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Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them
Antibiotic-resistant microbes infect more than 2 million Americans and kill over 100,000 each year. They spread rapidly, even in such seemingly harmless places as high school locker rooms, where they infect young athletes. Throughout the world, many more people are dying from these infections. Astoundingly, as antibiotic resistant infections are skyrocketing in incidence―creating a critical need for new antibiotics―research and development of new antibiotics has ground to a screeching halt!In Rising Plague, Dr. Brad Spellberg―an infectious diseases specialist and member of a national task force charged with attacking antibiotic resistant infections―tells the story of this potentially grave public health crisis. The author shares true and very moving patient stories to emphasize the terrible frustration he and his colleagues have experienced while attempting to treat untreatable infections, not to mention the heart-break and tragedy that many of these patients' families had to endure. Dr. Spellberg corrects the nearly universal misperception that physician misuse of antibiotics and "dirty hospitals" are responsible for causing antibiotic-resistant infections. He explains the true causes of antibiotic resistance and of the virtual collapse of antibiotic research and development. Most important, he advocates ways to reverse this dire trend and instead bolster the production of desperately needed new and effective antibiotics. He also warns against complacency induced by the decades-old assumption that some miracle drug will always be available to ensure the continuation of our "antibiotic era." If we do nothing, we run the risk of inviting a bleak future when infectious diseases will once again reign supreme. Then many of the medical breakthroughs that we now take for granted―from routine surgery and organ transplants to intensive care and battlefield medicine―might all be threatened. This crucial and timely book is lucidly written in terms that everyone can understand. It issues a call to action, explaining how, through a strong and concerted effort, we can all help prevent this nightmare scenario from happening. By following this courageous doctor's recommendations, we can assure that magic bullets will be there for our families and us in the future.
264 pages, Hardcover
First published September 22, 2009
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Displaying 1 - 22 of 22 reviews
August 20, 2012
I stumbled across this book while reading reviews online related to how fever suppression can harm rather than help patients with active infections, and one review mentioned this book when saying that in the future 'pyrotherapy' may be something that we will need to use in a possible 'postantibiotic era.'
This book (written by an ID physician) forced me to re-look at several of my beliefs which is an exercise that I often enjoy (not always lets be honest). It looks at many issues related to two major and compounding crises today: increasing antibiotic resistance and the lack of development of new antibiotics.
If you have any interest in infectious diseases some of the data presented and his arguments are sure to intrigue you. He basically shows that the USA is the only country that is really developing new drugs to the phase III stage(a fact he claims is related to poor incentive to develop in other countries esp Europe due to their stronger laws related to allowing the wider availability of generic drugs). Yes there are many biotechnology companies that take medicines to phase II clinical trials but they have never in the past been able to take a drug, without pharmaceutical company help, to the multi hundred million dollar phase III clinical trial.
The US is a capitalist society, a fact that we cannot easily change; pharmaceutical companies exist in this environment and he shows the very many ways in which pharmaceutical companies do not have a large enough incentive to develop new antibiotics - drugs that are just not profitable. He argues that there needs to be government intervention and describes exactly the types of interventions that are needed. We need more antibiotics and the fact is that almost all antibiotics known to man were developed by pharmaceutical companies, and the few that weren't had pharmaceutical company help to take the drug to phase III.
This book has really made me re-look at my deep hatred of pharmaceutical companies. I adore PHARMAC - the regulatory body in New Zealand that facilitates cheaper medicines but I now understand that this comes at a cost to the rest of the world and in the long run to us. There is no way that a new drug will ever be developed and make it past phase III in any country with laws like ours. Pharmaceutical company profits are directly related to their reinvestment in research and development and in a way the US is subsidising countries like ours with their high drug prices. (Something that I am not upset about!)
Other beliefs that were challenged: the small role that doctors play in antibiotic resistance (more stringent prescribing will buy us more time but we will eventually need more antibiotics), the non-evidence based policies of MRSA screening and subsequent isolation in many hospitals (something that I had come across before in the 'gobbet of pus' podcast by another ID physician) and others!
So yes I will still avoid pharmaceutical company representatives etcetera but my dislike of the companies as a whole has been challenged.
This book (written by an ID physician) forced me to re-look at several of my beliefs which is an exercise that I often enjoy (not always lets be honest). It looks at many issues related to two major and compounding crises today: increasing antibiotic resistance and the lack of development of new antibiotics.
If you have any interest in infectious diseases some of the data presented and his arguments are sure to intrigue you. He basically shows that the USA is the only country that is really developing new drugs to the phase III stage(a fact he claims is related to poor incentive to develop in other countries esp Europe due to their stronger laws related to allowing the wider availability of generic drugs). Yes there are many biotechnology companies that take medicines to phase II clinical trials but they have never in the past been able to take a drug, without pharmaceutical company help, to the multi hundred million dollar phase III clinical trial.
The US is a capitalist society, a fact that we cannot easily change; pharmaceutical companies exist in this environment and he shows the very many ways in which pharmaceutical companies do not have a large enough incentive to develop new antibiotics - drugs that are just not profitable. He argues that there needs to be government intervention and describes exactly the types of interventions that are needed. We need more antibiotics and the fact is that almost all antibiotics known to man were developed by pharmaceutical companies, and the few that weren't had pharmaceutical company help to take the drug to phase III.
This book has really made me re-look at my deep hatred of pharmaceutical companies. I adore PHARMAC - the regulatory body in New Zealand that facilitates cheaper medicines but I now understand that this comes at a cost to the rest of the world and in the long run to us. There is no way that a new drug will ever be developed and make it past phase III in any country with laws like ours. Pharmaceutical company profits are directly related to their reinvestment in research and development and in a way the US is subsidising countries like ours with their high drug prices. (Something that I am not upset about!)
Other beliefs that were challenged: the small role that doctors play in antibiotic resistance (more stringent prescribing will buy us more time but we will eventually need more antibiotics), the non-evidence based policies of MRSA screening and subsequent isolation in many hospitals (something that I had come across before in the 'gobbet of pus' podcast by another ID physician) and others!
So yes I will still avoid pharmaceutical company representatives etcetera but my dislike of the companies as a whole has been challenged.
November 30, 2017
Thought provoking. I enjoyed the stories of patients and their nasty infections the most (authors have me at "pus" ;)) but while I initially felt that Spellberg was totally in the pocket of the pharmaceutical companies I appreciated reading some counter arguments to what I've tended to believe about those same companies and can see that there really are two sides to every story. Recommended.
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March 16, 2010a little unnerving ..... wash your hands ....
August 18, 2015
While Spellberg does provide both personal, clinical anecdotes of his experiences with infection as a physician in Los Angeles and a knowledgeable assessment of the rising antibiotic crisis in America and worldwide, this work would have made more sense as a lengthy article in Scientific American or even Time. As a book, it lumbers along, with possibly one (or two) too many stories, and a repetitive description of the obstacles on the road to the development of new antibiotics. Spellberg does, however, rise above many others who have championed this cause by actually providing some solutions, both immediate and long term, to the problem. Overall, a more concise manifesto in a publication reaching a wider audience would drive his point home more effectively. Antibiotic resistance and the possibility of a "post-antibiotic age" is truly a societal emergency that warrants immediate attention, and while this book conveys that message, it does so somewhat ineffectively.
March 10, 2017
"we must not be fooled into believing we are somehow entitled to effective antibiotics."
People should remember that.
People should remember that.
February 20, 2018
the first half of this book is very readable and enjoyable with lots of anecdotes. Second half is more difficult. When he starts talking about "push" and "pull" strategies, it is quite dry and not very enjoyable. It is very informative, but around 10 years old so I really wonder what has changed since it was written.
April 17, 2018
Couldn't stick with it. The anecdotes were too few and far between. The stories of corporations prioritizing profit over patient care were unsurprising and depressing.
December 15, 2012
The three top infectious causes of death in the United states are: sepsis, influenza and pneumonia. Each year, more Americans die of MRSA (Methicillin-resistant Staphylococcus aureus) infections than die of AIDS. MRSA was originally only a hospital-acquired infection, but now it is more often community acquired. Besides MRSA, there are also many other antibiotic-resistant bacteria: Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae.
Even if hospitals greatly improve their hygiene, and physicians stop over-prescribing antibiotics, there would still be many hospital acquired infections. The reason is that bugs crawl into patients on their catheters, plus their skin is broken during surgery. Also, chemotherapy weakens the immune system and makes patients more susceptible to infection.
Pharmaceutical companies are reluctant to spend money on a drug that the patient will take only for a couple weeks. In contrast, blood pressure medications and statins are taken every day for decades.
The author points out that it is not sufficient to fund academic laboratories conducting basic research, because no academic laboratory has ever developed an antibiotic. Only pharmaceutical companies have developed antibiotics. Many foreign drug companies sell their drugs for a ot less than American drug companies, because the foreign drug companies have only manufacturing costs, not research and development costs. Most foreign companies piggy back on American research. After the European Union instituted pharmaceutical price controls, European drug development declined.
The author gives details about Project Bioshield, where the government spent a large sum of money developing a new vaccine for smallpox, even though smallpox had already been eradicated from the face of the earth. The Hollis-Eden pharmaceutical company was promised a large order for its radiation-poisoning steroid drug Neumune by the U.S. federal government, which reneged on the deal after the drug was developed. The author describes the case of the Oscient biotechnology company and its sinusitis drug gemifloxacin, where the FDA changed its rules for clinical trials in the middle of the game, that is, while the clinical trials are being run. During the 2001 anthrax scare, the United States government threatened to revoke the German Bayer company's patent on ciprofloxacin if it did not cut the price in half. Bayer was accused of profiting from people's suffering. But, to my thinking, Bayer should be criticized only if it created the problem it is attempting to solve. Bayer did not give anyone anthrax.
The author is critical of the widespread dislike of pharmaceutical companies for irrational, emotional reasons. Those of us on the political Right are willing to admit that the people running large corporations are motivated more by profits than by compassion. But politicians and government officials are no more moral. They just pretend to be.
The author suggests that for antibiotic development we pursue something similar to the Orphan Drug Act for rare diseases. For individuals, the author recommends lots of hand washing, avoiding being admitted to the hospital, and, if admitted, keeping your stay short.
Even if hospitals greatly improve their hygiene, and physicians stop over-prescribing antibiotics, there would still be many hospital acquired infections. The reason is that bugs crawl into patients on their catheters, plus their skin is broken during surgery. Also, chemotherapy weakens the immune system and makes patients more susceptible to infection.
Pharmaceutical companies are reluctant to spend money on a drug that the patient will take only for a couple weeks. In contrast, blood pressure medications and statins are taken every day for decades.
The author points out that it is not sufficient to fund academic laboratories conducting basic research, because no academic laboratory has ever developed an antibiotic. Only pharmaceutical companies have developed antibiotics. Many foreign drug companies sell their drugs for a ot less than American drug companies, because the foreign drug companies have only manufacturing costs, not research and development costs. Most foreign companies piggy back on American research. After the European Union instituted pharmaceutical price controls, European drug development declined.
The author gives details about Project Bioshield, where the government spent a large sum of money developing a new vaccine for smallpox, even though smallpox had already been eradicated from the face of the earth. The Hollis-Eden pharmaceutical company was promised a large order for its radiation-poisoning steroid drug Neumune by the U.S. federal government, which reneged on the deal after the drug was developed. The author describes the case of the Oscient biotechnology company and its sinusitis drug gemifloxacin, where the FDA changed its rules for clinical trials in the middle of the game, that is, while the clinical trials are being run. During the 2001 anthrax scare, the United States government threatened to revoke the German Bayer company's patent on ciprofloxacin if it did not cut the price in half. Bayer was accused of profiting from people's suffering. But, to my thinking, Bayer should be criticized only if it created the problem it is attempting to solve. Bayer did not give anyone anthrax.
The author is critical of the widespread dislike of pharmaceutical companies for irrational, emotional reasons. Those of us on the political Right are willing to admit that the people running large corporations are motivated more by profits than by compassion. But politicians and government officials are no more moral. They just pretend to be.
The author suggests that for antibiotic development we pursue something similar to the Orphan Drug Act for rare diseases. For individuals, the author recommends lots of hand washing, avoiding being admitted to the hospital, and, if admitted, keeping your stay short.
November 28, 2017
Probably too dry for most readers, but I find the subject fascinating. I have been reading books about germs and viruses as research material for my zombie fiction writing.
My only main gripe against this book is it was obviously written by a left-leaning liberal who stated that those who buy weapons do so only because they wish to kill someone. I disagree with the doctor's opinion that socialized medicine is a good thing (because it works so well in Canada, most of Europe and the UK, right?).
However, I do agree that the American health system needs improving. Should a major outbreak happen, the American health system (which is far too reactive rather than proactive), will take a long time to effectively battle the outbreak.
I did find the book interesting. The author's insight into MRSA (which I suffered) and other deadly bacteria I found captivating. The text also gave me several ideas for my zombie fiction although that happens because of a mutated viral bio-weapon, rather than a bacteria.
The author's analogy explaining how bacteria exchange DNA so freely by comparing bacteria to computers was easy to envision even for a layman like myself with only a rudimentary understanding of bacteria.
My only main gripe against this book is it was obviously written by a left-leaning liberal who stated that those who buy weapons do so only because they wish to kill someone. I disagree with the doctor's opinion that socialized medicine is a good thing (because it works so well in Canada, most of Europe and the UK, right?).
However, I do agree that the American health system needs improving. Should a major outbreak happen, the American health system (which is far too reactive rather than proactive), will take a long time to effectively battle the outbreak.
I did find the book interesting. The author's insight into MRSA (which I suffered) and other deadly bacteria I found captivating. The text also gave me several ideas for my zombie fiction although that happens because of a mutated viral bio-weapon, rather than a bacteria.
The author's analogy explaining how bacteria exchange DNA so freely by comparing bacteria to computers was easy to envision even for a layman like myself with only a rudimentary understanding of bacteria.
March 5, 2011
A fascinating look at the causes of increasing antibiotic resistance and also at some of the issues plaguing our health care system. I didn't agree with everything the author said, and sometimes I felt the author had a definite, biased agenda. But I can't blame him when he's the one watching patients die of rare and horrific flesh-eating bacterial diseases that don't respond to any known antibiotics. However, most of the time I felt that the information the author set forth was factual and supported by scientific evidence, dispelling much of my own misinformation with real knowledge. I learned a LOT. And I'll never think the same way about the subject again. A fabulous read.
October 5, 2012
Started off well enough. I think I was expecting a memoir/history of resistant bacteria from an infectious disease doctor's perspective. That lasted maybe the first few chapters, after which it became a big screed about how Big Pharma Will Save Us All, If Only They Got Some Incentives!
Nowhere in the author's bio or text did he indicate any formal background in health economics, or even business. Nowhere did he interrogate the assumptions of the existing system.
I actually didn't finish because, after living with an economist who also holds an MBA and has been an entrepreneur, I was unable to keep reading his proposed solution without wanting to throw my Kindle.
Nowhere in the author's bio or text did he indicate any formal background in health economics, or even business. Nowhere did he interrogate the assumptions of the existing system.
I actually didn't finish because, after living with an economist who also holds an MBA and has been an entrepreneur, I was unable to keep reading his proposed solution without wanting to throw my Kindle.
January 8, 2014
This book was completely terrifying. I mean that in a good way. The anecdotes Spellberg provides really are quite frightening, and made me think about what would happen to me if I had to enter the hospital for minor surgery. The very real possibility that I could die after minor surgery is a huge incentive to take better care of myself, and it also gives me a sort of helpless desperation about how this problem can be solved.
The second half of the book is more dry and much less interesting than the first half, largely due to its focus on problem-solving rather than problem-illustrating. But still! Scary as hell.
The second half of the book is more dry and much less interesting than the first half, largely due to its focus on problem-solving rather than problem-illustrating. But still! Scary as hell.
March 8, 2010
Interesting information about the origins and dangers of resistant bacteria. The writing style was somewhat sophomoric and more conversational than I expected, but felt well-informed. Nice to see some of the arguments about the government vs. pharma company role in drug development outlined and discussed. Perhaps more interesting to someone who doesn't work on antibiotics all day already?
November 24, 2009
Points out a human problem as crucial, if not quite as pervasive, as the global warming phenomenon. Should be read by anyone who seeks to be well-informed. Gives the lie to those who depend upon antibiotics while they deny natural selection.
March 16, 2017
Great explanation of the problem of antibiotic resistant bacteria and a helpful group of solutions. The problem can be solved if we have the collective will to do so. Sadly, I doubt we'll muster the required will until a whole lot more people die from infections. Sad and scary.
August 30, 2015
Interesting breakdown of antibiotic resistance, the lack of antibiotic development and why, and the obstacles to antibiotic creation. Already a tad out of date, I think, because it was published in 2009, but the overall message is clear.
September 17, 2010
Interesting information about our antibiotic crisis. I don't know if I agree with Dr. Spellberg's solutions, but it was nice to hear SOME solutions.
February 12, 2013
Great book because it explains how outnumbered we are by multistage resistant bacteria.
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May 5, 2014616.9041 S743 2009
February 17, 2016
We are so deeply screwed
November 13, 2016
Prometheus Books
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September 24, 2017Read only half, and got the point.
Displaying 1 - 22 of 22 reviews