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A battle is taking place on the frontiers of medicine between rapidly evolving bacteria and the doctors struggling to outwit them. "The Killers Within" tells this horror story that just happens to be true.
- Sales Rank: #1471458 in Books
- Published on: 2003-09-02
- Original language: English
- Number of items: 1
- Dimensions: 8.50" h x .76" w x 5.51" l, .94 pounds
- Binding: Paperback
- 336 pages
- ISBN13: 9780316735667
- Condition: New
- Notes: BRAND NEW FROM PUBLISHER! 100% Satisfaction Guarantee. Tracking provided on most orders. Buy with Confidence! Millions of books sold!
From Publishers Weekly
Bacteria preceded human life by millions of years but will they also outlive us? Shnayerson, a staff writer at Vanity Fair magazine, and Plotkin, an ethnobotanist, paint an alarming picture of the crisis posed by antibiotic-resistant bacteria. They focus on the three most common types: enterococci, streptococci and staphylococci. They tell of the deadly S. aureus a particularly virulent strain of staph that has shown up in deadly resistant strains and the infamous "flesh-eating bacteria" (necrotizing fascitis), whose incidence has been on the rise. They explain the myriad factors that have contributed to antibiotic-resistant bacteria and disease, most important among them the overprescription and misuse of the drugs, including the antibiotics fed to livestock to promote growth. Sharing the latest research, the authors suggest that future antibiotics are in the most unlikely places, from shark-bellies and silkmoths to the saliva of the Indonesian Komodo dragon. Shnayerson and Plotkin write in a lively, journalistic style and spotlight many victims, microbiologists and other "faces" behind the statistics, going far to make the copious scientific information accessible to general readers (though some may still be daunted). Yet their alarmist tone may strike many readers as overly sensationalistic and grating. Moreover, many of the facts about antibiotics abuse and drug-resistant bacteria are simply old news, and this book may not drum up much interest in spite of its informative analysis.
Copyright 2002 Cahners Business Information, Inc.
From Library Journal
At first glance, Shnayerson, a Vanity Fair staff writer, and noted ethnobotanist Plotkin (Tales of a Shaman's Apprentice) seem an unlikely pair to be writing a book about antibiotic resistance. Yet the reader quickly becomes engrossed in their tale. The authors provide an extremely readable look at the overuse of antibiotics, the methods bacteria use to develop resistance, the role of antibiotics as animal growth promoters, and the outlook for antibiotics. Drawing on a vast number of interviews with key people in the field, Shnayerson and Plotkin have managed to demonstrate their concern over the future of antibiotics while keeping the scientific background manageable for lay readers. A brief, annotated bibliography and list of web sites adds to the work. An interesting complement to Gerald Grob's The Deadly Truth, which discusses the inevitability of disease, this work also offers readers a riveting update to the section on antibiotics in Laurie Garrett's The Coming Plague. Recommended for public and academic collections.
Tina Neville, Univ. of South Florida at St. Petersburg Lib.
Copyright 2002 Reed Business Information, Inc.
From Scientific American
Commenting in 1969 on the success of antibiotics, U.S. Surgeon General William Stewart declared: "We can close the books on infectious diseases." Commenting three decades later on the rapid spread of bacterial resistance to antibiotics, U.S. Surgeon General David Satcher declared: "We are seeing a global resurgence of infectious diseases." Shnayerson and Plotkin (respectively, a staff writer at Vanity Fair and an ethnobotanist serving as president of the Amazon Conservation Team) recount what brought about the resurgence: "The principal cause was overuse--and misuse--of antibiotics." Poor infection control in hospitals and nursing homes is a contributing factor. Is there a way of stopping the march of the bugs? Maybe. The authors explore several possibilities but stop short of predicting that any of them will succeed.
Editors of Scientific American
Most helpful customer reviews
13 of 13 people found the following review helpful.
The frightening return of infectious disease
By Dennis Littrell
This book is scary. According to ethnobotanist Mark J. Plotkin and longtime Vanity Fair contributing editor Michael Shnayerson, the golden age of antibiotics that began with penicillin, a time when it was generally thought that infectious diseases were under control and largely a menace of the past, is over. Our naivete and our arrogance in imagining that we had just about defeated the bugs and could move on to other more pressing public health concerns came to an end in the nineties as one after another of the major human borne bacteria became resistant to our drugs. Through the exchange of DNA, that immunity has been transferred to other bacteria so that, as this book went to press just a few months ago, infectious diseases caused by bacteria are once again a major threat to humans everywhere in the world.
What happened? As the authors explain there are three main problems, (1) the overuse of antibiotics by the medical profession, (2) the misuse of antibiotics as growth enhancers in the meat and poultry industry, and (3) the failure of hospital personnel to follow CDC guidelines on hygiene, especially simply washing their hands.
(1) Too many doctors, either through ignorance or a desire to please their demanding patients, have over-prescribed antibiotics for routine infections, and in some cases actually prescribed antibiotics for viral infections (for which they are useless) "just in case" the patient also gets a bacterial infection. The result of this massive overuse of antibiotics is to give the bugs countless trillions of generational opportunities to evolve defenses against the antibiotic, leading to the antibiotic becoming useless.
(2) Tons of antibiotics--"24.6 million pounds a year," see p. 123--are routinely added to animal feed by the meat and poultry industry to promote growth so that their products will get fatter faster. What has happened is that the bugs have grown resistant to the antibiotics while transferring that immunity to bacteria living in, on and around humans. Even the use of an "analogue" antibiotic such as growth promoter virginiamycin can promote changes in bacteria that make them resistant to the antibiotic Synercid (e.g., see pages 115, 119 and 285). As the authors chronicle, this is a serious problem fraught with angry political battles as the meat and poultry people fight to maintain their profit margins while the disease control people fight to restrict the use of growth promoters.
(3) Surprisingly enough the authors report (see page 282 and elsewhere) that there is cynicism among some hospital personnel about the effectiveness of washing their hands and a belief that hygiene won't stop the proliferation of the bugs. The result is that hospitals have become very dangerous places. Most of the drug-resistant bacteria developed their resistance in hospitals. Most (or all) of them are endemic to the hospital environment. If you have to go to a hospital for any reason you are taking a chance of contacting a drug-resistant bug. Heaven help you if you have a compromised immune system, or if you are an infant or an elderly person.
How bad is the situation? According to the authors on pages 278-279 the high cost of developing new drugs (average "$802 million") and the fact that "return on investment from producing an antibiotic that might be used by a patient for less than a week versus return from a drug for a chronic condition that a patient might take daily for fifty years" is persuading big pharma to downsize the antibiotic end of the business. (See also page 94.) The authors ask the question, where are new drugs coming from? and answer that the "great glittering prospect was genomics." But "reality" has "sunk in." (p. 280) Drugs to fight bacteria developed from DNA manipulation "might take even longer to reach the market" than those previously developed. (p. 281)
The authors also touch on the possible use of drug-resistant bacteria as a bioterrorist weapon.
What does all this mean for you and me? It means that should we or our loved ones get a life-threatening bacterial infection, it's possible there won't be an antibiotic around that works. In effect, we might find ourselves back in the days before penicillin (the first really effective antibiotic, and one of the greatest of all medical miracles) when millions of people routinely died from staph, strep, TB and other bacterial infections. As Shnayerson and Plotkin report, right now there are strains of bacteria, including Staphylococcus aureus (the golden-globed bacteria pictured on the cover), Streptococcus pneumoniae, and the Mycobacterium that causes tuberculosis, that are immune to almost every antibiotic in use. There is even a strain of Enterococcus that is resistant to every antibiotic in use.
The authors do offer some hope. They report on the promising use of bacteriophages (viruses that invade and destroy bacteria)--see the very interesting Chapter 14, "Bacteria Busters." They present the idea of a more vigorously controlled use of antibiotics. If we prohibit their use as growth promoters and use them sparingly in an ordered sequence, perhaps bacteria would not have time to gain immunity and/or would lose it after the antibiotic is no longer in use. As pointed out on e.g., page 183, resistant bacteria are "encumbered" by an "extra chunk of DNA" that gives their non-resistant brethren an "ecological advantage" in an environment that doesn't contain the antibiotic. Additionally, the authors report the theory of population biologist Richard Levins who believes that if antibiotics are "saved for the most severe cases...then natural selection would favor the pathogens that produced the milder symptoms." (Explained on page 287).
Bottom line: this is a fascinating, scary and state of the art report on the pathogen wars written in a readable manner sure to interest not only the general public at which it is aimed but professionals as well.
10 of 10 people found the following review helpful.
Stephen King...stand aside! Reality is scarier...
By K. L Sadler
Excellent, excellent job done in research and writing by Shnayerson & Plotkin. If the reader is involved in science or public health, the 'news' in this book does not come as a surprise to anyone. It's been known for years among those in these communities that bacteria has been developing resistance to our antibiotics from day one. We get taught this if you work in a lab, because it becomes vitally important to keep everything absolutely sterile and clean. I know it is taught in medical school, but they don't emphasize this enough to medical students and doctors and nurses, because many doctors continue to dispense antibiotics like candy even though they have been warned and warned again by the Center for Disease Control and others.
For those who enjoy reading stuff like this to scare themselves...well, good luck. This is the stuff of nightmares, and if you spend a lot of your time worrying, I certainly wouldn't recommend you read this book. There is always hope, as the authors point out, that researchers will continue to find antibiotics that will temporarily restrain bacterial onslaught. However, be assured this hope has been relied upon in the past, and the bacteria always seem to find a way to mutate around medication, regardless of whether the antibiotics had an organic chemical basis or was a synthetic/man-made one, not seen in nature.
Most of the time, the people who pick up this type of book are already involved and concerned about this public health disaster-in-the-making. Yet these authors are trying to get this information out to the public, and write in such a way as to make this science knowledge understandable. The book starts out slowly, but picks up pace quickly. I had difficulty putting it down after the first couple of chapters. It is absolutely vital that the public be aware that responsibility for correct antibiotic use lies not just with the physicians, but with the patients and parents of patients who beg their doctors for antibiotics, when those antibiotics are not called for. As the authors bring up, most antibiotics given out by pediatricians are for ear infections (>60%). Yet often times those ear infections will go away on their own, with the antibiotics only minimalizing the length of time of the course of infection. Yet, all of us are guilty of expecting physicians to give us 'something' to make a cold or the flu 'go away'. Unfortunately, too often those illnesses are not caused by bacteria, but by viruses, and giving antibiotics in this manner just give bacteria an opportunity to switch genes around to build resistance. Same thing with not taking all of a prescription after the patient starts feeling better, or sharing medication not prescribed for others.
I hope this book is widely read. Maybe if enough consumers become concerned, we can put a stop to certain practices such as the use of antibiotics in animal feed as growth factors, regardless if they are known to be used for human consumption. The public needs to get more involved in their own medical care, and that means participating in governmental processes to fight against massive lobbying by pharmaceutical companies and livestock/meat companies and their lackeys, who often don't know and don't care about the possible consequences of their indiscriminate use of antibiotics.
Karen Sadler,
Science Education,
University of Pittsburgh
6 of 6 people found the following review helpful.
This is an important book
By Robert Adler
This is a serious book about a very serious subject--the escalating arms race between humans and disease-causing microbes. The bad news is that we're losing, making the emergence of resistant disease causing bacteria "one of the greatest threats to the survival of the human species."
Co-written by Mark Plotkin, a leading ethnobotanist and Michael Schnayerson, a talented writer and editor, The Killers Within is a highly readable, often gripping narrative, full of stories, personalities and drama. At the same time, it presents a lot of the history, science and politics that surround the struggle of medical science to stay a step ahead of the deadly bugs that are proving remarkably adept at evolving ways to defeat our antibiotics.
The authors have no trouble identifying the culprits in this losing battle--an agricultural industry pouring millions of pounds of antibiotics into poultry and livestock as "growth promoters," doctors and patients who overuse antibiotics, and the interaction of profits and politics that determine what kinds of drugs reach the market and when. But behind these lies our naive blindness to the bacterial world's incredible capacity to defeat our most powerful weapons. Bacteria have multiple ways to evolve and swap handy genetic information, such as how to cleave penicillin molecules or pump antibiotics out of their cells. All it takes is one bacteria that survives an antibiotic by evolving a new resistance mechanism; within a few years even unrelated bacteria thousands of miles away will know the trick. It's as easy for the bacteria, the authors write, "as collecting charms on a charm bracelet."
The authors chillingly describe the costs of this war being fought out in our labs, hospitals and bodies--millions of illnesses, hundreds of thousands of deaths worldwide, and the risk to all of us of returning to a world where we are no longer protected by antibiotics. Most of the major pathogens have already evolved multiple drug resistance. The very young and the very old are already dying from untreatable infections, but any one of us is now at risk that a cut, an accident, a minor surgery or a bout of flu can lead on to a raging infection by bacteria resistant to most if not all antibiotics.
The authors do hold out some hope. Perhaps phages, vaccines, or new generations of genetically engineered antimicrobial agents will once again tip the balance in our favor. But for now, expect to see more headlines about outbreaks of resistant strains of bacteria and to hear more horror stories from friends whose scratch or surgery turned into a life-threatening nightmare. This book will help you make sense of those events. Let's hope that the dedicated and farsighted researchers it depicts will eventually win the day.
Robert Adler, author of Science Firsts: From the Creation of Science to the Science of Creation (Wiley, 2002).
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