Why The Overuse of Antibiotics May Be Linked To Asthma And Obesity
The development of antibiotics in the 1940s ushered in a golden age of medicine. Bacterial infections and illnesses that were commonly fatal became treatable. But researchers now say the overuse of antibiotics has disturbed the natural balance of beneficial bacteria in our bodies. New studies indicate that some diseases - including obesity, childhood diabetes and asthma - may be on the rise because we have upset the delicate equilibrium of microbes in our gut and on our skin. In the next hour, Diane Rehm talks with two leading medical experts about this new research.
Guests
Dr. Anthony Fauci: director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
Martin Blaser: director, Human Microbiome Program at NYU. He is author of the book, "Missing Microbes: How The Overuse of Antibiotics is Fueling Our Modern Plagues." He is the former chair of medicine at NYU and president of the Infectious Diseases Society of America.
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MS. DIANE REHM
Thanks for joining us. I'm Diane Rehm. More than 70 percent of all the cells in the human body are not human at all. They're microorganisms or bacteria and other types of microbes. But researchers say the overuse of antibiotics is killing off some of the good bacteria and may be linked to the rise of some diseases.
MS. DIANE REHM
Here with me to talk about these new studies, Dr. Anthony Fauci of the National Institutes of Health. Joining us from a studio at NPR in New York, Dr. Martin Blaser at the Microbiome Program at New York University. You're welcome to be part of the program. Join us by calling 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Dr. Fauci, Dr. Blaser, welcome.
DR. ANTHONY FAUCI
Thank you. Good to be here.
DR. MARTIN BLASER
Thank you. Good to be back.
REHM
Good to have you both with us. Before we start on our discussion about antibiotics and the concern with overuse, Dr. Fauci, let me ask you about the discovery of decades-old smallpox vials found in a storage room at the NIH campus in Bethesda. What in the world were they doing there?
FAUCI
Well, this is a multi-decade old specimens that were sealed very, very carefully. They were very likely used -- again, it's still unclear. It's being investigated. Very likely used since it was in an FDA facility that happened to be on the NIH campus, and that, since the FDA has been involved in regulation and standards for things, that it is likely that that material was used to test against reference (word?), what have you. That's just the guess, Diane. We don't know. But it's certainly back decades ago.
FAUCI
Smallpox was kept by laboratories. And then at a certain period of time, everyone gave in their specimens to be destroyed with only two locations, one at the CDC and one in Russia, and at a period of time everyone was asked to look into their freezers for it. So it's very interesting that, just as recently as two years ago, in 2012, the NIH looked at every one of the freezers and had every single principal investigator look at the freezers.
FAUCI
The odd thing about this is that this was literally in a box in a cold room, freeze-dried, that people probably hadn't touched in years and years and years. And the good news about it is -- I mean, obviously, it shouldn't have been there. But the good news is that it was perfectly intact. It was removed, properly taken down to the CDC where it'll be examined and ultimately destroyed.
REHM
So there was no risk to anyone?
FAUCI
No. No, no. There was not.
REHM
And yet this morning, in The Washington Post, some NIH employees are saying they should have been told earlier about the vials.
FAUCI
Right. Well, it was an interesting evolution of the situation, Diane. When it was known that this was there, the most important thing to do was to get it secured and get it out of there as quickly as possible to the CDC who could handle it and do the examination and the destruction. And the -- I believe the reason they were not let known because we wanted to make sure that the secure taking it and putting it where it could be completely safe was done without a lot of fanfare and a lot of publicity. And by the time that was done, it hit the press. And then the press knew about it, and everybody knew about it.
REHM
OK. And one more thing. Since this was actually the second incident in 30 days involving the mishandling, if you will, of a highly dangerous pathogen by a federal agency, the accidental release of live anthrax bacteria.
FAUCI
Right. It -- are you referring to the CDC?
REHM
Yeah, I am indeed.
FAUCI
Yeah. I -- again, I wouldn't necessarily say accidental release. There was -- what it was it was handled in a facility that hadn't had the total type of security -- you know, we have the bio level -- the biosafety level, X, Y, Z, one, two, three, four -- and that it was taken out of a facility and put into a lesser secure facility before it was completely inactivated and that they absolutely picked it up. They approached it in the appropriate way, had the individuals that might have been exposed, and those who might have been exposed, had the opportunity to get on antibiotics and/or vaccination.
REHM
I see. So they, as you say, were flown to the CDC for further testing.
FAUCI
Right. 1
REHM
Now, what happens next?
FAUCI
It get destroyed.
REHM
Totally?
FAUCI
Totally.
REHM
OK. All right. Dr. Blaser, maybe you have a comment on that or not.
BLASER
I do. And it's -- actually, it's a very nice segue into our discussion because the public has mostly focused on bad germs, like smallpox, like anthrax, which are quite real, which are quite bad. But I've become -- after studying bad germs for many years, I've become interested in the good germs, the good bacteria and the question of what's happening to our good bacteria, which in part are a protection against the bad germs. And that's the focus of my book, "Missing Microbes." And I hope we're going to have a great discussion.
REHM
Absolutely. And scientists, as you say, have long been concerned about antibiotic resistance, but your concerns are different. Tell us about your research which you do outline in your book "Missing Microbes."
BLASER
Yes. Thank you. In order to begin, I just have to introduce a couple concepts, the first of which is the Human Microbiome, which you mentioned already, the fact that most of the cells in the human body are microbial. These are the organisms we've lived with since time immemorial. We got them from our moms, and they got them from their moms. And they do good things for us. They help us. They protect us against invaders. They train our immunity. They help us digest food.
BLASER
And what happens is that, in early life, there's a choreography between the microbes and the host. And that allows babies to develop normally. But we're changing that because of a lot of antibacterial practices, antibiotics, Cesarean sections, food additives. Many kinds of things are changing those initial bacteria in life. And our work and the work of other scientists is beginning to provide evidence that that has cost, that that is changing how babies are developing, and potentially leading to some of today's epidemics: obesity, diabetes, allergies, asthma. I could go on. So that's the big idea.
REHM
All right. And, Dr. Fauci, first of all, explain what is meant by good bacteria and bad bacteria.
FAUCI
Well, OK, so I think the simplest way to explain it is the bad bacteria is what we generally refer to as a pathogen or something that could make you ill under certain circumstances. What Dr. Blaser was referring to as good bacteria are bacteria that are really part of the natural environment in various components of a body, the gut being the one that has, you know, the most dense occupation by microbes, particularly bacteria.
FAUCI
And when we refer to good bacteria, we refer to bacteria that do things that Dr. Blaser has referred to. For example, there are bacteria that are very important in the evolution and the development of your normal immune system, the kinds of stimuli that they give. And, number two, it creates an environment that actually protect pathogens from actually overcoming, in a micro-environment way, the bacteria that are essentially protecting you.
FAUCI
They also are important in metabolic processes. They help you digest your food. They provide certain materials, metabolites that are very, very important. And also, they provide a protection against aberrant responses that you might not want to have in your gut. And sometimes what happens is that when you get imbalance of this type of protective mechanism, you can get diseases, like inflammatory bowel diseases, things like that.
REHM
Indeed. All right. And, Dr. Blaser, you mentioned obesity. You mentioned asthma. Talk about the new research specifically as it relates to antibiotic use and obesity.
BLASER
Great. Thank you. The first thing I want to mention is that antibiotics are miraculous. When people are really sick with infectious diseases due to bacteria, there's nothing like it. And to not use antibiotics would be a grave error. Antibiotics can be lifesaving and important. Nevertheless, because they are so effective, we doctors have been using them more and more and more. And we're also -- people are getting exposed to antibiotics in their food and water because of practices at the farm so that the CDC did a survey in 2010. There were 258 million courses of antibiotics prescribed in the United States in that year.
BLASER
That's five courses for every six people in the United States, enormous antibiotic pressure on our microbes. And we've been concerned about the critical time in early childhood when babies are developing. So we began studies in mice to give mice antibiotics or not and see what happens. And in studies that we published a co
Why The Overuse of Antibiotics May Be Linked To Asthma And Obesity
The development of antibiotics in the 1940s ushered in a golden age of medicine. Bacterial infections and illnesses that were commonly fatal became treatable. But researchers now say the overuse of antibiotics has disturbed the natural balance of beneficial bacteria in our bodies. New studies indicate that some diseases - including obesity, childhood diabetes and asthma - may be on the rise because we have upset the delicate equilibrium of microbes in our gut and on our skin. In the next hour, Diane Rehm talks with two leading medical experts about this new research.
Guests
Dr. Anthony Fauci: director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
Martin Blaser: director, Human Microbiome Program at NYU. He is author of the book, "Missing Microbes: How The Overuse of Antibiotics is Fueling Our Modern Plagues." He is the former chair of medicine at NYU and president of the Infectious Diseases Society of America.
*******************************************************************************
MS. DIANE REHM
Thanks for joining us. I'm Diane Rehm. More than 70 percent of all the cells in the human body are not human at all. They're microorganisms or bacteria and other types of microbes. But researchers say the overuse of antibiotics is killing off some of the good bacteria and may be linked to the rise of some diseases.
MS. DIANE REHM
Here with me to talk about these new studies, Dr. Anthony Fauci of the National Institutes of Health. Joining us from a studio at NPR in New York, Dr. Martin Blaser at the Microbiome Program at New York University. You're welcome to be part of the program. Join us by calling 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Dr. Fauci, Dr. Blaser, welcome.
DR. ANTHONY FAUCI
Thank you. Good to be here.
DR. MARTIN BLASER
Thank you. Good to be back.
REHM
Good to have you both with us. Before we start on our discussion about antibiotics and the concern with overuse, Dr. Fauci, let me ask you about the discovery of decades-old smallpox vials found in a storage room at the NIH campus in Bethesda. What in the world were they doing there?
FAUCI
Well, this is a multi-decade old specimens that were sealed very, very carefully. They were very likely used -- again, it's still unclear. It's being investigated. Very likely used since it was in an FDA facility that happened to be on the NIH campus, and that, since the FDA has been involved in regulation and standards for things, that it is likely that that material was used to test against reference (word?), what have you. That's just the guess, Diane. We don't know. But it's certainly back decades ago.
FAUCI
Smallpox was kept by laboratories. And then at a certain period of time, everyone gave in their specimens to be destroyed with only two locations, one at the CDC and one in Russia, and at a period of time everyone was asked to look into their freezers for it. So it's very interesting that, just as recently as two years ago, in 2012, the NIH looked at every one of the freezers and had every single principal investigator look at the freezers.
FAUCI
The odd thing about this is that this was literally in a box in a cold room, freeze-dried, that people probably hadn't touched in years and years and years. And the good news about it is -- I mean, obviously, it shouldn't have been there. But the good news is that it was perfectly intact. It was removed, properly taken down to the CDC where it'll be examined and ultimately destroyed.
REHM
So there was no risk to anyone?
FAUCI
No. No, no. There was not.
REHM
And yet this morning, in The Washington Post, some NIH employees are saying they should have been told earlier about the vials.
FAUCI
Right. Well, it was an interesting evolution of the situation, Diane. When it was known that this was there, the most important thing to do was to get it secured and get it out of there as quickly as possible to the CDC who could handle it and do the examination and the destruction. And the -- I believe the reason they were not let known because we wanted to make sure that the secure taking it and putting it where it could be completely safe was done without a lot of fanfare and a lot of publicity. And by the time that was done, it hit the press. And then the press knew about it, and everybody knew about it.
REHM
OK. And one more thing. Since this was actually the second incident in 30 days involving the mishandling, if you will, of a highly dangerous pathogen by a federal agency, the accidental release of live anthrax bacteria.
FAUCI
Right. It -- are you referring to the CDC?
REHM
Yeah, I am indeed.
FAUCI
Yeah. I -- again, I wouldn't necessarily say accidental release. There was -- what it was it was handled in a facility that hadn't had the total type of security -- you know, we have the bio level -- the biosafety level, X, Y, Z, one, two, three, four -- and that it was taken out of a facility and put into a lesser secure facility before it was completely inactivated and that they absolutely picked it up. They approached it in the appropriate way, had the individuals that might have been exposed, and those who might have been exposed, had the opportunity to get on antibiotics and/or vaccination.
REHM
I see. So they, as you say, were flown to the CDC for further testing.
FAUCI
Right. 1
REHM
Now, what happens next?
FAUCI
It get destroyed.
REHM
Totally?
FAUCI
Totally.
REHM
OK. All right. Dr. Blaser, maybe you have a comment on that or not.
BLASER
I do. And it's -- actually, it's a very nice segue into our discussion because the public has mostly focused on bad germs, like smallpox, like anthrax, which are quite real, which are quite bad. But I've become -- after studying bad germs for many years, I've become interested in the good germs, the good bacteria and the question of what's happening to our good bacteria, which in part are a protection against the bad germs. And that's the focus of my book, "Missing Microbes." And I hope we're going to have a great discussion.
REHM
Absolutely. And scientists, as you say, have long been concerned about antibiotic resistance, but your concerns are different. Tell us about your research which you do outline in your book "Missing Microbes."
BLASER
Yes. Thank you. In order to begin, I just have to introduce a couple concepts, the first of which is the Human Microbiome, which you mentioned already, the fact that most of the cells in the human body are microbial. These are the organisms we've lived with since time immemorial. We got them from our moms, and they got them from their moms. And they do good things for us. They help us. They protect us against invaders. They train our immunity. They help us digest food.
BLASER
And what happens is that, in early life, there's a choreography between the microbes and the host. And that allows babies to develop normally. But we're changing that because of a lot of antibacterial practices, antibiotics, Cesarean sections, food additives. Many kinds of things are changing those initial bacteria in life. And our work and the work of other scientists is beginning to provide evidence that that has cost, that that is changing how babies are developing, and potentially leading to some of today's epidemics: obesity, diabetes, allergies, asthma. I could go on. So that's the big idea.
REHM
All right. And, Dr. Fauci, first of all, explain what is meant by good bacteria and bad bacteria.
FAUCI
Well, OK, so I think the simplest way to explain it is the bad bacteria is what we generally refer to as a pathogen or something that could make you ill under certain circumstances. What Dr. Blaser was referring to as good bacteria are bacteria that are really part of the natural environment in various components of a body, the gut being the one that has, you know, the most dense occupation by microbes, particularly bacteria.
FAUCI
And when we refer to good bacteria, we refer to bacteria that do things that Dr. Blaser has referred to. For example, there are bacteria that are very important in the evolution and the development of your normal immune system, the kinds of stimuli that they give. And, number two, it creates an environment that actually protect pathogens from actually overcoming, in a micro-environment way, the bacteria that are essentially protecting you.
FAUCI
They also are important in metabolic processes. They help you digest your food. They provide certain materials, metabolites that are very, very important. And also, they provide a protection against aberrant responses that you might not want to have in your gut. And sometimes what happens is that when you get imbalance of this type of protective mechanism, you can get diseases, like inflammatory bowel diseases, things like that.
REHM
Indeed. All right. And, Dr. Blaser, you mentioned obesity. You mentioned asthma. Talk about the new research specifically as it relates to antibiotic use and obesity.
BLASER
Great. Thank you. The first thing I want to mention is that antibiotics are miraculous. When people are really sick with infectious diseases due to bacteria, there's nothing like it. And to not use antibiotics would be a grave error. Antibiotics can be lifesaving and important. Nevertheless, because they are so effective, we doctors have been using them more and more and more. And we're also -- people are getting exposed to antibiotics in their food and water because of practices at the farm so that the CDC did a survey in 2010. There were 258 million courses of antibiotics prescribed in the United States in that year.
BLASER
That's five courses for every six people in the United States, enormous antibiotic pressure on our microbes. And we've been concerned about the critical time in early childhood when babies are developing. So we began studies in mice to give mice antibiotics or not and see what happens. And in studies that we published a co
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