Saturday, 21 November 2015

Our Retreating Medical Defences !

The world got a scare when Ebola broke out in Africa and caused a frantic search for a cure.  We had been warned that the overuse of antibiotics was narrowing their effectiveness and that many diseases were building immunity which would make them " untreatable " !   Despite that, their use in agriculture continued at an undiminished rate and many patients fail to complete the full course, allowing the pathogen to regroup and build immunity.

It seems that there are many new diseases laying dormant in the world and Australians love of travel is bringing some of them home to this country.  A Melbourne man enjoying a hot spring in Macedonia had the misfortune to encounter Pseudomas bacteria which entered his ear canal.   It caused deafness, delivered unbearable pain and started to eat the bone at the back of his skull - and it did not respond to any of the antibiotics we have in our armoury.   Fortunately, a world search cobbled together Ceftolozam, a new combination that suited this particular disease, but we are fast running out of options because few new antibiotics are entering the drug market.

The biggest offender in the overuse of antibiotics is the agricultural industry.  Huge quantities are automatically fed to cattle, pigs and poultry to ward off a range of afflictions and bring them to market size faster, and many animal diseases have a close affinity with those that attack humans. Despite warnings, this industry regards antibiotic use as essential to it's economics and has no plans to curtail use - and that will deliver a human price.

We may be about to see the return of an old scourge - Tuberculosis !    In the early years of the twentieth century this was rampant in Australia and a diagnosis was a virtual death sentence.  It was highly contagious and the only means of slowing it's progress was rest and mountain air.  Many Australians ended their days in sanatoriums high in the Swiss alps, but the states build special hospitals purely for Tuberculosis sufferers and the one in New South Wales still exists as a nursing home at Waterfall.

Tuberculosis is endemic in Papua New Guinea - and the distance across the sea between that country and Cape York is easily accessible by canoe or a dingy, and there is a constant exchange of people trading goods that is impossible to police.  In the past, Australia has provided medical help aimed at Tuberculosis prevention on the offshore islands and this has helped prevent the disease obtaining a foothold on the Australian mainland, but now the disease in Papua New Guinea is developing into a new and virulent strain.  This does not respond to any of the known antibiotics and the medical profession despairs that it is " untreatable " !    There is a very real prospect that this very contagious version will spread to the wide Australian community.

In the Twentieth century we wiped out Tuberculosis in this country.   Mobile X-Ray vans toured cities and towns and the people were urged to have a safety check because the antibiotics available at that time were hugely effective in providing treatment.   If this new format that has developed gets loose in the general community we could see the beginning of a plague similar to that which scourged Europe several centuries ago.

What we badly need is incentives for pharmaceutical research to develop new antibiotics.  The costs are huge and patents deliver a short profit window, hence there has been a decrease in R&D spending. With Tuberculosis again knocking on our door, the urgency to develop an effective treatment is critical  !

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