On March 13th you published a letter written by reader Lois Raimondi Munchel titled "Stop the spread of deadly bacteria in nursing homes." The letter was timely. It should send alarm bells ringing not only through the hallways of our nursing homes but also through our hospitals and our operating rooms.

Not too long ago, at the NIH hospital, deadly Klebseilla bacteria resistant to all antibiotics, were found. Fifty percent of patients with this bacterial infection will die. These lethal, resistant bacteria have appeared in hospitals up and down the East Coast. While we are blithely using antibiotics in agribusiness, the astute bacteria have been mutating and defying our sense of superiority — that man can conquer the microbial world with his intelligence. It seems that microorganisms of all sorts have far more innate intelligence than we do, and we are not up to the task of keeping up with their magical mutating abilities.

Why are we not up to the task of keeping these microorganisms in check? One reason is the American character. In my own practice of medicine, I have several patients who are demanding and impatient. Every time they catch a cold they want an antibiotic. Medical illiteracy is rampant, and explaining to patients the intricacies of antibiotic resistance and how antibiotic misuse plays a role in causing and spreading deadly organisms is a task so arduous that most doctors give up without even trying. These are trying times for physicians. Their pay is down, their work is up and time is of the essence. It is so much easier to capitulate and write the antibiotic prescription, especially when a sick patient threatens to leave your practice and go to an urgent care place down the road or to an on-line consultant and achieve what he wants with less hassle. And that is the key. Most Americans want what they want as fast as they want it, if not faster. That character is manna from heaven for microbes.

The same impatience manifests itself in other ways. To prevent the spread of bacteria we need to wash our hands several times. Doctors must follow clean practices. Their white coats, stethoscopes, shoes and clothes harbor bacteria. Bacteria lurk in shower curtains, on hospital walls, in hospital sinks, coffee mugs, eating utensils, on bed railings, door knobs and taps. It takes time and wisdom to wash up, wear gloves and sterile gowns and keep articles prone to contamination away from patients.

Doctors are always in a hurry. The American medical system now operates for pure profit. Administrators, many of whom are paid infinitely more than doctors, squeeze the doctors to show more efficiency and bring more money into systems that have become number crunchers, rather than deliverers of quality patient care. Hence doctors who rush from patient to patient to save time and maximize efficiency and profit in order that they may be the darlings of the "Relative Value Unit" business model, don't wash up as thoroughly or as often as they should.

Administrators have also cut back on the cleaning staff. Such staff are paid dismally. Though they are a vital part of every hospital, they are hardly noticed by the upper echelon, treated humanely or thanked for their services. In the old days hospitals smelled of disinfectants and floors were scrubbed clean. These days when you enter a hospital, you hardly ever see a busy cleaning crew and you don't smell disinfectants. Instead you are often faced with the "hospital as hotel" model — you may see a fountain in the lobby, art work hanging in the corridors or an automatic player piano exuding soft strains into the atmosphere. You may see carpets on floors, large mirrors on walls, plants on the wards, computers at every desk, coffee machines and water dispensers.

The "hospital as hotel" model has been great for microbes. Microbes fill every crack, crevice, twist and turn of every unnecessary modern device we find so essential to our daily existence. They multiply there, laughing at our propensity to give them one hiding niche after another, where they can thrive and plot.

The greatest and most immediate threat to humanity is the rapid emergence of antibiotic resistant bacteria. Our government now does not respect science or young investigators and it is loath to fund the NIH which, because it is hurting for money, cannot be at the helm of basic science discoveries that could lead to the development of new antimicrobials. Big pharmaceutical companies too, beaten down by many class action law suits and spurred by greed, are not willing to invest the time or the money required to develop novel medications that will counter antibiotic resistance.

We are at the crossroads and we are the architects of our own microbial sorrows. The war against the microbes is not the Trojan War of the Iliad. It has no end in sight, no soothing auguries and no great big wooden horse to hide the soldiers and win the day.

Usha Nellore, Bel Air

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