Ring Around the Sun

Earlier this month, my 23 month old fell ill with a virulent ear infection. After a trip to the emergency room, we came back home with some ear drops and an antibiotic prescription. The antibiotic worked for about 3 days, the ear pain and fever was gone, but now he had developed chest and sinus issues. The fever returned as soon as we were done with the 5 day antibiotic dose. Back to the doctor: this time, another antibiotic with the same results. The fever returned in 5 days along with the sore throat and congenstion. Our latest trip to the doctor resulted in yet another antibiotic prescription, this time a 10-day dosage. Thankfully, the toddler seems to have recovered fully this time and the fever has not come back.

This, rather scary brush with illness got me thinking about my own childhood in the late seventies and eighties, where the slightest hint of fever would trigger generous doses of antibiotics. Things really have not changed at all. Doctors today may be much more aware of the declining efficacy of antibiotic drugs and the rise of reisistant germs, but that has not stopped them from prescribing antibiotics. Its almost like fighting a battle you know you are going to lose…eventually. Very quickly, the drug resistant species of the same germ would emerge and start propagating.

A recent article in Newsweek, highlighted the need for a shift in thinking for the medical research community…from trying to kill all microbes in our bodies to trying to understand the critical role they play in balancing human vitality and illness:

As antibiotics lose their effectiveness, researchers are returning to an idea that dates back to Pasteur, that the body’s natural microbial flora aren’t just an incidental fact of our biology, but crucial components of our health, intimate companions on an evolutionary journey that began millions of years ago. The science writer Jessica Snyder Sachs summarizes this view in four words in the title of her ground-breaking new book: “Good Germs, Bad Germs.” Our microbes do us the favor of synthesizing vitamins right in our guts; they regulate our immune systems and even our serotonin levels: germs, it seems, can make us happy. They influence how we digest our food, how much we eat and even what we crave. The genetic factors in weight control might reside partly in their genes, not ours. Regrettably, it turns out that bacteria exhibit a strong preference for making us fat.

The recent spate of news reports about MRSA, methicillin resistant Staphylococcus Aureus is really not news. MRSA has targeted select groups of vulnerable people for the last five years: football players and hospitalized patients. However, it has recently made the leap from those select groups to the general population….

….first as an opportunistic infection among people already hospitalized, now increasingly a wide-ranging threat that can strike almost anyone. The strain most commonly contracted outside hospitals, dubbed USA300, comes armed with the alarming ability to attack immune-system cells.

In terms of infectious disease, the environment of the American suburb is unquestionably a far healthier place than most of the rest of the world. But we’ve made a Faustian bargain with our antibiotics, because most researchers now believe that our supersanitized world exacts a unique price in allergies, asthma and autoimmune diseases, most of which were unknown to our ancestors. Sachs warns that many people drew precisely the wrong conclusion from this, that contracting a lot of diseases in childhood is somehow beneficial. What we need is more exposure to the good microbes, and the job of medicine in the years to come will be sorting out the good microbes from the bad.

The microbes we have all our lives are the ones that colonize us in the first weeks and months after birth, while our immune system is still undeveloped; in effect, they become part of the landscape. “Dendritic” (treelike) immune cells send branches into the respiratory and digestive tracts, where they sample all the microbes we inhale or swallow. When they see the same ones over and over, they secrete an anti-inflammatory substance called interleukin-10, which signals the microbe-killing T-cells: stand down.

And that’s an essential step in the development of a healthy immune system. The immune reaction relies on a network of positive and negative feedback loops, poised on a knife edge between the dangers of ignoring a deadly invader and over-reacting to a harmless stimulus. But to develop properly it must be exposed to a wide range of harmless microbes early in life. This was the normal condition of most human infants until a few generations ago.

Today, of course, that is not the case in the developed world. The turnover of products used to kill household bacteria, good or bad, rivals the economies of many third word countries. The proliferation of such products is so pernicious that many doctors and prominent scientists are paid to be on the advisory boards of such companies.

The effect is to tip the immune system in the direction of overreaction, either to outside stimuli or even to the body’s own cells. If the former, the result is allergies or asthma. Sachs writes that “children who receive antibiotics in the first year of life have more than double the rate of allergies and asthma in later childhood.” But if the immune system turns on the body itself, you see irritable bowel syndrome, lupus or multiple sclerosis, among the many autoimmune diseases that were virtually unknown to our ancestors but are increasingly common in the developed world.