Mountainous Microbes: Guest Blogger Dr. Kiran Kumbhar

Mountains: huge, gargantuan structures they are. They remind us through their mere presence and through occasional bouts of fury like mudslides, that Earth is not at all a quiet planet but highly dynamic and unstable. When you are on a mountain, a small mistake or a small misstep can send you hurtling down to sudden and quick death. In some mysterious invisible script, mountains have 'NOT TO BE MESSED WITH' written all over them, and all living beings seem to respect that. All except, of course, humans – who have always been a tad bit weak in understanding Nature's unwritten but implied words and rules. Any visit to India's so-called 'booming' towns and cities provides enough evidence: mighty, ancient hills, which have been present even before humans evolved, are being turned into dust with utter disdain. But then, the earth has a life of its own despite being technically 'nonliving'. It is highly vibrant. One day for sure, it will fight back. Perhaps as terribly as another entity – microbes – has.

When it comes to size, how ridiculously insignificant micro-organisms are compared to mountains, or even humans. But unlike the lithospheric mega-structures, microbes are winning the battle against humans (interestingly, almost each and every creature on earth is engaged in a battle against humans – who of course in turn are engaged in their own battles against each other). Microbes are triumphing in a way that has brought Planet Earth's most intelligent species to its wit’s ends. In the 1940s when antibiotics started being produced on a mass scale, many of us thought that was the beginning of the end of nasty bacteria. But in just a few decades we realized that even the smartest of humans are no match for the strongest of microbes. We made new drugs, and they made new escape mechanisms. As of now, it has been almost 30 years since any new major class of antibiotics was developed. Like the Mumbai policemen during the 26/11 attacks, we are fighting an advanced enemy with outdated weapons.

Micro-organisms have been our arch-enemies since ages. People generally know about the earthquakes, cyclones and other calamities that killed record number of people, but few seem to realize that the most consistent annihilators of the most successful species on earth have actually been these most primitive organisms. E.g. in the 1300s, the plague bacterium Yersinia pestis wiped out 30 to 50% of Europe's population in the 'Black Death' pandemic; the influenza pandemic of 1918 killed more people than the First World War which it immediately followed. This is perhaps the greatest of paradoxes. Humans, the master killers of even the mightiest of animals, still cannot save their derrieres completely from tiny invisible creatures. Antibiotics were supposed to be our perfect swords against them, but we started using them so irresponsibly and recklessly – even in battles where simpler weapons would have sufficed (read wrong/unnecessary prescriptions) – that the killer edges have turned hopelessly blunt. For the uninitiated, this is in short what 'antimicrobial resistance' (AMR) or 'antibiotic resistance' is, described in more detail here and here. The ‘post-antibiotic era’, which we are rushing into courtesy AMR, is a kind of biological Kaliyug, where disease and death will be rampant: small injuries like falls at homes, routine procedures like wound suturing and deliveries, and common infections all will turn deadly in many people, even with the best of medical care. 'Old' terrible diseases will come back. E.g., over the last few years, several doctors and medical staff in India have lost their young lives to new, resistant forms of tuberculosis, and several dozen are currently suffering from the deadly condition. In a typical display of journalistic neglect bordering on irresponsibility, the Indian media has miserably failed to highlight this serious health issue.

To use an Americanism, this is a ‘war on microscopic terror’; a war that we are losing for now. As already noted, humans have been utterly puerile fighters, careless and unwise. There's one huge difference between antibiotics and other medicines: when your doc prescribes you a paracetamol or when you take it on your own, the action is going to affect just one individual i.e. you (or perhaps your spouse in case your headache has been giving them sleepless nights). But the act of consuming an antibiotic has wider, community implications. In fact, global implications, considering the present damning scenario. An antibiotic is the only perfect weapon against humankind's most colossal enemy, but we have never, doctors and patients alike, treated it with respect. In fact, there is a strong case for putting the larger (though not entire) blame on doctors: despite stupendous knowledge and experience, many of them have failed to display proportionate wisdom and responsibility in handling such powerful drugs. The page here provides a few methods of tackling this challenge.

In Jurassic Park the novel, author Michael Crichton beautifully enunciates a very profound concept, through the ubercool Ian Malcolm: …the history of evolution is that life escapes all barriers. Life breaks free. Life expands to new territories… LIFE FINDS A WAY. Microbes did just that. In microbial language, AMR may well translate to ‘Screw You Humans’. As WHO's new report testifies, there is just no way we are going to have the upper hand in this battle soon; but if we don’t try hard, we risk the possibility of terrible consequences. It is high time the terms antimicrobial resistance and post-antibiotic era left the confined shores of academia and entered the vast ocean of popular conscience; like the way ‘BRCA gene’ and 'mastectomy' jumped from medical parlance to colloquial usage aboard an Angelina Jolie-catapult.

This article is used with permission from Dr. Kiran Kumbhar and originally appeared on his blog.

Kiran Kumbhar Dr Kiran Kumbhar, MBBS, BJ Medical College, Pune. Formerly Medical Officer at Sassoon Hospital, Pune