Ordinary Gweilo

Did anyone else watch that documentary on TVB Pearl three weeks ago about antibiotics? Unfortunately, having a good subject doesn’t guarantee a good documentary.

Their concept was to send a presenter off around Europe within a hidden camera in his bag. This is a favourite technique of documentary makers, but for it to work you need a bad guy who can be confronted later when you have gathered the shocking evidence. Sadly for them, in this case there was no villain but rather a number of misguided but well-meaning doctors and pharmacists trying to give people what they wanted. Worse than that, the evidence was neither surprising nor shocking.

Nevertheless, we were treated to several trips to pharmacies around Europe. In each case, the reporter tried to get antibiotics for his imaginary cold. In Belgium, Spain and the UK he was successful. In the Netherlands he was not successful. Unfortunately we were not give any information about how many pharmacies in each country would have refused to sell antibiotics without a prescription (I am quite sure that many in the UK would have sent the reporter on his way empty-handed) nor whether any action is taken to prevent this abuse.

Then the action switches to the doctor’s surgery and our hero is offered antibiotics for his imaginary cold or sore throat – except in the good old Netherlands where the doctor sent him on his way with no medicine at all. Quite right, too, because antibiotics are useless against viral infections such as colds and sore throats, and all doctors ought to know that. Unfortunately, many people believe that antibiotics will help, and all too many doctors and pharmacists seem quite happy to indulge them by giving them what they want.

The producers weren’t quite out of ideas yet – there were also some fancy computer graphics showing how microbes attack the body, and an explanation of what was happening that seemed to have been written mainly with children in mind.

We saw people being interviewed in the street and asked whether they they took antibiotics. Some did, whilst others didn’t. Well, who’d have guessed that?

There were interviews with people who have contracted MRSA, though the dramatic effect was somewhat spoiled by the fact that most of them looked quite healthy. The scary thing is that they got sick when they went to hospital, mainly because some doctors didn’t follow basic hygiene procedures (such as washing their hands and wearing gloves). The link with antibiotics is that they have been over-used to the point where many of them are now useless, and so an infection that would have been easy to treat 10-20 years ago is much more of a challenge to deal with. MRSA is the most frightening example of this, though the number of casualties are a matter of dispute. After all, many people in hospital are already quite ill, but we do tend to have an expection that hospitals will look after people and make then better, not kill them off. To be fair to the programme makers, they did make this point quite well.

Amazingly, they had more pointless hidden camerwork, this time showing us an anonymous Belgian going to the toilet and not washing his hands. Er, right. Again, do we really need to be convinced that many people don’t bother to wash their hands after going to the toilet? Possibly not.

The Economist had a rather more thoughtful piece in its annual publication Intelligent Life (not on sale in Hong Kong, but available online to subscribers).

The world’s arsenal of antibiotic drugs is dwindling fast. Pharmaceutical firms are not developing new ones, and many of the existing antibiotics are no longer effective against strains of “superbugs” such as methicillin-resistant Staphylococcus aureus. A recent study by the Infectious Diseases Society of America (IDSA) found that approval of new antibiotics by the government’s Food and Drug Administration (FDA) has declined by 56% over the past 20 years. The society found only six new antibiotics in development. In 2003 the FDA approved just two new antibiotics. And this is at a time when drug-resistant strains of bacteria are becoming ever more prevalent.
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Another problem is that although it’s in a bug’s nature to develop immunity over time to drugs designed to kill it, patients and medical practitioners are responsible for accelerating the process. How many doctors haven’t had patients demanding antibiotics for a sore throat, even though most throat infections are viral rather than bacterial? And even if they don’t do us any good, they can’t do any harm, right?
Wrong. Not only do antibiotics kill swathes of useful microflora in a person’s gut, they can also cause thrush, nausea, diarrhoea, vomiting and stomach pain. Worse, the indiscriminate use of antibiotics in this way only encourages the majority of bugs that cause infections to become resistant to the very drugs that were designed to kill them. Life-threatening diseases could then become untreatable. That would be disastrous. John Edwards of the IDSA has warned that we could revert to a pre-1940s world when there were no antibiotics to treat life-threatening infections.
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Now a raft of new household products has hit the market—from soaps to chopping-boards and even toys—that contain antibacterial agents. Adverts show infants playing safely on the floor because a responsible parent has wiped the surface with some new antibacterial cleaning liquid, while the toy the child is chewing has likewise been impregnated with antibacterial agents. “Kills 99% of all known germs—dead!” goes the slogan. But it’s the 1% that escape because of their immunity that are the problem.
The most common antibacterial agent found in household products is a chemical called triclosan. It works by focusing on an enzyme involved in making the cell wall of a bacterium. In other words, antibacterials and antibiotics work in much the same way, and both can cause more resistant strains of bacteria to develop. Triclosan-resistant mutants of Escherichia coli and Staphylococcus aureus have already been isolated in the laboratory. It can only be a matter of time before resistant strains of both of these dangerous organisms start turning up in people’s homes.

There is hope, however, as the New Scientist reports this week:

A UK company claims to have discovered a compound that renders the MRSA superbug vulnerable to the antibiotic it normally resists. MRSA – methicillin-resistant Staphylococcus aureus – is defined by its ability to resist the antibiotic methicillin. Like penicillin, methicillin works by blocking bacterial enzymes called PBPs, which normally strengthen cell walls by forming cross links.

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But the long-term strategy should be to prevent MRSA infections, points out Dan Jernigan of the US Centers for Disease Control. “No matter what we do, bacteria will find a way around it. But there are some things that always work. Resistant bacteria are not resistant to hand washing.”

I suppose that is what I found so irritating about the programme. All the information you needed to know was there, but the presentation was simultaneously banal and sensational. As the closing credits came up, I noticed that this film had been funded by the European Commission. It therefore seems that it was intended to be educational/worthy, but that somebody was determined to make it “compelling” viewing, hence the covert filming, vox pop interviews and other silly gimmicks.

It would surely have been better to make a serious programme about a serious subject. I believe that the presenter of this programme made his name doing documentaries exposing wrong-doing. The problem with this subject was that there wasn’t any serious wrong-doing, but instead a combination of negligence (dirty hospitals, people not washing their hands, etc.) and a mis-placed desire to give people what they want (doctors and pharmacists giving out antibiotics). It would have been far more interesting to confront some of these people with experts who could explain the problem and perhaps persuade them to change their ways. Unfortunately that was apparently not dramatic enough for the programme makers!