Normally I'm allergic to health scaremongering of any sort, especially if it uses government-funded studies to bolster its dire predictions. But here in America the subject of superbugs – microbes that have developed resistance to the drugs once effective in killing them – has resurfaced with a disturbing and ironic twist. Superbugs already kill 700,000 people a year around the world. Now they are apparently being spread by a surgical camera used to help treat cancer.
The US Food and Drug Administration (FDA) announced on March 12 that it will convene a panel on the spread of superbugs. The panel is to meet in mid-May. This announcement follows deaths in Los Angeles and North Carolina from carbapenem-resistant enterobacteriaceae, or CRE, which many patients (we can't be sure how many) contracted following gastroenterological procedures using a device called a duodenoscope.
The duodenoscope is a sophisticated device, a triumph of medical technology – or so it seemed. It's a form of endoscope – a tube with a lighted video camera on one end of it – that is designed to examine the duodenum, the portion of the small intestine closest to the stomach. It has many applications, including the treatment of intestinal cancer. Unfortunately its sophistication is part of the problem: put simply, it's so intricate that it is difficult to clean properly.
The duodenoscope is manufactured by the biggest names in camera technology. They include Olympus, which has put out a carefully worded statement saying it's 'aware of reports of patient infections following procedures involving duodenoscopes'. I should hope it was 'aware' of these reports – suspicion about these instruments has been mounting since 2012. Yet the FDA, which for its part says it became 'aware' of the matter in 2013, did not publicly address this issue until this February following pressure from Senator Patty Murray of Washington.
Meanwhile, as Wired reported last week, patients exposed to superbugs 'have now filed lawsuits against the manufacturers of the duodenoscopes; other suits have blamed hospitals for failing to adequately clean the devices between uses'. The FDA has tightened up its rules, so that manufacturers will now have to prove that their cleaning procedures work. But it only got round to doing so at the beginning of this month. And so far there's no evidence that companies can come up with the proof.
British readers have long known how deadly superbugs can be: the most notorious of them, MRSA, was implicated in 1,629 deaths in England and Wales in 2005 alone. Ten years on, the BBC was reporting that superbugs could kill more people than cancer worldwide by 2050 (see map below).
We can't be sure how reliable that horrendous projection is. But what's undeniable is that doctors will remain unprepared to treat superbug-infected patients if current trends in drug development continue. Big Pharma developed precious few new antibiotics in recent decades. Antibiotic resistance first emerged as a clinical problem in the 1960s. Since then, pharmaceutical companies, which on average spend five billion dollars to create and market a new drug, have found that antibiotics are not profitable. Why spend billions creating a drug that will eventually be ineffective? Pfizer, a major American pharmaceutical company, closed its antibiotic-research facilities in 2011.
The duodenoscope crisis exposes an additional problem. As Wired's Katie Palmer notes, 'newer medical devices have so many tiny crevices that it’s impossible to know which ones will pick up bacteria'. Crucially, they are resistant to steam sterilisation and are cleaned using complex manual processes. Somehow, medical technology will have to come up with ways of designing instruments that resist contamination – no easy task, given that the complexity that makes these instruments effective renders them also dangerous. It's a horrible irony, underlining once again the diabolical ability of superbugs to keep just one step ahead of science.