A short history of nearly everything - Bill Bryson [156]
The scariest, most out-of-control bacterial disorder of the moment is a disease called necrotizing fasciitis in which bacteria essentially eat the victim from the inside out, devouring internal tissue and leaving behind a pulpy, noxious residue. Patients often come in with comparatively mild complaints—a skin rash and fever typically—but then dramatically deteriorate. When they are opened up it is often found that they are simply being consumed. The only treatment is what is known as “radical excisional surgery”—cutting out every bit of infected area. Seventy percent of victims die; many of the rest are left terribly disfigured. The source of the infection is a mundane family of bacteria called Group A Streptococcus, which normally do no more than cause strep throat. Very occasionally, for reasons unknown, some of these bacteria get through the lining of the throat and into the body proper, where they wreak the most devastating havoc. They are completely resistant to antibiotics. About a thousand cases a year occur in the United States, and no one can say that it won't get worse.
Precisely the same thing happens with meningitis. At least 10 percent of young adults, and perhaps 30 percent of teenagers, carry the deadly meningococcal bacterium, but it lives quite harmlessly in the throat. Just occasionally—in about one young person in a hundred thousand—it gets into the bloodstream and makes them very ill indeed. In the worst cases, death can come in twelve hours. That's shockingly quick. “You can have a person who's in perfect health at breakfast and dead by evening,” says Marsh.
We would have much more success with bacteria if we weren't so profligate with our best weapon against them: antibiotics. Remarkably, by one estimate some 70 percent of the antibiotics used in the developed world are given to farm animals, often routinely in stock feed, simply to promote growth or as a precaution against infection. Such applications give bacteria every opportunity to evolve a resistance to them. It is an opportunity that they have enthusiastically seized.
In 1952, penicillin was fully effective against all strains of staphylococcus bacteria, to such an extent that by the early 1960s the U.S. surgeon general, William Stewart, felt confident enough to declare: “The time has come to close the book on infectious diseases. We have basically wiped out infection in the United States.” Even as he spoke, however, some 90 percent of those strains were in the process of developing immunity to penicillin. Soon one of these new strains, called Methicillin-Resistant Staphylococcus Aureus, began to show up in hospitals. Only one type of antibiotic, vancomycin, remained effective against it, but in 1997 a hospital in Tokyo reported the appearance of a strain that could resist even that. Within months it had spread to six other Japanese hospitals. All over, the microbes are beginning to win the war again: in U.S. hospitals alone, some fourteen thousand people a year die from infections they pick up there. As James Surowiecki has noted, given a choice between developing antibiotics that people will take every day for two weeks or antidepressants that people will take every day forever, drug companies not surprisingly opt for the latter. Although a few antibiotics have been toughened up a bit, the pharmaceutical industry hasn't given us an entirely new antibiotic since the 1970s.
Our carelessness is all the more alarming since the discovery that many other ailments may be bacterial in origin. The process of discovery began in 1983 when Barry Marshall, a doctor in Perth, Western Australia, found that many stomach cancers and most