Wednesday, January 5, 2022

A Future Full of Plagues


Happy New Year, y’all.

The late nineteenth and the twentieth century was an amazing time of medical progress. Nearly every disease at least began to submit to scientific eradication. Not just infectious diseases, but cancer and nutritional diseases also. It seemed as if nothing could stop the progress of medicine.

But, it was apparent by the late twentieth century, one thing could stop the progress of medicine against bacterial diseases: the evolution of antibiotic resistance. Many bacteria that cause disease (which most do not) evolved resistance against many antibiotics, rendering them obsolete. This actually occurred by the process of natural selection: resistance evolved. By the end of the twentieth century, two things became apparent. The first is that we needed to keep developing new antibiotics. The second is that we had to decrease our reliance on antibiotics.

With regard to the first, we have done an inadequate job. Private pharmaceutical companies have not been developing new antibiotics as rapidly as the old ones become obsolete. This is because new antibiotics are not profitable. When a corporation develops a new antibiotic, it has a limited time span of use. First, each patient takes the antibiotic for a limited time, usually ten to fifteen days. Second, after a few years, the bacteria evolve resistance. It is much more profitable for pharmaceutical corporations to develop and market new drugs against diseases that cannot evolve resistance, and for which the patient must take the drug every day for the rest of his or her life. An example would be depression. The result is that our “armamentarium” (medical historians like military metaphors) of antibiotics is growing smaller each year.

With regard to the second, there are clearly things that we can do. Doctors used to prescribe antibiotics with little regard as to whether they were necessary. Since antibiotics do not work against viruses, doctors began to prescribe antibiotics only after they knew the infection was bacterial, not viral, in origin. This was and continues to be a good thing. But another thing we can all do to reduce the use of antibiotics is to prevent the spread of diseases.

There are many ways to reduce the spread of disease, and everyone knows what they are. As the covid pandemic broke out, and before vaccinations were available, we were told to practice social distancing and to wear masks. These practices were very effective, so that covid incidence began to decline even before vaccinations were widely available. It is now very clear that we can reduce our dependence on antibiotics by using vaccination, masking, and social distancing to control the spread of bacterial diseases. If we do these things, the old antibiotics will become obsolete more slowly, or, if we are lucky, not at all. Penicillin almost became obsolete, but it remains effective for some uses even after almost eighty years of use.

But there are no antibiotics against viruses. For viral diseases such as the various kinds of coronavirus, we have only vaccination, masking, and social distancing. That’s it. (Well, there is one alternative: massive dieoff, in which natural selection produces a resistant population of humans. I have actually had people tell me that this is an acceptable solution to the problem.)

Political conservatives in many countries, however, have shown hostility against all three of these ways of preventing the spread of disease. The Islamic fundamentalists have been rejecting vaccination for decades, with the result that many diseases that could have been eradicated are still in the world. And now Christian fundamentalists, and fierce conservatives (often the same people) reject masking, social distancing, and vaccination with unbridled fervor. They would, literally die—and have you die, too—than to participate in any of these.

New infectious diseases will come along. They always do. And when the next one comes, millions of fierce conservatives will make sure that the disease gets a free ride to spread through the world as much as possible. It is almost as if death from covid (even their own deaths) are a badge of honor to them. If the disease is bacterial, these conservatives who would rather die than to wear a mask will get the germs to spread faster than antibiotics can be used to control them.

The nurse in this photo is showing a headline to a man who is confined to a ventilator because the polio virus destroyed the nerves that allowed him to breathe. The news came too late for him, but the nurse intended it as good news that, at least, the next generation of people would not have to suffer from polio. Neither of them would have guessed that millions of people would consider the polio vaccine to be evil. When Edward Jenner developed the smallpox vaccine; when Louis Pasteur developed the rabies vaccine; when Jonas Salk developed one of the polio vaccines—they could not have imagined that people would consider them evil and actively work against them.

We are, it appears, entering a new dark age of plagues. We have political conservatives to thank for it.

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