Don’t call it a war on superbugs. That’s the latest advice from international public health experts who have been watching with alarm as bacteria and fungi that cause disease have become ever more adept at evading the drugs we deploy against them. The vocabulary we use to debate what to do about this rising resistance is so confusing that it may actually be an obstacle to success, the experts argued in a commentary published Wednesday in the journal Nature. “People … are talking past each other,” they wrote. “Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations.” They’re urging a new UN group established to coordinate the fight against drug resistance to come up with a common and easily understandable lexicon for the problem. There’s no dispute that the superbug menace is real: The rise of resistant pathogens poses a grave threat to modern medicine. Many surgeries we take for granted — caesarean section births, hip replacements, organ transplants — can only be safely conducted if the bacterial infections that might follow can be quelled with antibiotics. When the bugs evolve to evade the available drugs, the risk-benefit ratio for these types of operations will shift dramatically. But a 2015 World Health Organization survey of nearly 10,000 people from 12 countries found fewer than half knew the term “antimicrobial resistance.” And only one-fifth knew its acronym “AMR” — which has become the preferred term among scientists and public health authorities. That means a term increasingly being used by the scientific community means nothing to most of the population. “The terminology leaves people cold,” professor Marc Mendelson, head of infectious diseases at Groote Schuur Hospital in Cape Town, South Africa, told STAT. “The public are absolutely key in this. … [But] unless we get to the bottom of this, we’re going to lose people.” He was a lead author of the commentary. Sweeping phrases about the looming bacterial menace can also create problems, the authors said. Such terminology can create the erroneous impression that all bacteria are bad and need to be expelled — which can in itself lead to health problems. For example, losing a healthy balance of gut bacteria can make a person vulnerable to Clostridium difficile infection — a hard-to-treat diarrheal disease. Likewise, a push to ban all antimicrobials given to livestock raised for food could have unintended consequences. Some medicines used in agricultural production are crucial to raising these animals, but have no impact on human health, the authors said. So simply calling for a blanket ban “misses the point and could potentially harm food security,” they write. What language is advisable? Mendelson and his coauthors recommended using the phrase “drug resistant infections.” That more clearly defines the problem and could help erase a common misconception; some folks believe people (not the microbes that infect them) are becoming resistant to the drugs. And that in turn, can make the public think these are problems that happen to other people, or problems they are helpless to influence, he said. They may then be less likely to take proactive steps like limiting their use of antibiotics or trying harder to prevent infections in the first place, for instance by getting vaccinated on schedule. The authors also argued against the ubiquitous martial metaphors. Declaring war on superbugs creates misunderstandings about how important bacteria are to human health, they suggested: “War and threat were once potent rallying calls. But a more nuanced, balanced, standardized vocabulary is now needed — one that takes ecological balance into account.” Mendelson cautioned that making linguistic adjustments is not going to solve the serious problems the world faces on the drug resistance front. But he said it could help the public get on board with changing the way the world uses antibiotics. Source
