The title of this post might also read "Don't Mess with Mother Nature"
We have seen remarkable improvements in human health as a direct result of the science that has brought us our antibiotic age with significant reductions in infant mortality, deaths due to bacterial pneumonia, and other serious infections that sometimes led to systemic infection and death.
Fast forward to today, when we may obtain with a prescription many of these powerful germ killers for $4 at WalMart and Target and drug and grocery store chains. Some retailers even give away a prescribed course of antibiotics as a loss leader to entice the customer to enter that store.
The liberal (excessive, really) use of antibiotics in the United States and much of the rest of the world is having profound unintended negative consequences.
In his well researched and insightful book, "Missing Microbes: How the Overuse of Antibiotics is Fueling Our Modern Plagues," Dr. Martin J. Blaser convincingly makes the case linking overuse of antibiotics with the dramatic rate of increase in many immune mediated conditions in children (asthma, Type 1 diabetes, food allergies, obesity) and adults (inflammatory bowel disease, eczema, other skin disorders, and reactive airway diseases).
Dr. Blaser writes:
"…the autoimmune form of diabetes that begins in childhood and requires insulin injections (juvenile or Type 1 diabetes) has been doubling in incidence about every twenty years across the industrialized world. In Finland, where record keeping is meticulous, the incidence has risen 550 percent since 1950....
"Food allergies are everywhere. A generation ago, peanut allergies were extremely rare. Now, if you stroll through any preschool, you will see walls plastered with "nut-free zone" bulletins. More and more children suffer immune responses to proteins in foods, not just in nuts but in milk, eggs, soy, fish, fruits — you name it, someone is allergic to it. Celiac disease, an allergy to gluten, the main protein in wheat flour, is rampant. Ten percent of children suffer from hay fever. Eczema, a chronic skin inflammation, affects more than 15 percent of children and 2 percent of adults in the United States. In industrialized nations, the number of kids with eczema has tripled in the past thirty years.
"These disorders suggest that our children are experiencing levels of immune dysfunction never seen before, as well as conditions such as autism, a much discussed and debated modern plague that is a focus of my laboratory. Nor are adults escaping their own share of modern plagues. The incidence of inflammatory bowel disease, including Crohn's and ulcerative colitis, is rising, wherever we look."
The lessons are clear. As prescribers, we need to redouble our efforts to practice good antibiotic stewardship and to have the conviction to say no to persons that are requesting antibiotics for what we know to be with very high likelihood a self-limited viral infection or, perhaps ironically, an allergic condition that may have been promoted by the very antibiotics that the patient is seeking. Health plans, health system leaders, and public health officers should seek ways to educate both health care professionals and consumers about these profound unintended negative consequences to antibiotic overuse/ misuse, and provide actionable feedback to prescribers.
The lesson is clear: "Don't Mess with Mother Nature"
We are destroying the microbiome that by evolution or design exists to protect us.
Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.