Much ado about Superbugs : What is the truth?

A major fracas has erupted in the healthcare and political world after a study published in the Lancet. The paper entitled “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study” which was authored by a total of 31 researchers from places as diverse as Chennai, Kolkata, Lahore, Karachi. Stockholm, Cardiff and Brisbane (among others) has sparked off a bitter row in India. Accusations are flying around about motivated reports aimed at tarnishing the Indian image and trying to damage the burgeoning medical tourism industry.
What is the fuss all about? As is well known, one of the biggest threats to life is infections. In fact before the thirties there was nothing we could do about most infections. But after Fleming’s fortuitous discovery of Penicillin we have been gifted with a wide array of antibiotics that have been great help in Man’s battle against infectious disease. However over the past decade or so there has been some concern that bacteria are rapidly becoming resistant to most antibiotics and that new antibiotics are now not being developed to keep us ahead of the game. One such infection, well known now to the world is the Methicillin-resistant Staphylococcus aureus which has been responsible for many outbreaks of difficult to treat infections especially in crowded conditions. In fact the first epidemic outbreaks of this disease were reported from prisons in the United States. These organisms are resistant to beta lactam antibiotics which mean that they produce an enzyme called beta lactamase which destroys these antibiotics. The particular bacteria that has created all this fuss is another one which uses betalactamases to destroy antibiotics. The specialty of this organism is its ability to use a plasmid, a small snippet of DNA that can easily infiltrate other bacteria to spread its effects rapidly and easily. These bacteria named after the Indian capital, have been isolated in patients all over the world, but there seems to be special predilection to the Indian subcontinent. The authors of this paper have perhaps gratuitously commented that those from the West rushing to India for medical treatment should beware.
This has led to predictable outcry in India and as is usual when Indian politicians and journalists get into the act, there is more heat than light. The first author of this paper has claimed that he did not see the unflattering comments before publication of the paper. This is unbelievable and if it is so, it is not at all flattering that he was so eager to publish in Lancet that he did not even bother to see what was being published in his name. Others have claimed that naming the bug after New Delhissi another conspiracy.
There are several things that need to be discussed dispassionately. The first is that this bug was not named by the authors of this study. There was a US CDC warning about these bacteria as early as June where it was pointed out that three such cases had been detected and that this could be the cause of an outbreak. Several Indian authors had also reported on these bacteria earlier. Also it is not really unusual to name bacteria after a city of origin, however in this case a mischief making motive was very probably the reason for the name
One important factor that seems to have escaped all those who jumped to save the honour of the country is that antibiotic resistance is a fact of life in India which is well known worldwide to be perhaps the country with the worst antibiotic usage record. This has been pointed out umpteen times in various Indian journals with nobody taking note. The wide availability of all types of antibiotics over the counter is an open secret. Not only this, all the drug companies including the major multinational players encourage the misuse of antibiotics by making it available to the most rural areas where ill informed quacks and unscrupulous physicians prescribe high end antibiotics in exchange for gifts in cash or kind. The superbug is a natural outcome of these practices. I personally know one of my colleagues in Siliguri obtained a car from a pharmaceutical company in lieu of these sharp practices. Any practitioner will know of many such examples.
Instead of blaming outsiders for their mischief, and mischief it is, no doubt, we should immediately take note of the mote in our own eyes and eliminate these practices. If we do that, no devious journeymen from the West will be able to point fingers at us. But if we fail in these basics, please don’t blame others because they are making use of our plight.


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