Welcome to the new age of antibiotics

By Alex Hale

“I have been trying to point out that in our lives chance may have an astonishing influence and, if I may offer advice to the young laboratory worker, it would be this – never to neglect an extraordinary appearance or happening.” Alexander Fleming

Nearly 30 years after the discovery of the last antibiotic, a new bacterial culturing technique may end the drought of new medicines.

Scientists have discovered 25 new antibiotics using a new lab technique which will hopefully discover many more. One of these new antibiotics, called teixobactin, has shown promising results in treating gram-positive bacteria such as MRSA and bacterial tuberculosis. The researchers are also hoping that harmful bacteria won’t gain resistance to teixobactin for at least another 30 years, as it uses an unusual multi-pronged attack that will be much harder for any germs to combat. It hasn’t been trialled on humans yet, but the test mice have responded very well. If human trials also go well, it may finally be possible to treat some of the nasty multi-drug resistant superbugs that have been troubling doctors for many years.

Although it’s fantastic news that a new antibiotic has been discovered, the main

Traditional testing of antibiotics in vitro. Image credit: Graham Beards
Traditional testing of antibiotics in vitro. Image credit: Graham Beards

story here is the new technique.  Traditionally, bacteria are grown on agar plates in a lab, but this new technique uses soil as the culture medium where bacteria feel at home and are happy to grow. This may not sound as interesting as a new superbug-killing drug, but teixobactin comes from the 99% of bacteria that have never been cultured, and without this technique it would never have been! This 99% is an untapped treasure trove that researchers were unable to culture in a lab environment until now, and this unexplored group could hold the secret to treating any number of infectious diseases.

If these new antibiotics are everything that they appear to be then it’s an easy bet that the team from Northeastern University in Boston, Massachusetts, will be up for a Nobel Prize. Perhaps they will have a more positive message than Alexander Fleming, who in his Nobel Prize speech for the discovery of Penicillin, couldn’t resist presciently warning everyone of the dangers of over use.

It has all come just in the nick of time as well, as we were all starting to prepare for the worst. A horrid future of antibiotics slowly becoming useless as more and more bacteria became resistant to them. Hopefully, that is no longer the case.

It’s not just a girl thing: A health crisis that’s being ignored

By Alex Hale

A sex induced epidemic could be sweeping across the western world. 80% of people get some form of a human papillomavirus (HPV) infection at a point in their lives. This is one of the most common sexually transmitted diseases and is the cause of many preventable types of cancer, but why are only women vaccinated against it? The HPV vaccine is in widespread use to help prevent cervical cancer and several other types of cancer in women. However, it’s now widely accepted that this fantastic vaccine could also benefit males by reducing cancers in areas like the mouth, anus and penis. Should men be vaccinated for the savour of their manhood’s?

The human papillomavirus has over 120 different types, which are generally fairly mundane in nature. It is mostly transmitted by sexual activity of all varieties and although it currently isn’t curable, it clears itself up within a year in 90% of cases. When the more malicious types are present however, diseases like genital warts and skin warts develop, usually these are treatable by doctors. In some uncommon cases, the infection progresses and causes some cells to turn cancerous.

Those cancerous cells originate in the sensitive parts of the body that the virus is most prone to infecting like skin cells and mucosal membranes. The mouth and vagina are perfect example of mucosal membranes, they cover areas of the body that are involved in secretion and absorption and have outside exposure. This makes a perfect environment for the virus to live and then get passed on. Sex makes that process so much easier as most of the mucosal membranes susceptible to HPV infection happen to be pleasure related as well.

Vaccination. Image Credit : Yanivba
Vaccination. Image Credit : Yanivba

The vaccine for the most malevolent forms of HPV was introduced in 2008 to help prevent the second most common cancer in women, cervical cancer. As many as three quarters of all cervical cancer cases are caused by two specific types of HPV, types 16 and 18. The new vaccine defended against those two types as well as types 6 and 11, which are the cause of 95% of genital warts. On top of massively reducing the chance of getting this horrible disease, the vaccine also reduced the chance of getting several other types of cancer including vaginal, vulval, anal, oral and penile cancer in men.

With the mention of anal, penile and oral cancer, there is obviously some vested interest for males here as well. Oral cancer is a major problem for men around the world. There are four times as many male oral cancer sufferers than there are women sufferers, with almost a third of those being caused by HPV. A big push towards vaccination could help a massive group of people by protecting them from this disease.

Who needs protection?

The idea that is being discussed in government now is that all boys should be vaccinated at around ages 11 to 12, before sexual activity starts. The campaign to vaccinate girls at the same age has gone really well in the UK with the government claiming 80% coverage of girls last year. This full coverage in girls raises the question of whether vaccinating the boys is really worth it and affordable. So called ‘herd immunity’ is an effective way of controlling rising infection levels, the greater the proportion of people who are resistant, the smaller the probability that a susceptible person will come into contact with an infectious person. Six years into the programme and a substantial amount of the teenage girl population is now immune to the virus and wouldn’t be able to be infected or be infectious to anyone else.

Nevertheless, the vaccination of men and boys should not be ruled out. There are still a substantial number of adult men and women unprotected that could easily be exposed to the virus; the vaccine should be available to all if they want it. The other group that would be unaffected by a virus free female population are homosexual males who are 20 times more likely to be diagnosed with anal cancer, which affects about 2 in 100,000 people, than a heterosexual male. It wouldn’t be possible to know which boys will become homosexuals at 11-12 so how can they be protected? Statistics like that would never be enough to convince a government to vaccinate all boys though.

Dr Krupar Patel, a GP and sexual health specialist from Dorset would like to see the vaccine available widely and freely. “It’s so frustrating every time I see young people come into my surgery with entirely preventable diseases” she said “I see a lot of patients about HPV related illnesses, mostly it’s people with things like genital warts but I do Pap smears [the test for cervical cancer] for ladies and I know several men with oral cancer. I’m not even allowed to give out the vaccine when I think someone could benefit from it, they have to pay privately and not everywhere offers that” she added. Krupar considers having the HPV vaccine available to everyone as a “vital step forward” in both reducing the number of sexually transmitted diseases and in reducing the number of cancers in the general population. “To be honest with you, I don’t think giving all boys the vaccination is worth it, especially not in today’s financial climate” she went on to say “but I would really love the option to give it to anyone who needs it”.

Some other options?

What else can the government do to help reduce the levels of infection then? Increasing pressure is being put onto policy makers to use sex education and public awareness campaigns to increase the public’s knowledge of this virus. It’s fairly common knowledge that HPV is the cause of most cervical cancers, the media frenzy around the vaccination of girls made sure of that.  An increase in the general knowledge around HPV infection could help both reduce the chance of infection and allow more people to make an informed decision on whether they want to be vaccinated.

Dr Patel said “I would love to see a big campaign letting everyone know that they can be protected from it [HPV], it’s just a shame the politicians keep stalling over what to do”. She went on to outline some other methods that could be used in increasing general knowledge of the disease and for getting more people vaccinated. “…it could be a mandatory vaccine to get into secondary schools. England doesn’t have any mandatory vaccinations for schools at the moment but some other countries do like the US [USA], I know Greece has compulsory HPV vaccinations for school”.

Mandatory vaccination to get into secondary schools would certainly make sure parents got their children vaccinated but it does raise questions of compulsory mass medication. The government always wants to avoid any rumours of that sort of thing, it smells too much of political totalitarianism. If you use the public water fluoridation debate as an example, the media and the public rebelled heavily against any suggestion that they couldn’t be in control of what went into their bodies. Programmes like this are potentially very expensive though and the cost to the government may not be worth it compared to the cost of treating the patients in hospital or cheaper, easier programmes like ad campaigns or better education in schools.

Dr Patel’s colleague, Dr Roland Sedoo agreed with most of the Dr Patel’s

Condom. Image Credit: KONDOMI
Condom. Image Credit: KONDOMI

comments but had one major point to make that he thinks could make the difference if done by everyone. “I’m a big believer in the condom, it’s just so easy to use, super cheap and almost 100% effective” he said “the other doctors in my surgery think I’m a bit excessive but I hand out a ludicrous amount of them. I like to think that the more you give out the higher the chance that people will use them”. He went on to talk about how a big push to increase the use of condoms in young people could mean the world of difference. “Condoms have been around for ages now and there was a brief period a few years ago when there was a big push to get people to use them, especially in kids. But it’s sort of trailed off a bit now and I get lots of people come to see me who tell me they’ve never used a condom. Mostly it’s people in their twenties who have forgotten their sex education lessons at school and then went and had a great time at university or something”.

The Future

There are bigger problems and more serious problems in the world, no one is denying that. This however, is not something to be ignored. The Department of Health recently stated that “there are currently no plans to extend HPV vaccination to males, based on an assessment of available scientific evidence”. Does there need to be detailed scientific evidence if there are very few risks and the potential to save many lives? Dr Patel and Dr Sedoo are both optimistic however, “we think that give it a few years and we will at least be able to give out the vaccine to at risk patients, maybe the boys won’t need it. We will just have to wait and see”.

The efficacy of the vaccine in stopping the spread of the virus will take several more years for the full effect to be seen. Those girls who first had the vaccine in 2006 will be coming up to 20 years old now, so it will be a while before the vaccinated population will make an impact on cancer incidence rates. The true test of whether the girls only vaccine is enough is time.

Option or obligation: an opt-out donation issue

By Alex Hale

“Every right implies a responsibility; Every opportunity, an obligation, Every possession, a duty”   John D. Rockefeller

Not everyone wants to donate their organs. Sadly, in our aging, obese, drug addicted nation, the demand for organs is on the rise. The keep our nation healthy. People seem happy enough with the default position: a full two thirds of people have decided not to opt-in to the register. What is less clear is whether this is laziness or an ethical position.

The organ donor register is a beautifully simple system. All you need to do is sign-up, select which organs you’re happy to donate when you die and then forget about it. But the signing up step seems to be a barrier as only a third of people in the UK have joined the list. Thousands of sick people are currently waiting desperately for the right organ which is so frustratingly hard to find. As I type, over 7,000 patients around the country are waiting for a donor organ and this number just isn’t going down.

20 million sounds like an ample amount of people to help save the lives of 7,000. That 20 million are the third of the UK that are on the organ donor register but it still isn’t enough, there are so many factors that get in the way of someone getting that life saving organ. The donor has to have healthy organs at the time of death, so this excludes the many that die from illness and whose organs aren’t healthy enough for transplant. There is also a chance that the recipient’s immune system could reject the new organ because it would recognize it as foreign, making them even sicker and ruining the new organ. The donor needs to have the same blood type as the recipient as well as similar cellular markers called major histocompatibility complexes, the more markers that are similar, the less likely rejection is. Sadly, finding an exact match is almost impossible so recipients usually need powerful drugs to suppress their immune systems after the operation.

Could fear, ignorance or misunderstanding be the reason that the medical community is in such dire need of new donors? One answer is the infamous opt-out system that’s been making the rounds in political, social and ethical discussion circles for years. Opt-out would mean you join the register automatically once you reach a certain age and then would have the option to unregister if you wanted to whenever you like. Wales has recently chosen the opt-out system and Austria has had the system for years. The result? Austria has eight times as many donors as neighboring Germany.

In general, one of the main contributors to organ donations comes from the unexpected death of healthy people, like in a car accident or extreme sports. Sadly, these sorts of deaths are associated with younger people but they often don’t end up being donors. They haven’t had thoughts of signing up yet and of course no one expects to die young. Under the opt-out system, the tragic death of one could help save the life of another.

What else could be done if the opt-out method is opposed? Economists have suggested that maybe a monetary incentive could be offered and the cost of this would be recovered by allowing so many more people to not depend on expense medical treatments. This however, could be seen as venturing into the unsavory world of organ sales and trafficking, a black market trade that has cost many people their lives around the world. A monetary incentive would also the raise the question of whether the kind people who have already joined the register would receive the compensation as well.

LifeSharers uses social incentives to encourage people to sign up to their private donor list; in return, donors are assured priority if they ever need an organ. This privatization is probably something the government would back as it would save them money but it suffers from several major drawbacks. If everyone signs up then they obviously can’t guarantee them first choice of organ when they need one, essentially invalidating the entire process. The small pool of donors that LifeSharers has also means that it would be much harder to find an organ that matches your immune system; if it’s hard to find a match with 20 million, imagine how hard it would be with much fewer.

Our aging, smoke and alcohol addicted, obese nation needs to make a decision soon on these issues. The health statistics that point to half the UK being obese by 2050 means a much higher number of people potentially needing heart and pancreas transplants. The ‘binge drinking society’ will be in need of liver transplants in a few years’ time and all those smokers are going to need new lungs. The list of people that need new organs will be never ending and ways to fix that are a different topic all together. The main concern is time, something everyone seems to be short of. How long can we let people wait for the organ that could change their life? Signing up today could mean the difference to someone’s life tomorrow.