Terence Kealey
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Last Thursday the Office for National Statistics confirmed that more than 20 patients a day now die from the superbug infections, MRSA and C difficile.
NHS practice has been poor. MRSA (methicillin-resistant staphylococcal aureus) is a bacterium that many people carry, safely, in their noses. Yet when people are weakened by sickness, MRSA can invade the bloodstream and kill. In Scandinavia, Holland and Harley Street (three places where MRSA is rare) carriers are screened and treated before being admitted to the wards, but the NHS has been slow in following suit.
Clostridium difficile is another bacterium that many people carry safely (in their intestines), but when hospital toilets are poorly cleaned, when wards are overcrowded, or when people fail to wash their hands, patients will acquire C difficile from each other and, in their weakened state, die of diarrhoea.
Can science offer a technological solution to the NHS's failings? Can we invent new antibiotics? Two papers offer hope.
Our bodies make their own natural antibiotics, of which nitric oxide is one. In a recent paper in Science, Dr Fang of the University of Washington, Seattle, showed that MRSA produces a special enzyme that detoxifies nitric oxide. That is why MRSA can kill us.
Meanwhile Dr Pierik of Philipps University, Marburg, has shown that C difficile's enzymes are equally special. They are ancient. There is no oxygen within our guts because the bloodstream does not extend into them. But billions of years ago - before green plants evolved - there was no oxygen in the Earth's atmosphere either. Yet bacteria were already established, and C difficile still uses the enzymes of its primordial ancestors to flourish without oxygen.
Antibiotics work as “magic bullets”. It was Paul Ehrlich, the German microbiologist, who in 1909 invented antibiotics by identifying chemicals that, magically, disabled bacterial but not human enzymes. But to find his bullets, Ehrlich had to search randomly. He infected rabbits with syphilis and he dosed them with random chemicals. He named his first drug Salvarsan 606 because it was the 606th chemical he tested that finally cured the rabbits.
Drs Fang and Pierik now proffer the hope of a focused future. Now that we can characterise the key enzymes of MRSA and C difficile, we might design new antibiotics systematically, not randomly. Science may indeed rescue us from the NHS's failings.
Yet the NHS, as a state monopoly, will find new ways to fail. And we will have ourselves to blame. The insurance-based systems of continental Europe - whose hospitals have bed occupancy rates of only 75 per cent and whose hospitals, being separately owned, compete for patients - are better than our own. But the British resist reforms that cost them money.
Terence Kealey is the Vice-Chancellor of the University of Buckingham
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