pH7

MRSA
Book Review
Joe Kimble reviews: The Killers Within: the deadly rise of drug-resistant bacteria, by Michael Shnayerson & Mark J Plotkin, £9.99, Time Warner UK

 

The Killers Within deals with how bacteria could rise to become the major threat to the survival of the human race. Clearly envisioned as a rival to 1995's Ebola blockbuster, The Hot Zone, not least because the authors collared a $750,000 advance from Time Warner for their efforts, it is pitched as a painstakingly researched, and therefore credible, warning of our potential impending extinction.

There's lots to enjoy in the book, a lot of information to digest, and a lot of Latin to chew on. Microbiology is an infinitely complicated subject and a very broad one. However the authors have done exceptionally well to make their source material accessible. They do inject a bit of drama to make the book flow, anthropomorphising their main bad guys methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and, of course, using italics:

"Doctors had a phrase they used among themselves to refer to such patients - the ones with infections resistant to one or more drugs and who seemed too sick to respond to any antibiotics. Train wrecks, they called them."

The authors also do their best to flesh out the protagonists, mostly unglamorous microbiologists, and give them some character:

"At the university racquetball courts, where he still played a pretty serious game, Schlievert's nickname was 'Maverick'. A tall, lean, tightly coiled figure in his mid-forties. Schlievert also ran marathons: 24 to date, 18 of which, he was proud to say, he had finished in under four hours. Competitive and aggressive in sports, he had hustled to be in front of the pack in his research, too, and had irked more than a few colleagues as he did."

So far, so airport. One doctor is quoted as saying getting necrotising fasciitis is like "getting a pterodactyl through your windshield". But some of the stories are genuinely fascinating, full of human drama, and don't need to be given a Hollywood gloss. In the section on phages, we find out how the enormously talented Tbilisi-based microbiologist George Eliava, a friend of Joseph Stalin, is executed in the purges, along with his wife. We then get treated to an account of the demise of Lavrenti Beria, Stalin's infamously sadistic henchman, and the man who sent Eliava to his death:

"After Stalin's death in 1953, several Soviet leaders feared Beria might claw his way to the top, so Nikita Khrushchev had him arrested and tried as a spy in a secret trial. He was found guilty and was reportedly executed by a Soviet general after crawling on his knees to beg, weeping, for mercy".

The main thrust of the authors' argument is that through a combination of over-prescription of antibiotics and bacteria's ability to evolve and adapt at quite terrifyingly efficient speeds we are facing a new breed of highly resistant bacteria.

"The warnings were proving prophetic. By 1946, 14 per cent of the S.aureus strains isolated in US hospitals were penicillin resistant. A year later, that figure rose to 38 per cent. One year after that, it was 59 per cent."

For every new drug that "Big Pharma" produces bacteria will raise its game and find a way to survive its onslaught. Consequently most of the book is dedicated to finding alternatives to combination drug therapy, and ways to reduce the rate at which resistance is achieved. The worth of synthetic drugs is explored. The potential for reducing the use of growth promoters in the food chain that account for up to 80 per cent of the antibiotics in animals (related strains of bacteria and antibiotics crossover into humans) is investigated. Arguably the most appealing part of the book is the section on phages, viruses one fortieth the size of most bacteria, which are being prepped to be the next generation of bacteria busters:

"Viewed through an electron microscope, phages look like live lunar landers, with multi-panelled heads, spindly legs, and tails they use as natural syringes. When a phage lands on a bacterial cell, its legs attach to its surface. Through its tail, it then injects DNA from its 'head' directly into the cell."

There are some quite fascinating passages about the science of phages and about their potential to fight back against the super bugs. This is probably the most successful part of the book.

However, try as the authors might to make bacteria sexy it's just not Ebola. This is a good book, solidly researched and written with decent erudition. But it's not another The Hot Zone because even though necrotising fasciitis is pretty gruesome it's not got the box office draw of viruses that liquefy your entire body. If you're looking for an educational journey into the macabre, this isn't it. Like its subject, it's just a bit bland.


 
pH7
Also in this issue:
REGULARS

NEWS: Ministers establish renal services framework

NEWS: Prisons Inspector calls for action on mentally ill in jail

NEWS: Minister withdraws obesity claims

NEWS: CJD blood donation ban

NEWS: Reid launches public health public consultation

NEWS: Howard tackles PM over blindness treatment

NEWS: HIV "a greater risk to women" warns UN

NEWS: Doctors withdraw claims on MMR safety

NEWS: Govrnment gives green light to GM crops

NEWS: Dementia Drugs stroke warning

NEWS: Health "Heroes" top national polls

NEWS: NHS fertility treatment extended as anonymity for donors comes to an end

QUARTERLY CHECK_UP

Quarterly Check-Up

SPECIAL FOCUS: PROPERLY UTILISED PATIENT-BASED DATA

Heart of a nation

Prescription for progress

Bridging the information gap

WANLESS II

Groundhog Day

Action Pact

RENAL NSF

Defusing a human time-bomb

TUBERCULOSIS

Global Warning

The path of least resistence

MRSA

Getting off clean?

Book Review

FOOD SAFETY

Angling for the Truth

COVER STORY: MENTAL HEALTH AND HUMAN RIGHTS

Breaking the cycle of fear

The rule not the exception

Criminal Neglect

No place of safety

AVIAN FLU

Transmission Control

DIRECTIVES AND BILLS

A question of consent

Test Anxiety?

Awake to the danger?

Private Members' Bills

New parliamentary inquiry into cancer care

ALL PARTY GROUP VISIT TO CUBA

On a medical mission

MUNCHAUSEN’S SYNDROME BY PROXY

Cruel and Unusual?

Law and disorders

DISEASE FOCUS: MULTIPLE MYELOMA

Life Support Services

APPOINTMENTS & DIARY

DOH

NHS Modernisation Agency

Select Committees: New Inquiries

Recent Reports

Reports

Diary

NHS IT

Comply and Demand

VIEWPOINT - DIABETES CARE

Zero tolerance?

POST-OPERATIVE CARE

Condition Critical?

BOOK REVIEW

Chloroform; The Quest for Oblivion