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TOP 500 REVIEWERon 29 September 2013
This is a Penguin Special, a deliberately slim book that gets across a single point with devastating effect. Sally Davies (I really can't call her 'Professor Dame' like the cover does - it makes her sound like a character from a pantomime) ought to know what she's talking about when it comes to antibiotics, as she is the Chief Medical Officer for England.

We start with a stark little story of life in the 2040s when all the antibiotics have failed and even what appears to be a harmless throat infection could result in isolation and death. Davies then takes us swiftly through the history of antibiotics and the various nasties we have to face up against.

In case it's not obvious by now, the theme is that our over-use of antibiotics is resulting in growing resistance building up in more and more diseases. At the same time, there really isn't a lot of work going into the next generation of drugs, as it isn't a hugely profitable thing for pharma companies to do.

Left with only the current facts we are presented with a dire situation, particularly for the next generations. However, Davies does come up with a range of possibilities for making things better, from the simplest aspects like washing our hands more effectively through to means to encourage production of the next generation of antibiotics. The trouble is, these positive bits seem to me to be primarily filled with the optimism of the scientific professional, rather than a reflection of the political reality. Specifically, I think unless we see Bill Gates and his equivalents pouring vast amounts into the research we won't get very far until things start going horribly wrong. For instance, the use of antibiotics in animal rearing should be clamped down on at draconian levels worldwide, but politicians have fudged it again and again.

But whether or not you take solace from the practical suggestions, and the rosier picture of the future the book finishes with, there is no doubt that this is a highly important message that, for a start, every MP and GP should be reading. And wash your hands. Right now.
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on 31 May 2017
This book proved to be a very interesting and enlightening read… It was very clear and informative without being full of technobabble so for the general public it doesn't go over one's head. It looks at why we should all be concerned about how antibiotics are used and how this may well lead to them eventually becoming ineffective in treating many diseases that they used to treat previously or are still able to treat at present. It touches on a lot of reasons for this e.g. the food industry giving antibiotics to animals in the food chain, antibiotics being prescribed by doctors like Smarties, patients requesting antibiotics for simple little things, patients being put on a course of antibiotics and not taking the complete course, antibiotics being watered down by some countries & the greed of pharmaceuticals who are more interested in watching their profit margins then carrying out research and development in this area…

We can do simple things for ourselves to try and help the situation which the author tells us about in her book like for example with regards to cleanliness and hygiene, after going to the toilet the author says:

"In order to kill off the bugs, all it takes is fifteen to twenty seconds of vigorous hand-washing with soap and water – this is about how long it takes to sing ‘Happy Birthday to You’ twice through."

This book is well worth reading.
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on 27 April 2017
Fascinating book that could have been twice as long the subject matter is so intriguing. More people need to read it.
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on 28 June 2015
Fab little read!
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on 17 November 2013
Excellent book that explains why the difficulties arising out of bacterial resistance to antibiotics are so potentially worrying to all of us. We may be returning to the situation we had before antibiotics were available to us and that simple infections will no longer be so easy to deal with, but may become life-changing or life-threatening to us in the future. Rampant overprescribing and inappropriate prescribing of antibacterials for the treatment of viral infections for example are the cause, plus the lack of new innovations from the pharmaceutical industry - a fascinating read - well written without patronising the reader.
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on 8 January 2014
This book should be part of every school's reading list in an effort to educate the population about the health problem associated with the growing menace of drug resistant antibiotics through over use, mis-use and lack of understanding how they work. Food for thought on what steps doctors and patients can do about it.
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on 23 December 2013
People need to be educated about the threat that lies ahead due to the poor misuse of antibiotics. Fascinating reading.
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on 7 July 2016
So we're all agreed - it's shocking and frightening. The world is about to end. We're all going to die at the hands of a superbug. 200,000 years of Homo sapiens wiped out because of 60 years of antibiotic overuse, and a sluggish pharmaceutical industry that won't do the decent thing and invent a load more drugs for pennies.

Except, as a doctor with a fascination in microbiology, I don't buy it.

The only frightening thing here is how credulous everyone is here, including almost every reviewer. The author may be a dame, a professor, may have published a thousand papers and be at the top of her profession - she's certainly very good at getting noticed - but she does NOT have a crystal ball. There is a difference between an educated short term prediction about the future, and then there is wild extrapolation of the most tenuous evidence, and this is definitely the latter. In general in science, the more conviction an author shows that they are right, the more you should question their assumptions.

The basic error made by all these Cassandras is to forget that most of us live long, healthy lives without the need for antibiotics most of the time. They do know this, because they spend the other half of their time telling us all not to go to the doctor and telling off well-meaning GPs, frightened for their licenses, for prescribing antibiotics in good faith when they believe a chest infection (for instance) to be bacterial in nature and not viral.

Staphylococci, Streptococci and E. coli are all around us - and on us, and in us. They were here first and we evolved in their presence. One might even say we live by their permission! When you cut yourself, millions of bacteria flock to the wound. And yet 9 times out of 10, no infection. Your immune system deals with it. Commensal (friendly) bacteria also help. The not-so-friendly bacteria don't even "want' to kill you - they just want to replicate. In fact many diseases get less virulent the longer they are around. It is in the invading organism's interest for you to survive, or even not notice. Look at bed bugs!

Sometimes, a Strep A gets into the cut. This is life threatening. Penicillin + your immune system is effective in the majority of cases. If not, it's almost never the penicillin's fault - it will be late diagnosis, inadequate care, immune compromise or just a really nasty virulent bug.

Some bacteria are multi-resistant, sure. They get in my way as a doctor, sure. But we did not invent them. Most antibiotics are based on naturally occurring compounds. Penicillin from Penicillium fungus, etc. Again, bacteria have had aeons to develop resistance to these things, and so, unsurprisingly, antibiotic resistance is found in nature. (Not that much though, because in nature species do not tend to throw industrial quantities of the stuff at each other, with the exception of the occasional poison dart frog, or whatever. But I digress)

What is interesting is that so many bacteria remain sensitive to the drugs. Why? Because outside hospital, or the antibiotic-soaked patient, it simply is not important to that strain / species to be resistant. This is why MRSA (a resistant Staphylococcus) is pretty uncommon in the community. In hospital, it is commoner because we need to use flucloxacillin quite a lot to treat Staph infections. As evolutionary theory predicts, this selects for and encourages the resistant MRSA strain. As long as people don't stay too long (and we wash our hands and beds and curtains) they don't generally get MRSA. In England the NHS has had great success in reducing MRSA simply by screening for it and isolating it when found - NOT by inventing a better antibiotic (although luckily, a few exist that work for MRSA). But also, most Staphs are going to remain sensitive to flucloxacillin simply because they never encounter it, so there is no need for them to become resistant. It is not as if most of us are on antibiotics most of the time.

Some farm animals are on antibiotics most of the time, and that is where the Cassandras are right to warn us - this will create universally resistant strains in our food which is a terrible idea. This, not GP prescribing, should be the real target if we want to reduce resistance.

Finally, to tackle one of the commonly advanced theories head on - the idea that you will not be able to have your appendix out safely in 20 years. This is bunkum because, when I was a house doctor only 15 years ago, I remember some surgeons still did not use any antibiotics at all for appendicectomy, or for abscesses, or other "surgical" infections. It did not matter whether the bowel bacteria were sensitive to antibiotics, or not, because you weren't getting any! The vast majority of patients recovered uneventfully. A few caught infections (from themselves) and required antibiotics and/or further surgery to drain an abscess. Antibiotics do reduce, but not eliminate, that number, if used universally, so we do that now. If all bacteria became resistant - which I do not accept they will, see above - but if they did, only that small percentage of appendix patients would suffer. Going by current experience, even with resistant strains we will usually find one or two drugs that will work. This current, small problem may get worse, but on a population-wide basis, I predict it will remain small.

Unlike the author, my views are moderate, and cautious. I may be a little wrong, or very wrong. I do agree that we need to think about antibiotic resistance and that it may be on the increase in some quarters, though on the decline in others. We need to monitor it, use drugs rationally, and continue to improve infection control in and out of hospitals. Multi resistant TB from Russia for instance, brought about by shoddy disease management, is a threat to world health - but a relatively small threat. Most people survived TB before we had any antibiotics, and most still do, until they become malnourished or immunocompromised. Yes, it would be good to invent a new antibiotic or two in the next decade. But I simply refuse to indulge in the scale of hysteria that is being encouraged here. AIDS, BSE, SARS, Swine flu, Ebola, all produce terrible effects on small portions of the population and all should be fought, but each time we are told a quarter of us are going to be wiped out, lots of sage professors get articles published and get promoted, lots of newspapers are sold, and yet each time the predictions are wildly over-estimated. This book will join the long list of forgotten inaccurate disaster predictions. Mark my words in 2040.
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on 25 November 2013
Excellent review of the problems that modern medicine faces for the future. Compares how much time and money may be spent on producing new drugs, and how few may actually be appropriate to use. Worrying trends for future use of antibiotics. Conventional medicine may be less able to treat future epidemics. Easy to read and a fairly short book written by the Chief Medical Officer.
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on 19 March 2014
A skinny book in the Penguin Specials genre which spells out a single message - but not exhaustively. The message is,"Germs" are becoming resistant to "antibiotics". Examples are given and some of the reasons why are explained.Basically these appear to be, biology, misuse and complacency.
The prose can be a bit turgid and the pace overwhelming. Content flows somewhat erratically between the technical specialisms and the mundane.
The structure would have benefited from a more thought through layout - diagrams, headings, bullet points, etc More of a PowerPoint presentation than a constant fast jog through a very varied and complex landscape. On occasions it's a bit like being trapped at the bar with a bloke who's a single issue fanatic. An index would have been useful.
Nevertheless it is a startling read. Some issues are depressingly simple in fact but fiendishly complex in practice. Multiple contributing circumstances provide such overwhelming variables that it's difficult not to despair.
There needs to be a parallel book on the potential effects of genetics and nano-technology to combat or at least restrain infection as this book appears to provide an overarching suggestion that ultimately "antibiotics" will always be - at the very least - on the back foot. the science works but is constantly undercut by greed, incompetence and plain stupidity.
This work by three eminent specialists is beyond doubt worth the reading as a primer covering a very scary situation. Other than providing generalist knowledge it does present portals through which anyone hitherto uninitiated can travel for more knowledge and understanding in depth.
My composite thought as I reached the final page was, we're in this problem together but we don't care all that much. In that respect the book succeeded.
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