The Invisible Enemy

Steve Silberman:

“Interviews with current and former military physicians, recent articles in medical journals, and internal reports reveal that the Department of Defense has been waging a secret war within the larger mission in Iraq and Afghanistan – a war against antibiotic-resistant pathogens.” (Wired News)

In a major scoop, Silberman, who has become one of the best-informed and best-sourced reporters about neuroscience and medical topics, exposes an epidemic of multiply resistant Acinetobacter baumannii infecting wounded troops in the ‘evacuation chain’ from field hospitals in Iraq through medevac facilities to civilian hospitals in Europe and the US; it has already spread to civilian patients in those hospitals. Although the US government long maintained that the organism originated in Iraqi soil and infected soldiers wounded by IEDs, it is clear that the real culprits are the unsterile conditions and unrestrained use of broad-spectrum state-of-the-art antibiotics in US field hospitals in Iraq. Silberman does a good job of laying out the factors that continue to prevent an effective response to these issues. These include, of course, Rumsfeld’s doctrine of fighting the war on a shoestring and the military’s misuse of medical resources to keep casualties on the front lines as long as possible.

“The wounded soldiers were not smuggling bacteria from the desert into military hospitals after all. Instead, they were picking it up there. The evacuation chain itself had become the primary source of infection. By creating the most heroic and efficient means of saving lives in the history of warfare, the Pentagon had accidentally invented a machine for accelerating bacterial evolution and was airlifting the pathogens halfway around the world.”

Silberman’s story is one of the Huffington Post’s “most huffed stories.” Huffit is HuffPo’s new Digg-like feature in which readers register which stories they feel are most newsworthy.

Multiply-resistant strains of bacteria are becoming a fact of life. As a physician working in a medical hospital, I am dealing with increasing regularity with patients with MRSA or C. difficile. The situation is only going to become worse as resistant bacteria’s sharing of drug resistance genes (a process which Silberman aptly likens to sharing open source software code) accelerates and we enter a fallow period in antibiotic development. There has always been an ‘arms race’ (another apt metaphor) between infectious disease organisms and medical tactics, and medicine is losing out. Could the Iraq war end up playing a major role in the end of the era of medical ascendancy over infectious disease?