One year ago, President Obama signed an executive order creating a national strategy to tackle the growing problem of antibiotic resistance. As the New York Times reported, researchers had been warning for years that antibiotics are losing their resistance from overuse.
When humans and livestock receive antibiotics, it’s normal that some bacteria in their gut will develop resistance. As these germs spread, their resistance to antibiotics undermines the effectiveness of drugs we take for granted. The President’s announcement elevated a critical public health issue that the CDC says kills at least 23,000 Americans every year.
However, this initial description of the issue doesn’t really drive home how terrifying a world without antibiotics would be. Maryn McKenna’s sobering Ted Talk, “What do we do when antibiotics don’t work any more?” does.
McKenna explains how common infections were a death sentence before penicillin emerged as the first antibiotic in the 1940s, beginning “the golden epoch of the miracle drugs.” But penicillin-resistant bacteria were identified just two years after the drug was released, beginning a leapfrog game of resistance and new drug development that has continued for seventy years. New drug development hasn’t kept up with the pace of spreading resistance, and McKenna says that “we stand today on the edge of the post-antibiotic era,” when simple infections will once again kill people. They already are.
A 2014 Review on Antimicrobial Resistance (chartered by the British Government) estimates that worldwide 700,000 people die each year from infections that no drug can help. The same project estimates that the worldwide toll will be 10 million deaths a year by 2015, if we continue on our current path.
These numbers are startlingly high because we use antibiotics for nearly everything. As McKenna explains, antibiotics routinely provide protection for everyone from cancer patients, to people with diabetes insulin pumps, to premature babies. They allow children to survive strep throat and everyone to survive pneumonia. Perhaps most frightening is how our confident approach to life would change in a world without antibiotics, where any minor scrape or injury could result in an infection that could kill you.
This somber vision of a post-antibiotic world emphasizes the importance of the new National Action Plan to Combat Antibiotic-Resistant Bacteria, released in March. The President’s 2016 budget nearly doubles funding for preventing antibiotic resistance, including incentives for new drug development as one of five key priorities.
So what role do mHealth and health IT play in all of this? Drug resistance is an inevitable process that’s been happening for seventy years. But health IT will help track resistance, which is another key priority of the National Action Plan.
On the other hand, a recent study by the RAND Corporation suggests that doctors are overprescribing antibiotics via telemedicine. Because they have less information, telehealth practitioners tend to prescribe more broad spectrum antibiotics, which don’t target specific bacteria as effectively, leading to overuse and waste.
While the study suggests telemedicine providers consider quality-improvement initiatives to change physician and patient behavior, it’s worth remembering that up to 50% of all human antibiotic use is unnecessary or inappropriate, according to the CDC. These telemedicine findings are part of the bigger problem of antibiotic resistance that is targeted by the National Plan.