Friday, April 8, 2011

The myth of antibiotic resistance and taking your full course of antibiotics or antimicrobials-bad medicine

Weird logic and false conclusions abound in medicine, as has been an important part of this blog. We are not doing blood-letting anymore; but doctors make mistakes sometimes because a) of very smart drug company salesmen disguised as scientists and researchers, and b) because they don't have the time to fully understand Darwin's theory of evolution, and another researcher or biologist gives them a wrong interpretation of the theory. Here's an example of what I believe most people take for granted-but isn't true.

No need to finish the full dose of antibiotics

Doctors recommend that you take your full course of antibiotics (and more generally, antimicrobials-which includes viruses, fungi and parasites in addition to bacteria) even if your infection goes away and you become better. They say that you should take the full course because the residual bacteria which might remain (you have taken care of most of the bacteria with the antibiotic, but not all)  is LIKELY TO BECOME RESISTANT to the drug if the drug is not taken anymore.

That is false logic.

Let's say 1% of the bacteria is left, the antibiotic having taken care of 99% of it. If you give up the drug now-and start your medication when this residual bacteria multiplies in a few years let's say and you fall sick again, or get infected with more bacteria-you are back to square one. The bacteria resistance may develop; but taking the full course now, or spread out over 5 years, wont change the resistance pattern of the bacteria. It is saying in effect that you have to kill all of them to eliminate them developing resistance; which is perverse logic, because if you are able to kill them, then by definition they are not developing resistance to it!

Of course there are many different kinds of bacteria and antibiotics, and antibiotics have side-effects etc. which much be considered, but the rule of finishing your whole course is recommended for antibiotics, and that's what I am questioning. It may even have been some eager drug company salesmen, who are paid by volume of drugs sold, who might have presented this twisted logic in some medical conference, and the poor doctors fell for it.

What on earth is a full course anyway? Someone says three weeks, someone 1 week. It would obviously depend on the person's size and age. There are too many variables; you can't say what a full course is. That's why, it is completely fine to stop taking the drug when the infection or the symptoms go away-you are cured for now. In a few years you will get infected again and we will start all over, nothing has changed; but you haven't overmedicated yourself senselessly.

This is not to be confused with other drugs which adult humans need to take larger amounts of in comparison to children-e.g. painkillers, sedatives, etc. In these cases because of a larger body, you will need a larger amount for the person to feel better. Here you are often taking care of the symptom, not the disease. As a general rule, if you are taking care of symptoms, the higher body weight needs more drugs (adults will need more drugs). But if you are attacking the disease itself-e.g. in antibiotics, vaccinations, anti-virals, adults will need less of it.

Antibiotic resistance does not develop from overuse of antibiotics

A very closely related issue which you hear in the medical profession is that you should not take antibiotics unnecessarily, otherwise bacteria become resistant to it, and that bacteria and microbes are developing newer and newer varieties and that's why we need newer and newer antibiotics to kill them. This is also bad logic by the medical community. Why?

While it may be true that drug-resistant mutants of a bacteria may develop, which will make a particular antibiotic drug ineffective, but that does not mean that taking the drug is the cause of the development of drug resistant bacteria! The mutant bacteria are not being created by the antibiotic drug (a misplaced causality). To give you a simpler example, imagine if you have terrorists who are killed by gunfire. Some terrorists will survive and you can think of them as the ones who beat gunfire and are "resistant to gunfire". Would it not be absurd to say that let's not use gunfire on these terrorists, because using gunfire on them resulted in these gunfire resistant survivor terrorists? Well it is the same strange logic with antibiotics causing the birth of resistant bacteria. It is unfortunate that antibiotics will stop working on bacteria and you will have surviving mutants, and it is unfortunate that you will have terrorists who will survive all your gunfire, but that doesn't mean that stopping antibiotic or gun use will stop these mutant bacteria or surviving terrorists to develop. The resistant mutants were already present in the population-and it is just that after you administer antibiotics, you have a larger fraction of them, because the other ones who couldn't resist the drug are dead!  According to Darwin's theory of Evolution, mutations are random, internal to the organism, and are not generated by the environment; the mutant bacteria resistant to antibiotics are growing and multiplying spontaneously anyway, without anything to do with you giving the antibiotic to the person. Giving antibiotics does not affect the mutations of the bacteria or the growth of the resistant strains. It only kills the non-resistant strains, that's all.  Similarly, terrorists might already have gun-resistant abilities without you firing on them with your gun.

There is no evidence of antibiotic resistance in real life, human situations. What these biologists do in the name of science is grow bacteria in a petri dish, and "induce" resistance. They feel they are doing something great and novel-in reality they are just doing artificial selection, which has been done by man on plants and animals since centuries. Darwin's massive work "The Variation of Animals and Plants under Domestication" goes over dozens of examples of this-where pigeons, cats, dogs, etc. are selected by animal breeders depending on all kinds of characteristics. What he mentions clearly, and what these biologists doing experiments in petri dishes seem to ignore, is that controlled environment experiments have nothing to do with real life in the wild. The bacteria which are resistant to antibiotics in a petri dish will multiply (if you feed them) and it will seem that the antibiotic is doing this to the bacterial colony. However, this result is a controlled experiment, and in wild nature (or a human body), where there are thousands of species of bacteria, chemicals and antibodies, etc and other living organisms who compete with each other, it is impossible to have these "antibiotic resistance" bacteria survive, in all probability. The petri dish experiments have not much to do with the chaos of the real world. If you select for white pigeons (a favorite Darwin experiment) in a controlled setting, let's say by killing the others by an anti-pigeon drug, that breeding in a far has nothing to do with white pigeon selection in nature! Those are entirely different environments. The biologists who are marveling at antibiotic resistant strains produced in a lab would do well to read Darwin's "The variation of Animals and Plants.." and save themselves a lot of trouble (and wasted research dollars). Scientists seem to continue doing this not just for bacteria but for larger animals (developing butterflies of colors etc.) and believe that it is something amazing and novel; stuff which farmers and animal breeders have been doing for centuries.

It would bee impossible to  "induce" resistance in a real life situation (e.g. a human body) by administering antibiotics. There are a large number of factors involved (other bacteria and microorganisms, body's natural defenses which will change over time, availability of food, bacteria coming from other humans into the body of the host, etc, etc), and you could not assure anything. After you kill off the non-antibiotic resistant bacteria in the human body (as is done when you get Cholera or Pneumonia), you don't know what happens to the bacteria who didn't die from the drug-you can't predict how their population will evolve, etc. etc. It is a chaotic world out there, and all you can say is that by giving the antbacterial to kill off Streptococcus pneumoniae, you improved the patient, but after that, what happens to the small remaining bacteria (some resistant to the drug you used, some surviving just by chance, hiding in a place where the drug didn't reach, etc) you can't predict how their colonies will evolve. The human body is not a controlled petri-dish.

Another example, you can't predict the change in the pigeon population distribution in a jungle once you kill all the black pigeons. The real jungle is chaotic, dynamic, full of other animals, etc; and the proportion of black pigeons today (or other such statistics) has nothing to do with what it will be in a few years. Killing off a small part of the population of a species in a mighty jungle will not give you any predictability of what happens to others in that species. It is the same with killing off some bacteria in the jungle of a human or animal body. There is no such thing as an "equilibrium population" or "equilibrium population distribution" of species-bacteria in the human body, or black pigeons in a jungle full of pigeons of all colors, and thousands of other species. Researchers in biology tend to use the word "equilibrium population" a lot-it is a Physics terms and is best left there. Darwin never used this term in the context of population of species. The equilibrium are in small, controlled petri-dish type settings, and have little relevance to the real world. Killing all the black pigeons in a jungle, which has hundreds of other pigeon species, and thousands of other animal species, does not give you any idea about how the remaining pigeon species grow. You are killing off 0.001% of the species and are trying to predict the development of the rest of the animals, which is foolish, as you can obviously see.

Here's another example to explain that the oft repeated "overuse of antibiotics is leading to the development of antibiotic resistant superbugs. We must cut down on the use of antibiotics, otherwise we will develop these superbugs which we won't be able to kill anymore" is wrong.  Imagine an aquarium with 10 species of fish, S1, S2, S3..etc. Imagine now that the species S1 has fish with three colors, A, B and C. So S1 has three varieties of fish, S1A, S1B and S1C. Let's say we develop a drug which selectively kills S1A, but does not harm S1B or S1C. The drug also doesn't harm any other species of the aquarium. If we administer a dose of our S1A killer drug, and kill all the S1A or many of the S1A fish, can we predict what happens to the population of S1B and S1C and their progeny in the acquarium???  Clearly we cannot..the loss of S1A will not mean that we will suddenly have more of S1B or S1C in the aquarium. On removing S1A, we just can say that we have taken away that variety; but we have no control nor can we predict what happens to S1B, S1C, or their offspring. A few weeks down the road, the distribution is not predictable. The same example can be translated for bacteria (S1A being the bacteria which is killed by our antibiotic, while S1B and S1C are antibiotic resistant bacteria) and hopefully you can see that killing off one variety of bacteria doesn't give us any confidence is saying how the non-resistant bacteria will develop, they are independent things-much more so when thousands of other animals and species are present.

In certain countries like India and Argentina, where medicine hasn't bought this strange logic of antibiotic use causing resistance, you can buy antibiotics easily, over the counter. Developed countries in Europe, and both the Americas, have fallen for all this bad logic and the result is that you to get these wonderful life-saving drugs only with the prescription of a doctor. There seems to be some artificial regulation issues here-the medical community (probably because of  clever marketing by drug companies) is controlling the exact amount of antibiotics they can dispense, and when.

You can take all the antibiotics you want, that will not "cause" bacteria to become resistant. You may have other side effects which you may not like, and that's a good reason not to overdose yourself. But taking the antibiotics will not cause the resistant bacteria to develop. In addition, you can stop your antiobiotic use whenever you feel the symptoms are gone, there is no fear of left over bacteria multiplying etc. because of you stopping antibiotic use.

Antibiotics, if there are no severe side effects, should be used without problems. The older antibiotics, which we are quite sure do not have many severe side effects, should be brought back as over the counter drugs. Their overuse is not harmful, and if you stop using them just after symptoms go away, it won't hurt you either (except that the same illness can be born again, or of side effects).

Plenty of experienced medical professionals know this already.

Antibiotics act on the bacteria, not on the human body

The confusion of "resistance to antibiotics-therefore let's take less of them" is also because these doctors are missing the point that antibiotics are acting on the bacteria, and NOT on the human body. Obviously everyone knows that you need more and more alcohol to get drunk, more and more pain killers to relieve pain, etc. as you get "used to them". But that's entirely different from bacteria surviving after antibiotics. The resistance can be developed only by the ones who survive!  You need more alcohol to get drunk than you did 10 years ago, but this is not the same as you will need more antibiotic to fight off bacteria as well.

Horizontal gene transfer is a rare phenomenon

There is a theory of horizontal gene transfer with plasmids which is also use to explain development of antibiotic resistance. Horizontal gene transfer, spontaneously, is probably a very rare phenomenon-and exotic explanations like that do not prove or disprove that antibiotic resistance is developed at the first place (it explains the how, but doesn't answer why).

Uses of antibiotics

If you accept that overuse of antibiotics will not lead to developing of "resistance", you can use them for treatment of some very common infections and diseases.

That antibiotics are very safe and beneficial was supported by one of the finest doctors I have known in my lifetime, Dr. Dharam Veer, who worked in a crowded Government operated Hospital in Jaipur, India, for many decades. Dr Dharam Veer is no more, but his knowledge and experience with patients was immense, he was easily seeing a 100 patients per day. He worked in that hospital for more than 30 years, and if there's one medicine man who I trust for his experience with humans, it  is him. Dr. Dharam Veer was an avid fan of antibiotic use-went so far as to recommend their daily or weekly use for all of us just to take care of any infections out there, he used to say. He said he cured so many patients just by administering antibiotics them. Taking antibiotics once a week or a month is like taking vitamins, and it is good to have a good supply of both, he would say. India is still not affected by the foolishness of European and American "antibiotic resistance" theories-and doctors prescribe them routinely for all types of infections. The theory that there is misuse in Asia and India of antibiotics, professed by the high-science people in USA especially, is completely unfounded. Doctors in India and China are hardly stupid-and there is a reason why they prescribe antibiotics to patients-it works and has no negative long term consequences. I trust medicine in India and Argentina far more than a mercenary doctor in USA or Chile. The latter are paid by the pharma industry to attend glitzy conferences and get carried away by the bad research coming out of them. Given the financial incentive they are offered-it is easily understandable why they turn a blind-eye to the interests of the pharma companies-whose sole aim is to monopolize and control the distribution of drugs. How can an antibiotic like Penicillin or Amoxicillin have "resistance issues"! The drugs have been around for several decades-and still work quite well for many many bacterial infections (fingers, mount and dental infections, etc.). But the drug companies can't make much money of them anymore-so they come up with newer drugs, outlaw the older drugs, and the profits are secured-a very nice business strategy, don't you think? If drug companies do enough research-I am sure that they will find that the water purification done by municipalities worldwide is not 100% enough, that the tubes for distribution of water in a city will contaminate the water, and the only real pure water with 0% bacteria and 0% contamination would be the one you buy from a Pfizer or Merck-and you will be obviously required to get a prescription for it to buy it from a pharmacy. The drug companies only aim is profit, and they will gladly remove the free supply of water if you give them a chance. The profit motive is too strong for them not to do otherwise-and as I have said before in this blog several times-the research coming out of drug companies' labs is pretty dicey scientifically speaking. Simple statistics etc. are fudged to make the numbers look better-to get new drugs approved by the US FDA.

Infections on fingers from nail biting, or rough use of hands-construction workers, car mechanics, etc: This is another area where I have used antibiotics to cure myself and people around me very effectively. If you are "fortified" with antibiotics in your diet,  you won't even get these infections (the white pus kinda stuff is a symptom) but if you don't, you can quickly cure them by applying antibiotics locally. Tonic water has traces of quinine, which works well. Eugenol (Clove oil) is also excellent-apply it locally to an infection and it goes away in 24 hours or less. I don't claim to know how (the mechanism) and why antibiotics work in these infections.

I wouldn't go as far as taking antibiotics as vitamins, but I believe in these two very common infections-of teeth and of fingers, we can take care of them by taking antibiotics orally or applying them locally.

The dentist disaster

I will  now make a small comment on Dentists. The dentist is a medicine man who I trust the least amongst all medical professions. The damage they cause to teeth/gums is irreversible, and I think a almost all the procedures which dentists do today, in all parts of the world, are avoidable and useless-and in many cases, actually harmful to you. Any dental work is essentially a mini-surgery. Most of their knowledge is based on false, let's-fix-it-mechanically type of reasoning. They are like car mechanics-anytime you take your car to a mechanic he tells you 3 other problems which you should get fixed as preventative maintenance. I believe a car mechanic's knowledge of cars is more sound than a Dentist's knowledge of teeth.

Society would be better of if 95% of universities which offer courses in dentistry were shut down and production of these useless people would stop.

More on dentists and their sham art here.

See also this post on stress induced illnesses. 
this post on uselessness of low fat foods.