Speaker 1: Now, health matters with Daniel Martin. Welcome aboard to Health
Speaker 1: Matters right here on CN A 938. Every year. Around
Speaker 1: this time, I take the opportunity to speak to you
Speaker 1: about the what was 16 years ago when I first
Speaker 1: started talking about it, the rising threat of antimicrobial resistance.
Speaker 1: But now is the clear and ever present threat of
Speaker 1: antimicrobial resistance or am r you see last week, the
Speaker 1: world recognized antimicrobial
Speaker 1: resistance week as a result of growing drug resistance, many
Speaker 1: infections have become almost impossible to deal with due to
Speaker 1: a lack of effective drug treatment. Where are we in
Speaker 1: 2023 in terms of am and what will it take
Speaker 1: to effectively reduce it?
Speaker 1: We're learning more as I speak to Professor David Patterson
Speaker 1: who is a professor from the School of Public Health.
Speaker 1: Good to meet you, Professor Patterson. Welcome to the studio.
Speaker 1: Thank you so much. Let's talk about where we are today.
Speaker 1: So like I said, almost for over a decade, I've
Speaker 1: been discussing this on air and every uh
Speaker 1: talking about how this is. It's happening, it's happening, it's happening,
Speaker 1: it's happening. But right now I can see it is here.
Speaker 2: Absolutely. And it's here in Singapore, but to a much,
Speaker 2: much greater degree it's here in our neighbors. So, you know,
Speaker 2: if I was to go to a hospital in Indonesia
Speaker 2: or Malaysia or Thailand, Philippines, people are dying every day
Speaker 2: from AM R now, they're not dying necessarily,
Speaker 2: you know, healthy people at home. Typically it's people who
Speaker 2: are in hospital already with some critical illness. But, you know,
Speaker 2: I don't know if you've ever seen that uh picture
Speaker 2: in South America of the road, of death, this sort
Speaker 2: of narrow road with a huge drop behind you. You know,
Speaker 2: you can imagine you're driving on this narrow road and
Speaker 2: then a great big truck comes towards you,
Speaker 2: you don't have any chance. And it's the same as,
Speaker 2: you know, you're s very, very unwell in an intensive
Speaker 2: care unit and then along comes AM R so an
Speaker 2: infection that's almost impossible to treat or sometimes completely impossible
Speaker 2: to treat. Unfortunately, we do have a lot of patients
Speaker 2: who die in that scenario and simply
Speaker 1: put this has all happened because of
Speaker 1: the judicious and over usage of antibiotics amongst humans. And
Speaker 1: in our farming system has resulted in strains developing that
Speaker 1: are completely resistance to our existing Armamentarium. Is that it
Speaker 2: to a degree. Although it's fascinating to learn that even
Speaker 2: before antibiotics were discovered, there was antibiotic resistance. And you
Speaker 2: might say, well, why chicken egg here, what's going on? So,
Speaker 2: in fact, bacteria
Speaker 2: are clever. They don't have a brain but they're clever.
Speaker 2: So bacteria can naturally produce antibiotics to kill their competition,
Speaker 2: to kill other bacteria. So there was
Speaker 2: uh antibiotic production,
Speaker 2: but there was also the competition got canny, they became
Speaker 2: resistant to those antibiotics produced by other bacteria or other substances.
Speaker 2: And so am R has been around but of course,
Speaker 2: humans have and the development the access to antibiotics has,
Speaker 2: you know, magnified this millions fold. So, you know, we
Speaker 2: know that if a person goes into hospital,
Speaker 2: probably at least a third of people will get intravenous
Speaker 2: antibiotics and in some parts of the world that's even higher.
Speaker 2: We also have the issue that if you're a busy
Speaker 2: nurse or a busy doctor, you go from one patient. Oh,
Speaker 2: that one's got an emergency, you go to the other one.
Speaker 2: You haven't cleaned your hands. You can carry one person's
Speaker 2: resistant bacteria on your hands and pass it to another person.
Speaker 2: So it's antibiotic use in hospitals.
Speaker 2: It's
Speaker 2: cleanliness and part of that cleanliness is not just our hands,
Speaker 2: it's also the environment of hospitals.
Speaker 2: But then we have to think, well, where else are
Speaker 2: antibiotics used? And
Speaker 2: unfortunately in some parts of Asia, every chicken gets antibiotics
Speaker 2: for breakfast and you might think, oh, that just is
Speaker 2: going to be an issue for the chicken. But we
Speaker 2: eat chickens and you might say, well, I'm a vegetarian,
Speaker 2: I'm not going to be affected by animal use of antibiotics.
Speaker 2: But what do the farmers in many parts of the
Speaker 2: world use to fertilize their crops but it's animal manure.
Speaker 2: So in other words,
Speaker 2: the e coli the other bacteria that have been in
Speaker 2: the chicken or cow or pigs tummy that ends up
Speaker 2: uh all that e coli with antibiotic resistance is there
Speaker 2: contaminating our vegetables? So it's
Speaker 1: almost impossible to see that you would not be, you
Speaker 1: can't escape it. That's right. It's in every aspect of
Speaker 2: our lives. It is. But there are things we can
Speaker 2: do to minimize it and
Speaker 2: simple things. And of course,
Speaker 2: we shouldn't be tired of the vaccination message. I know
Speaker 2: with COVID. Exactly. Exactly. Some people, you know, oh, another needle.
Speaker 2: But in fact, if you don't get respiratory infections,
Speaker 2: you are less likely to need antibiotics. You're less likely
Speaker 2: e even though the, uh, vaccines are typically against viruses,
Speaker 2: you know, we, as doctors aren't always that clever. We
Speaker 2: can't differentiate viral and bacterial infections and we give people antibiotics.
Speaker 2: But so if you're vaccinated, you have a reduced risk
Speaker 2: of infections. In general, you have a reduced risk of antibiotics.
Speaker 2: You have a reduced risk of anti antibiotic resistance.
Speaker 2: Now,
Speaker 2: clean hands is obviously something we've been taught ever since
Speaker 2: we were little.
Speaker 2: There's an interesting twist to the cleanliness aspect, hygiene hypothesis. Yeah. And,
Speaker 2: and it's also, well, if we're cleaning everything, are we
Speaker 2: actually breeding superbugs? You might have heard about the bedbugs
Speaker 2: in hotels and bed bugs. Now, this is, they're not
Speaker 2: bacteria but they are getting resistant to some of the, uh,
Speaker 2: pesticides
Speaker 1: that the pest killers
Speaker 2: use on them. That's right. And it's almost this, the
Speaker 2: more we use anything, the, the more likely resistance is
Speaker 2: going to develop to it. So, absolutely. I advocate hand,
Speaker 2: you know, clean hands but we have to be a
Speaker 2: little bit mindful that we don't go completely overboard and,
Speaker 2: you know, have everything that isn't really meant to be
Speaker 2: perfectly clean all the time, you know, around our house.
Speaker 2: That's why
Speaker 1: I love our Hawker centers, except in a hospital surfing.
Speaker 1: I want it to be pristine in a hospital
Speaker 2: and, and of course, before we eat, we should have
Speaker 2: good hand hygiene. Uh but we don't want to live
Speaker 2: in an a a completely artificial world because that could
Speaker 2: actually magnify resistance. So vaccination, clean hands,
Speaker 2: generally a clean environment.
Speaker 2: But
Speaker 2: then we have to also consider,
Speaker 2: you know, do I need that antibiotic?
Speaker 1: So the owners can be on me, the individual to
Speaker 1: say no. And that would make a
Speaker 2: difference. It would make some difference. It's not going to,
Speaker 2: you know, just it would be
Speaker 2: silly for me to say, well,
Speaker 2: every person going around saying, look, I don't want antibiotics
Speaker 2: is going to solve the problem because
Speaker 2: there are many, many aspects. As I mentioned, the agricultural use, the,
Speaker 2: you know, the need for use in sick people, in
Speaker 2: hospitals of intravenous antibiotics. But just because we've got a cold, even,
Speaker 2: just because we've got COVID doesn't mean we need antibiotics,
Speaker 2: colds and COVID are due to viruses, antibiotics, kill bacteria. So, different,
Speaker 2: different things. So, yes, there's things we can do,
Speaker 2: but
Speaker 2: there's also a level of things that
Speaker 2: we, as regular people can't control.
Speaker 2: And
Speaker 2: then we almost need sort of an extra layer of intervention.
Speaker 2: So, one of the issues,
Speaker 2: it's true in Singapore, but it's even much more true
Speaker 2: in lower income settings in other countries is that we
Speaker 2: don't have the same antibiotics that are available to people
Speaker 2: in the US, for example. So there's this access issue
Speaker 2: and part of it is that
Speaker 2: drug companies don't make actually that much money from antibiotics.
Speaker 2: And so it's not necessarily profitable for them to sell
Speaker 2: in every country in the world. And
Speaker 2: in fact, where antibiotics are truly needed often is where
Speaker 2: the access to antibiotics. And, and I'm talking about intravenous
Speaker 2: big gun antibiotics is it's least likely to, to have
Speaker 2: access to them. And it's almost like the marketplace for
Speaker 2: antibiotics is broken for most things.
Speaker 2: We're happy to accept the more that is sold, the
Speaker 2: bigger the profits. But with antibiotics, we don't want that,
Speaker 2: we want to restrict them, but we want to have
Speaker 2: them though available when we really need
Speaker 1: them. They're not the, I think the problem is there's
Speaker 1: somehow this
Speaker 1: social idea that it is panacea, it solves all problems,
Speaker 1: but it really should only be there when it is
Speaker 1: most needed. That's
Speaker 2: right. And it's tricky for us in hospitals to work out. Oh,
Speaker 2: that person's really sick. They've got a high fever.
Speaker 2: You know, I think most of us
Speaker 2: would like to have the protection of antibiotics. And we,
Speaker 2: as doctors also feel that discomfort when our, our patient
Speaker 2: is suffering, but sometimes we have to sort of step
Speaker 2: back a little bit and say, even in that situation,
Speaker 2: is it truly, truly needed or could we get by
Speaker 2: with a, a narrower antibiotic one that's not as a
Speaker 2: big gun that's going to
Speaker 2: affect all of our good bacteria in our bellies? Because
Speaker 2: that's an, that's an issue. And that's something I always
Speaker 2: tell my patients is,
Speaker 2: do you really want to upset that natural balance of
Speaker 2: your good bacteria? Because every antibiotic, even if it's for a,
Speaker 2: uh you know, an infection of the right big toe,
Speaker 2: those antibiotics are not clever. They're also not just the
Speaker 2: bacteria on the right big toe, all the good bacteria
Speaker 2: in our bellies. So,
Speaker 1: which is increasingly research and being shown, I mean that
Speaker 1: we need the complexity of our gut bacteria for everything
Speaker 1: from potentially, I don't know, dementia to heart disease. I mean,
Speaker 1: it's so vital to keep that balance there and it's
Speaker 1: been thrown out of whack with every antibiotic dosage.
Speaker 2: That's true. That's exactly true. And, and it doesn't take much,
Speaker 2: you know, just a small number of days of antibiotics
Speaker 2: is enough to disturb the,
Speaker 2: the normal bacteria. Do I got to
Speaker 1: leave it off? And unfortunately, if you were to leave
Speaker 1: one message for antimicrobial resistance, what is the one thing
Speaker 1: you want my listeners to know today
Speaker 2: yet? That it is a problem today that
Speaker 2: we have to come up with solutions as a global
Speaker 2: audience because millions and it is millions of people are
Speaker 2: dying every year from antibiotic resistance
Speaker 1: doc Thank you so much for speaking to my listeners.
Speaker 1: It's been a pleasure having you here. Thanks so much.
Speaker 1: My guest on the program helping us understand antimicrobial resistance.
Speaker 1: The president, the problem is here and now professor David Paterson,
Speaker 1: who is a professor at the Socio School of Public Health.
Speaker 1: This has been health matters. I'm Daniel Martin.
Speaker 1: Before making any decisions based on the information in our program,
Speaker 1: please consult a medical professional.