Bit of self promotion here: I’ve got a piece in today’s Boston Globe, on one of the hidden consequences of failing to deal with the antibiotic crisis. In it, I focus on the use of antibiotics as prophylactics in surgery. Nowadays, it’s standard procedure for a wide range of operations to dose the patient with antibiotics shortly before she or he goes under the knife; doing so has been shown to signficantly reduce the risk of post-surgical infections.
I took off from a study that modeled the consequences of increased microbial resistance for ten common procedures, mostly surgeries, along with chemotherapy for a particular set of cancers.
The results of that study were predictable: more resistance leads to more post-op infections and to more deaths. If the situation gets really dire, if common causes of infection associated with surgery become increasingly untreatable then the calculation behind all kinds of medical interventions will change:
That’s what scares Dr. James Maguire, an infectious disease specialist at Brigham and Women’s Hospital. “I think some of the worst feelings we have are when we have a problem with a patient and there’s nothing we can do.” Infections following joint replacements are bad enough. They are, Maguire says, “catastrophic in terms of what happens to the patient.” Were the risk of infection to go up enough, he adds, “having seen what an infected joint replacement is all about I would think twice.”
That’s a response to an operation that may be vitally needed to reduce pain and increase mobility — but, as Maguire went on…
…while someone contemplating a joint replacement can choose to forgo the risk, if they need a new heart valve or a ventricular assist device, “that’s potentially life and death.” In such circumstances, “if your life depending on having the device, even with great risk you’d do it. But more would die.”
Behind such specific possible horror stories, this is for me a deeply cautionary tale about the way choices our society — our politics — makes have much deeper effects than our usual debate admits. Antibiotics are not just responses to disease; their use penetrates medical practice, to the point that basic expectations we may have about what how we can move through the stages of our life can be dashed, without our ever really grasping why.
That is: joint replacements are part of our medical and mental landscape now. There are over 330,000 hip replacements performed each year in the US. We know (some of us, venerable as we are, more than others) that our knees, elbows, shoulders and so on won’t always work as well as they do today. We know, most of us I’m sure, folks who’ve had the op and are now playing tennis again or whatever, and we have in the back of our minds (those of us fortunate enough to believe we’ll still have adequate health care available over time) that if and when that bit falls apart in our own bodies, we can look for the same outcome.
Except, of course, if the risks of surgery shift significantly in the meantime.
The last point I make in the piece, somewhat more gently than here, is that should the way we age, the way we give birth and so on deteriorates because of unchecked microbial resistance, that will be a more-or-less hidden consequence of political failure.
That’s because dealing with the antibiotic crisis boils down to doing two things: regulating economic activity and funding research. The GOP doesn’t want to do either. And, as usual, people will die as a result.
So, on that note of cheer, a link, again, to the piece.
Oh…and open thread too.
Image: Follower of Jan Sanders van Hemessen, An Operation for a Stone in the Head, date unknown (to me).