as if bacteria have Facebook, and they can spread plans that way.

We need to give more room to explaining what kind of instruments antibiotics are, how they came to be, and that they have, for the most part, always been a part of the microbiology of the world. That in the world of minuscule, there are predators and prey, locked in constant competition, evolving weapons and antidotes. But in coopting some of these compounds as antibiotics, we’ve taken it out of this evolutionary arms race (see the Red Queen Hypothesis). But the resistance will continue to evolve.

We should retire the term “superbug”. The word mostly fosters fear rather than inquiry. “Superbugs” aren’t caused by human use of antibiotics. They’ve always been there. Every antibiotic, once introduced, has always had a limited lifespan. For everyone. Like petroleum or rainforests. And similarly, they are caught in a complex set of economics and politics.

This part of the story shouldn’t be the buried nuance, but the forefront. We should bring in the narrative about conservation (even though, in the long scheme, like some endangered species, the end is inevitable). Or is the consequence more akin to the Simon-Ehrlich wager. The stakes are too high for this. Political decisions are being made based on emotions fostered by implication rather than education, all the while, the real problem — the lack of understanding in the microbial evolutionary arms race, and in developing novel strategies therein — gets buried amidst cries to form strong legislation regulating use. Not that everyone will follow legislation if the incentives aren’t there.