Essays. FSF Columns

If this is the case, then our most potent chemical weapons have been changed by our lethal enemies into sexual aphrodisiacs.

The greatest battlegrounds of antibiotic warfare today are hospitals. The human race is no longer wi

An epidemic of acquired immune deficiency has come at a particularly bad time, since patients without natural immunity are forced to rely heavily on megadosages of antibiotics. These patients come to serve as reservoirs for various highly resistant infections. So do patients whose immune systems have been artificially repressed for organ transplantion. The patients are just one aspect of the problem, though; healthy doctors and nurses show no symptoms, but they can carry strains of hospital superbug from bed to bed on their hands, deep in the pores of their skin, and in their nasal passages. Superbugs show up in food, fruit juices, bedsheets, even in bottles and buckets of antiseptics.

The advent of antibiotics made elaborate surgical procedures safe and cheap; but nowadays half of nosocomial infections are either surgical infections, or urinary tract infections from contaminated catheters. Bacteria are attacking us where we are weakest and most vulnerable, and where their own populations are the toughest and most battle-hardened. From hospitals, resistant superbugs travel to old-age homes and day-care centers, predating on the old and the very young.

*Staphylococcus aureus,* a common hospital superbug which causes boils and ear infections, is now present in super-strains highly resistant to every known antibiotic except vancomycin. Enterococcus is resistant to vancomycin, and it has been known to swap genes with staphylococcus. If staphylococcus gets hold of this resistance information, then staph could become the first bacterial superhero of the post-antibiotic era, and human physicians of the twenty-first century would be every bit as helpless before it as were physicians of the 19th. In the 19th century physicians dealt with septic infection by cutting away the diseased flesh and hoping for the best.

Staphylococcus often lurks harmlessly in the nose and throat. *Staphylococcus epidermis,* a species which lives naturally on human skin, rarely causes any harm, but it too must battle for its life when confronted with antibiotics. This harmless species may serve as a reservoir of DNA data for the bacterial resistance of other, truly lethal bacteria. Certain species of staph cause boils, others impetigo. Staph attacking a weakened immune system can kill, attacking the lungs (pneumonia) and brain (meningitis). Staph is thought to cause toxic shock syndrome in women, and toxic shock in post-surgical patients.

A 1994 outbreak of an especially virulent strain of the common bacterium Streptococcus, "necrotizing fasciitis," caused panic headlines in Britain about "flesh-eating germs" and "killer bugs." Of the fifteen reported victims so far, thirteen have died.

A great deal has changed since the 1940s and 1950s. Strains of bacteria can cross the planet with the speed of jet travel, and populations of humans -- each with their hundred trillion bacterial passengers -- mingle as never before. Old-fashioned public-health surveillance programs, which used to closely study any outbreak of bacterial disease, have been dismantled, or put in abeyance, or are underfunded. The seeming triumph of antibiotics has made us careless about the restive conquered population of bacteria.

Drug companies treat the standard antibiotics as cash cows, while their best-funded research efforts currently go into antiviral and antifungal compounds. Drug companies follow the logic of the market; with hundreds of antibiotics already cheaply available, it makes little commercial sense to spend millions developing yet another one. And the market is not yet demanding entirely new antibiotics, because the resistance has not quite broken out into full-scale biological warfare. And drug research is expensive and risky. A hundred million dollars of investment in antibiotics can be wiped out by a single point-mutation in a resistant bacterium.

We did manage to kill off the smallpox virus, but none of humanity's ancient bacterial enemies are extinct. They are all still out there, and they all still kill people. Drug companies mind their cash flow, health agencies become complaisant, people mind what they think is their own business, but bacteria never give up. Bacteria have learned to chew up, spit out, or shield themselves from any and every drug we can throw at them. They can now defeat every technique we have. The only reason true disaster hasn't broken out is because all bacteria can't all defeat all the techniques all at once. Yet.

There have been no major conceptual breakthroughs lately in the antibiotic field. There has been some encouraging technical news, with new techniques such as rational drug design and computer-assisted combinatorial chemistry. There may be entirely new miracle drugs just over the horizon that will fling the enemy back once again, with enormous losses. But on the other hand, there may well not be. We may already have discovered all the best antibiotic tricks available, and squandered them in a mere fifty years.

Anyway, now that the nature of their resistance is better understood, no bacteriologist is betting that any new drug can foil our ancient enemies for very long. Bacteria are better chemists than we are and they don't get distracted.

If the resistance triumphs, it does not mean the outbreak of universally lethal plagues or the end of the human race. It is not an apocalyptic problem. What it would really mean -- probably -- is a slow return, over decades, to the pre-antibiotic bacterial status-quo. A return to the bacterial status-quo of the nineteenth century.

For us, the children of the miracle, this would mean a truly shocking decline in life expectancy. Infant mortality would become very high; it would once again be common for parents to have five children and lose three. It would mean a return to epidemic flags, quarantine camps, tubercular sanatariums, and leprosariums.

Cities without good sanitation -- mostly Third World cities -- would suffer from water-borne plagues such as cholera and dysentery. Tuberculosis would lay waste the underclass around the world. If you cut yourself at all badly, or ate spoiled food, there would be quite a good chance that you would die. Childbirth would be a grave septic risk for the mother.

The practice of medicine would be profoundly altered. Elaborate, high-tech surgical procedures, such as transplants and prosthetic implants, would become extremely risky. The expense of any kind of surgery would soar, since preventing infection would be utterly necessary but very tedious and difficult. A bad heart would be a bad heart for life, and a shattered hip would be permanently disabling. Health-care budgets would be consumed by antiseptic and hygienic programs.

Life without contagion and infection would seem as quaintly exotic as free love in the age of AIDS. The decline in life expectancy would become just another aspect of broadly diminishing cultural expectations in society, economics, and the environment. Life in the developed world would become rather pinched, wary, and nasty, while life in the overcrowded human warrens of the megalopolitan Third World would become an abattoir.

If this all seems gruesomely plausible, it's because that's the way our ancestors used to live all the time. It's not a dystopian fantasy; it was the miracle of antibiotics that was truly fantastic. It that miracle died away, it would merely mean an entirely natural return to the normal balance of power between humanity and our invisible predators.