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Antibiotic resistance’s ‘apocalyptic’ threat

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Antibiotic resistance’s ‘apocalyptic’ threat

Britain’s most senior medical adviser has warned MPs that the rise in drug-resistant diseases could trigger a national emergency comparable to a catastrophic terrorist attack, pandemic flu or major coastal flooding.

Dame Sally Davies, the chief medical officer, said the threat from infections that are resistant to frontline antibiotics was so serious that the issue should be added to the government’s National Risk Register of Civil Emergencies.

She described what she called an “apocalyptic scenario” where people going for simple operations in 20 years’ time die of routine infections “because we have run out of antibiotics.”

The register was established in 2008 to advise the public and businesses on national emergencies that Britain could face in the next five years. The highest priority risks on the latest register include a deadly flu outbreak, catastrophic terrorist attacks, and major flooding on the scale of 1953, the last occasion on which a national emergency was declared in the U.K.

Speaking to MPs on the Commons science and technology committee, Davies said she would ask the Cabinet Office to add antibiotic resistance to the National Risk Register in the light of an annual report on infectious disease she will publish in March.

Davies declined to elaborate on the report, but said its publication would coincide with a government strategy to promote more responsible use of antibiotics among doctors and the clinical professions. “We need to get our act together in this country,” she told the committee.

The issue of drug resistance is as old as antibiotics themselves, and arises when drugs knock out susceptible infections, leaving hardier, resilient strains behind. The survivors then multiply, and over time can become unstoppable with frontline medicines. Some of the best known are so-called hospital superbugs such as MRSA.

“In the past, most people haven’t worried because we’ve always had new antibiotics to turn to,” said Alan Johnson, consultant clinical scientist at the Health Protection Agency (HPA). “What has changed is that the development pipeline is running dry. We don’t have new antibiotics that we can rely on in the immediate future or in the longer term.” Changes in modern medicine have exacerbated the problem by making patients more susceptible to infections. For example, cancer treatments weaken the immune system, and the use of catheters increases the chances of bugs entering the bloodstream.

“We are becoming increasingly reliant on antibiotics in a whole range of areas of medicine. If we don’t have new antibiotics to deal with the problems of resistance we see, we are going to be in serious trouble,” Johnson added. The supply of new antibiotics has dried up for several reasons, but a major one is that drugs companies see greater profits in medicines that treat chronic conditions, such as heart disease, which patients must take for years or even decades. “There is a broken market model for making new antibiotics,” Davies told the MPs.

She has met senior officials at the World Health Organisation and her counterparts in other countries to develop a strategy to tackle antibiotic resistance globally.

Powerful drugs losing efficacy

Drug resistance is emerging in diseases across the board. Davies said 80 per cent of gonorrhea was now resistant to the frontline antibiotic tetracycline, and infections were rising in young and middle-aged people. Multi-drug resistant TB was also a major threat, she said.

Another worrying trend is the rise in infections that are resistant to powerful antibiotics called carbapenems, which doctors rely on to tackle the most serious infections. Resistant bugs carry a gene variant that allows them to destroy the drug. What concerns some scientists is that the gene variant can spread freely between different kinds of bacteria, said Johnson.

Bacteria resistant to carbapenems were first detected in the U.K. in 2003, when three cases were reported. The numbers remained low until 2007, but have since leapt to 333 in 2010, with 217 cases in the first six months of 2011, according to the latest figures from the HPA. — © Guardian Newspapers Limited, 2013

British government strategy to promote more responsible use of antibiotics among doctors

Responsibility to protect

In banning the screening of Kamal Haasan’s Vishwaroopamfor a period of two weeks, the Tamil Nadu government has recused itself from a fundamental responsibility — that of protecting the right to free expression. It has relied on the old chestnut — maintenance of law and order and public tranquillity — to justify the indefensible. That a clutch of fringe Muslim organisations had protested against the film, claiming to be offended by its alleged depiction of the community in a negative light, hardly justifies restraining its screening. If a threat of violence was anticipated, the right response would have been to ensure that the necessary security arrangements were provided to ensure its smooth screening rather than slap a temporary ban. Whether a film contains objectionable elements, and whether it may be screened or not, are decisions that vest with the Central Board for Film Certification, constituted under the stringent Cinematograph Act, 1952. It is difficult to believe that a film which passes through the process of pre-censorship with its rigid guidelines contains material that would upset the sentiments of a religious community and pose a real danger to public order.

It is a pity that such reflexive bans are imposed despite the courts reiterating time and again that a law and order threat does not justify such action. In 2006, the Supreme Court adopted this position while dismissing a petition seeking to bar the screening of The Da Vinci Code ; a little later, the Madras High Court quashed the Tamil Nadu government’s order suspending the screening of the film on the ground that it “may lead to demonstrations and disturb the peace and tranquillity of the state.” The landmark case, which set the tone for these and related judgments is S. Rangarajan vs. P. Jagajivan Ram , in which the Supreme Court ruled in favour of the right of the former, a film producer, to release Ore Oru Gramathile , which was critical of the reservation policy in Tamil Nadu’s educational institutions. In a stirring judgment that underlined that it was the duty of the state to protect the right to unpopular forms of speech, the court held that “freedom of expression cannot be suppressed on account of threat of demonstration and processions or threat of violence.” As it observed, this “would be tantamount to negation of the rule of law and a surrender to blackmail and intimidation.” Given the precedents, it is highly doubtful that the Tamil Nadu government’s ban on Vishwaroopam will withstand judicial scrutiny. In capitulating before those who protested against the film, the State has only passed the buck on its screening to the judiciary. Could this be exactly what it wanted?

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