WEBVTT - Anti-Microbial Resistance

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<v Speaker 1>Now, health matters with Daniel Martin. Welcome aboard to Health

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<v Speaker 1>Matters right here on CN A 938. Every year. Around

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<v Speaker 1>this time, I take the opportunity to speak to you

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<v Speaker 1>about the what was 16 years ago when I first

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<v Speaker 1>started talking about it, the rising threat of antimicrobial resistance.

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<v Speaker 1>But now is the clear and ever present threat of

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<v Speaker 1>antimicrobial resistance or am r you see last week, the

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<v Speaker 1>world recognized antimicrobial

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<v Speaker 1>resistance week as a result of growing drug resistance, many

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<v Speaker 1>infections have become almost impossible to deal with due to

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<v Speaker 1>a lack of effective drug treatment. Where are we in

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<v Speaker 1>2023 in terms of am and what will it take

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<v Speaker 1>to effectively reduce it?

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<v Speaker 1>We're learning more as I speak to Professor David Patterson

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<v Speaker 1>who is a professor from the School of Public Health.

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<v Speaker 1>Good to meet you, Professor Patterson. Welcome to the studio.

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<v Speaker 1>Thank you so much. Let's talk about where we are today.

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<v Speaker 1>So like I said, almost for over a decade, I've

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<v Speaker 1>been discussing this on air and every uh

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<v Speaker 1>talking about how this is. It's happening, it's happening, it's happening,

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<v Speaker 1>it's happening. But right now I can see it is here.

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<v Speaker 2>Absolutely. And it's here in Singapore, but to a much,

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<v Speaker 2>much greater degree it's here in our neighbors. So, you know,

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<v Speaker 2>if I was to go to a hospital in Indonesia

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<v Speaker 2>or Malaysia or Thailand, Philippines, people are dying every day

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<v Speaker 2>from AM R now, they're not dying necessarily,

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<v Speaker 2>you know, healthy people at home. Typically it's people who

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<v Speaker 2>are in hospital already with some critical illness. But, you know,

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<v Speaker 2>I don't know if you've ever seen that uh picture

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<v Speaker 2>in South America of the road, of death, this sort

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<v Speaker 2>of narrow road with a huge drop behind you. You know,

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<v Speaker 2>you can imagine you're driving on this narrow road and

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<v Speaker 2>then a great big truck comes towards you,

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<v Speaker 2>you don't have any chance. And it's the same as,

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<v Speaker 2>you know, you're s very, very unwell in an intensive

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<v Speaker 2>care unit and then along comes AM R so an

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<v Speaker 2>infection that's almost impossible to treat or sometimes completely impossible

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<v Speaker 2>to treat. Unfortunately, we do have a lot of patients

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<v Speaker 2>who die in that scenario and simply

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<v Speaker 1>put this has all happened because of

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<v Speaker 1>the judicious and over usage of antibiotics amongst humans. And

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<v Speaker 1>in our farming system has resulted in strains developing that

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<v Speaker 1>are completely resistance to our existing Armamentarium. Is that it

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<v Speaker 2>to a degree. Although it's fascinating to learn that even

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<v Speaker 2>before antibiotics were discovered, there was antibiotic resistance. And you

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<v Speaker 2>might say, well, why chicken egg here, what's going on? So,

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<v Speaker 2>in fact, bacteria

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<v Speaker 2>are clever. They don't have a brain but they're clever.

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<v Speaker 2>So bacteria can naturally produce antibiotics to kill their competition,

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<v Speaker 2>to kill other bacteria. So there was

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<v Speaker 2>uh antibiotic production,

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<v Speaker 2>but there was also the competition got canny, they became

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<v Speaker 2>resistant to those antibiotics produced by other bacteria or other substances.

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<v Speaker 2>And so am R has been around but of course,

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<v Speaker 2>humans have and the development the access to antibiotics has,

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<v Speaker 2>you know, magnified this millions fold. So, you know, we

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<v Speaker 2>know that if a person goes into hospital,

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<v Speaker 2>probably at least a third of people will get intravenous

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<v Speaker 2>antibiotics and in some parts of the world that's even higher.

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<v Speaker 2>We also have the issue that if you're a busy

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<v Speaker 2>nurse or a busy doctor, you go from one patient. Oh,

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<v Speaker 2>that one's got an emergency, you go to the other one.

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<v Speaker 2>You haven't cleaned your hands. You can carry one person's

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<v Speaker 2>resistant bacteria on your hands and pass it to another person.

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<v Speaker 2>So it's antibiotic use in hospitals.

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<v Speaker 2>It's

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<v Speaker 2>cleanliness and part of that cleanliness is not just our hands,

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<v Speaker 2>it's also the environment of hospitals.

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<v Speaker 2>But then we have to think, well, where else are

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<v Speaker 2>antibiotics used? And

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<v Speaker 2>unfortunately in some parts of Asia, every chicken gets antibiotics

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<v Speaker 2>for breakfast and you might think, oh, that just is

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<v Speaker 2>going to be an issue for the chicken. But we

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<v Speaker 2>eat chickens and you might say, well, I'm a vegetarian,

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<v Speaker 2>I'm not going to be affected by animal use of antibiotics.

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<v Speaker 2>But what do the farmers in many parts of the

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<v Speaker 2>world use to fertilize their crops but it's animal manure.

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<v Speaker 2>So in other words,

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<v Speaker 2>the e coli the other bacteria that have been in

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<v Speaker 2>the chicken or cow or pigs tummy that ends up

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<v Speaker 2>uh all that e coli with antibiotic resistance is there

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<v Speaker 2>contaminating our vegetables? So it's

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<v Speaker 1>almost impossible to see that you would not be, you

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<v Speaker 1>can't escape it. That's right. It's in every aspect of

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<v Speaker 2>our lives. It is. But there are things we can

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<v Speaker 2>do to minimize it and

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<v Speaker 2>simple things. And of course,

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<v Speaker 2>we shouldn't be tired of the vaccination message. I know

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<v Speaker 2>with COVID. Exactly. Exactly. Some people, you know, oh, another needle.

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<v Speaker 2>But in fact, if you don't get respiratory infections,

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<v Speaker 2>you are less likely to need antibiotics. You're less likely

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<v Speaker 2>e even though the, uh, vaccines are typically against viruses,

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<v Speaker 2>you know, we, as doctors aren't always that clever. We

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<v Speaker 2>can't differentiate viral and bacterial infections and we give people antibiotics.

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<v Speaker 2>But so if you're vaccinated, you have a reduced risk

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<v Speaker 2>of infections. In general, you have a reduced risk of antibiotics.

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<v Speaker 2>You have a reduced risk of anti antibiotic resistance.

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<v Speaker 2>Now,

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<v Speaker 2>clean hands is obviously something we've been taught ever since

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<v Speaker 2>we were little.

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<v Speaker 2>There's an interesting twist to the cleanliness aspect, hygiene hypothesis. Yeah. And,

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<v Speaker 2>and it's also, well, if we're cleaning everything, are we

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<v Speaker 2>actually breeding superbugs? You might have heard about the bedbugs

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<v Speaker 2>in hotels and bed bugs. Now, this is, they're not

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<v Speaker 2>bacteria but they are getting resistant to some of the, uh,

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<v Speaker 2>pesticides

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<v Speaker 1>that the pest killers

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<v Speaker 2>use on them. That's right. And it's almost this, the

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<v Speaker 2>more we use anything, the, the more likely resistance is

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<v Speaker 2>going to develop to it. So, absolutely. I advocate hand,

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<v Speaker 2>you know, clean hands but we have to be a

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<v Speaker 2>little bit mindful that we don't go completely overboard and,

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<v Speaker 2>you know, have everything that isn't really meant to be

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<v Speaker 2>perfectly clean all the time, you know, around our house.

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<v Speaker 2>That's why

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<v Speaker 1>I love our Hawker centers, except in a hospital surfing.

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<v Speaker 1>I want it to be pristine in a hospital

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<v Speaker 2>and, and of course, before we eat, we should have

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<v Speaker 2>good hand hygiene. Uh but we don't want to live

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<v Speaker 2>in an a a completely artificial world because that could

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<v Speaker 2>actually magnify resistance. So vaccination, clean hands,

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<v Speaker 2>generally a clean environment.

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<v Speaker 2>But

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<v Speaker 2>then we have to also consider,

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<v Speaker 2>you know, do I need that antibiotic?

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<v Speaker 1>So the owners can be on me, the individual to

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<v Speaker 1>say no. And that would make a

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<v Speaker 2>difference. It would make some difference. It's not going to,

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<v Speaker 2>you know, just it would be

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<v Speaker 2>silly for me to say, well,

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<v Speaker 2>every person going around saying, look, I don't want antibiotics

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<v Speaker 2>is going to solve the problem because

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<v Speaker 2>there are many, many aspects. As I mentioned, the agricultural use, the,

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<v Speaker 2>you know, the need for use in sick people, in

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<v Speaker 2>hospitals of intravenous antibiotics. But just because we've got a cold, even,

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<v Speaker 2>just because we've got COVID doesn't mean we need antibiotics,

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<v Speaker 2>colds and COVID are due to viruses, antibiotics, kill bacteria. So, different,

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<v Speaker 2>different things. So, yes, there's things we can do,

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<v Speaker 2>but

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<v Speaker 2>there's also a level of things that

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<v Speaker 2>we, as regular people can't control.

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<v Speaker 2>And

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<v Speaker 2>then we almost need sort of an extra layer of intervention.

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<v Speaker 2>So, one of the issues,

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<v Speaker 2>it's true in Singapore, but it's even much more true

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<v Speaker 2>in lower income settings in other countries is that we

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<v Speaker 2>don't have the same antibiotics that are available to people

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<v Speaker 2>in the US, for example. So there's this access issue

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<v Speaker 2>and part of it is that

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<v Speaker 2>drug companies don't make actually that much money from antibiotics.

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<v Speaker 2>And so it's not necessarily profitable for them to sell

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<v Speaker 2>in every country in the world. And

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<v Speaker 2>in fact, where antibiotics are truly needed often is where

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<v Speaker 2>the access to antibiotics. And, and I'm talking about intravenous

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<v Speaker 2>big gun antibiotics is it's least likely to, to have

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<v Speaker 2>access to them. And it's almost like the marketplace for

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<v Speaker 2>antibiotics is broken for most things.

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<v Speaker 2>We're happy to accept the more that is sold, the

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<v Speaker 2>bigger the profits. But with antibiotics, we don't want that,

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<v Speaker 2>we want to restrict them, but we want to have

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<v Speaker 2>them though available when we really need

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<v Speaker 1>them. They're not the, I think the problem is there's

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<v Speaker 1>somehow this

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<v Speaker 1>social idea that it is panacea, it solves all problems,

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<v Speaker 1>but it really should only be there when it is

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<v Speaker 1>most needed. That's

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<v Speaker 2>right. And it's tricky for us in hospitals to work out. Oh,

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<v Speaker 2>that person's really sick. They've got a high fever.

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<v Speaker 2>You know, I think most of us

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<v Speaker 2>would like to have the protection of antibiotics. And we,

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<v Speaker 2>as doctors also feel that discomfort when our, our patient

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<v Speaker 2>is suffering, but sometimes we have to sort of step

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<v Speaker 2>back a little bit and say, even in that situation,

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<v Speaker 2>is it truly, truly needed or could we get by

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<v Speaker 2>with a, a narrower antibiotic one that's not as a

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<v Speaker 2>big gun that's going to

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<v Speaker 2>affect all of our good bacteria in our bellies? Because

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<v Speaker 2>that's an, that's an issue. And that's something I always

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<v Speaker 2>tell my patients is,

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<v Speaker 2>do you really want to upset that natural balance of

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<v Speaker 2>your good bacteria? Because every antibiotic, even if it's for a,

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<v Speaker 2>uh you know, an infection of the right big toe,

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<v Speaker 2>those antibiotics are not clever. They're also not just the

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<v Speaker 2>bacteria on the right big toe, all the good bacteria

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<v Speaker 2>in our bellies. So,

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<v Speaker 1>which is increasingly research and being shown, I mean that

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<v Speaker 1>we need the complexity of our gut bacteria for everything

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<v Speaker 1>from potentially, I don't know, dementia to heart disease. I mean,

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<v Speaker 1>it's so vital to keep that balance there and it's

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<v Speaker 1>been thrown out of whack with every antibiotic dosage.

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<v Speaker 2>That's true. That's exactly true. And, and it doesn't take much,

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<v Speaker 2>you know, just a small number of days of antibiotics

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<v Speaker 2>is enough to disturb the,

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<v Speaker 2>the normal bacteria. Do I got to

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<v Speaker 1>leave it off? And unfortunately, if you were to leave

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<v Speaker 1>one message for antimicrobial resistance, what is the one thing

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<v Speaker 1>you want my listeners to know today

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<v Speaker 2>yet? That it is a problem today that

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<v Speaker 2>we have to come up with solutions as a global

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<v Speaker 2>audience because millions and it is millions of people are

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<v Speaker 2>dying every year from antibiotic resistance

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<v Speaker 1>doc Thank you so much for speaking to my listeners.

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<v Speaker 1>It's been a pleasure having you here. Thanks so much.

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<v Speaker 1>My guest on the program helping us understand antimicrobial resistance.

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<v Speaker 1>The president, the problem is here and now professor David Paterson,

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<v Speaker 1>who is a professor at the Socio School of Public Health.

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<v Speaker 1>This has been health matters. I'm Daniel Martin.

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<v Speaker 1>Before making any decisions based on the information in our program,

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<v Speaker 1>please consult a medical professional.