The Grumpy Old Man

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....Dangers From Drugs Misuse, an Environmental Crisis in the Making?....

....Antibiotics and other drugs are a tremendous invention by man, but are we abusing their power, and will that abuse rebound on us?....

Some time ago I recall reading in the national dailies that chicken farmers were using antibiotics as an additive to feed purely as a preventative rather than curative measure. I've never been comfortable with the concept of battery chickens being kept in small cages. But to find that they are being fed a daily dose of antibiotics made me even more angry as these antibiotics must eventually finish up in the human food chain through the eggs or chicken meat. Thus, we are being unwittingly medicated, albeit in low dosages, by these drugs. It follows quite logically that any germs that come along in low concentrations will be overcome by this unwitting low dosage medication. However, as a great believer in the Darwinian process (see next paragraph), sooner or later a mutated version of this particular germ will develop that has an immunity to the drug. Logically this mutant will be much harder to hit as it already has developed its own immunity to the drug. Consequently, to effect a cure one has to use what is called a "last hope antibiotic". Recently, an article in the UK Times newspaper suggested a last hope antibiotic called Colistin, is becoming less effective, meaning that some diseases will soon be untreatable. The Times suggested that Colistin "may be useless within a decade" with fatal infections already being reported, with one patient dying from septic shock after Colistin could not stem her blood infection. On a wider but related front, it is estimated 12,000 people die in the UK from infections untreatable by antibiotic resistant drugs. (More than currently die of breast cancer).

Family members in the medical profession have also expressed concern regarding the continuing effectiveness of antibiotics and presumably other classes of drug. Having done some further reading I am not surprised! That reading left me even more alarmed as the same article stated that, within the last 12 months, the Veterinary Medicines Directorate has licensed 3 different products containing Colistin for use on British farms. Colistin is part of a group of antibiotics (Carbapenems) which are used in human medicine as a last-ditch treatment for superbugs that have mutated and developed an immunity to other medicines. Carbapenems Resistant Enterobacteriacae (CRE) evolve from common bacteria such as E. Coli and Klebsiella. Medical experts have called CRE "a nightmare bacteria" as the mortality rate from a bloodstream infection by this bacteria is approaching 50%. It also appears that nearly 500,000 doses of this drug were used on patients last year alone.

Against this background, the UK Chief Medical Officer asserts that antibiotic resistant infections ranks alongside terrorism as a threat and could mean simple infections could soon prove fatal.

To add insult to injury (excuse the pun), further investigation left me absolutely astounded when I read that over 40% of antibiotics used in the UK are currently being administered on a solely preventative basis to agricultural animals.

Now, Grumpy has already tweeted about antibiotic resistance bacteria developing by a Darwinian process. (That should not come as any surprise at all). Let me again describe the process. This Darwinian drug resistance is actually quite simple to understand. For example; say your usual disinfectant kills 99.9% of germs. The general buying public will think that's great. However with the nought point one resistant percent left, it is easy to see that the next use of the same disinfectant will also kill 99.9% of the germs it effects, thus leaving another nought point one resistant percent alive (yes, making a total of some nought point two percent) and so on, each use of the disinfectant will increase the population of germs with an immunity. What has happened is the nought point one resistant percent that is left, finds an increasingly competition free environment to evolve post disinfection, therefore they thrive. In this manner the resistant germs increase and eventually dominate the germ population. Grumpy accepts that the figures here are an example only, but they do demonstrate the outline of the process. Even if each percentage of resistant survivors is thousands of times smaller, the resistant population increase process will carry on, only taking longer to become effective, but it will do so, you mark my words!

There are other factors beyond the sensibility of man that I am sure are exacerbating the reduced effectiveness of modern pharmaceuticals. Some of these factors are outlined in the following incidents and research.

As long ago as 2014, concern was being expressed in the national press suggesting that pharmaceuticals were being flushed into the environment via human and animal sewage. This particular article pointed out that these pharmaceuticals have a potentially disastrous effect on wildlife and ecosystems. As an example of this adverse effect on wildlife, a particular breed of vulture in India were virtually wiped out by the indiscriminate use of an anti-inflammatory drug being given, as a preventative measure to cattle. The religious esteem in which some cattle are held in India resulted in their carcasses being left to rot where they fell and left for the vultures to eat. Unknown at the time, a particular breed of vulture was fatally allergic to the drug and the vulture population was decimated. Reduction in the use of the particular drug saw a slow population recovery in the vulture.

Research over the last 40 years, particularly in freshwater habitats, has demonstrated that up to 75% of fish and amphibians have been lost. Drug residues are most commonly found in freshwater habitats and have been attributed to this attrition. Also coming from this research, it was found that male fish were being feminised with the synthetic hormones in birth control pills being the prime suspect. Population collapse of many fish has also been identified in the area of sewage outfalls and where rivers meet the ocean. Even though this effect has been identified, it has been said that there is still a critical knowledge gap relating to the effect of drug pollution in the oceans.

Intersex frogs have been found in urban ponds contaminated with waste water.

Birth control pills residues were found to have wiped out fathead minnows, seriously disrupting a whole ecosystem, with the top predator (trout which I'm sure many of you eat) declined by some 40% due to food loss. Conversely, insects blossomed as they were no longer being eaten by the fathead minnows! Which is a further demonstration of the above argument and an example of the Darwinian process at work.

Tests for drug residues in Lake Michigan produced a number of surprises. (For example, the most common drug found was totally unexpected as it was a diabetes drug). Because of the size of Lake Michigan, a large and rapid dilution effect was expected. But drugs were still being detected over 3 miles from sewage treatment plant outfalls. Laboratory tests found that in male fish exposed to the level of concentrations found, a gene related to egg production was being produced indicating hormonal changes, or a feminising effect, thus decreasing their ability to take the male role in the reproductive process.

Lake Michigan is not an isolated case. Global Pharmaceutical Review found that of over 700 pharmaceuticals tested, 630 were found above detection limits, in 71 countries in 5 regional groups. They were found in surface water, groundwater, soil, manure and drinking water. It is believed that even now, this represents an incomplete picture of the problem.

It is known that a good proportion of any drug taken is excreted. This can be as much as 90% of the active ingredient in an oral dose. Also the metabolites of the active ingredient can also remain active in the environment after excretion.

In addition to drug residues in human effluent, drug pollution can come from the factories that manufacture them, as even the most modern of sewage plants do not remove drugs from the water before it is discharged back into the environment. Modern sewage plants finish up with solid matter (generically described as bio solids) requiring disposal. As you can imagine, these bio solids are quite rich in natural fertilisers and, as an example, in the United States alone, 4 million tons of bio solids are spread on the land each year. Since sewage plants don't remove the drugs, the bio solids will undoubtedly have a significant concentration of drugs which then re-enter the food chain.

The worst culprits are antibiotics, antidepressants, anti-inflammatories, analgesics, beta-blockers, oral contraceptives and all bone replacement drugs.

Antibiotic pollution has been found emanating from factories in China, India, Pakistan, Korea, Denmark, Norway and Croatia. Less widespread but still sufficient to cause problems, antidepressant pollution has been found in wastewater discharges from factories in Switzerland, Israel and Spain and also from narcotic opioid production in the United States. In India, high concentrations of antibiotics have been detected downstream of several drug manufacturing facilities. Two years after these tests, high levels of known antibiotic resistant genes in bacteria were also detected there.

Grumpy would reiterate that he has always thought this was no more than basic common sense. For all pharmaceuticals, your weight governs the dosage of your prescription. It would seem quite reasonable, that if any of this medicine gets into the natural hydrology system even at very small concentrations, it will have a significant effect. Just think about it, if the dosage is calculated for a patient weighing 100 kg, then what effect will one percent of that drug have on a fish weighing 1 kg? (Once again the weights and percentages are for example only).

It is clear to Grumpy that this is another huge "Man originated problem" brewing which has the potential to affect each and every one of us. It is high time that steps were taken by the "delivery" authorities (doctors and veterinarians) to act far more responsibly and explain to their patients the danger attached to over medication. And for the manufacturers to clean up their act, quite literally!

It is also clear, that as a result of this over medication and the multiple delivery systems (some unwitting) outlined above that there are a number of avenues worthy of investigation and action before it becomes too late. These are;

Firstly; the drugs companies should carry out work on the "half life" of drugs they are launching onto the market. Despite asking questions, Grumpy has found little evidence whatsoever of this. After all, looking at the other side of the coin, perhaps there is a negative aspect of this in that once manufactured, if the shelf life of the drug were much smaller it would give problems regarding pre-use storage. Additionally, if one knows the half life of the preparation, then one must be aware of the magnitude of the problems outlined above. After all, we are aware of the half life of nuclear waste and the problems that causes!

Secondly; an economical process for the removal of drug residues from all effluent should be addressed as a matter of high priority. Commercially, Grumpy would observe that whatever this mechanism is, there is quite a market for it around the world!

Thirdly; it has been stated that very few completely new drugs have been developed since World War II! The inference being that the huge majority of drugs used now are derivatives from discoveries made 70 or more years ago. Having said that, during his investigations, Grumpy came across a most interesting piece on work being done at Leicester University in the UK. This did actually lend hope that all is not doom and gloom. I refer to a study being carried out that is still at a relative early stage. The study entails the effect of "bacteriophages" to combat 72 multi-antibiotics resistant strains of the most important causes of gut problems in pigs. (One needs to start somewhere). Not being a medic or biologist, Grumpy's understanding is that these "bacteriophages" act in a completely different manner to current drugs.

The study recognises that there are many infections that we just can't treat with antibiotics because they have become resistant to them. Using "phage" therapy for specific diseases could change the way we treat infection. If this is the case, as early test suggest, then phage therapy could completely transform human health treatments. The process is shortly to undergo trials in pigs and if successful could be extended to people. As with many of these treatments, however human trials must still be some way off.

Finally; the time is ominously upon us when something must be done to tackle the problem. Particularly when one regularly sees in the popular press, reports along the lines that "12 types of bacteria pose the greatest threat to human health because soon no drugs will be able to fight them off". Also "The use of drugs containing Colistin in agriculture is shear and utter madness as it (the drug) is likely to become useless to humans within 10 years if its agricultural use continues". Unfortunately, one must convince a huge industry that action must be taken now. As an indicator of the size of that industry, it is calculated that the value of the pharmaceutical industry in the United States alone is greater than the individual gross domestic product of 98% of the nations in the rest of the world!

Many commentators believe that the problem is as severe as that presented by global warming. In the case of drugs resistant infections, if antibiotics lose their effectiveness, modern key medical procedures, including Organ Transplant, Caesarean Section and Chemotherapy regularly performed today could become too dangerous to undertake. Furthermore if no action is taken, it has been estimated that these immune infections will kill 10 million people a year by 2050.

Action must be taken now.

There is a common theme running through this and other grumps. Click here to more......