Fault Lines

This book was a huge disappointment. I’m a public health nerd, and my standards for a book about infectious disease is pretty low. Rising Plague didn’t meet them.

The book starts with an introduction to multi-drug resistant bacteria, which is illustrated with stories of real patients Dr. Spellberg has treated, and then moves into an exploration of the pharmaceutical industry, and the barriers to creating new antibiotics. This section was pretty successful. The patient case studies are interesting, and I learned quite a bit about pharmaceutical companies, and why they’re not responding to this threat in the way that the general public may expect them to (It’s not all because of money–but it’s mostly because of money).

After this he moves on to what he thinks needs to be done, and here’s where he lost me. There’s almost no discussion of antibiotic use in animals. This is a huge omission, seeing as how the majority of antibiotics are used in farming, not in humans, and yet the topic only gets about two sentences. His solution to the problem is basically for the government to throw money at the pharmaceutical companies to entice them to create new drugs. I agree that the government should probably get involved in this, but even if companies are developing drug after drug, if they’re all being used in healthy animals as a cheap preventative, we’re still screwed.

This book is also just not very well-written. There were several times where I had to stop and reread jumbled sentences to try and make sense of them. Spellberg tries to keep things simple, but something about his writing style is very convoluted.

What can be done to stop drug resistance in bacteria? Well, nothing can really stop it. The best we can hope for is to slow it down, by reducing antibiotic use and by constantly coming up with new antibiotics to try. This is a never-ending battle. Bacteria will always evolve to develop resistance to new drugs. The only thing we can hope to do is slow it down. Right now people in the developed world die from cancer, heart disease, stroke. . .but if we don’t get a handle on bacterial infections we will soon return to a world where most people die from those. If you want to read about infectious disease, I’d recommend Maryn McKenna’s Superbug or David Quammen’s Spillover.