Last week, I came across this article that referred to carbapenem-resistant enterobacteriaceae (‘CRE’) as a “phantom menace.” It struck me as odd, since the article claimed CRE is known as a phantom menace, yet I had never heard that phrase (until the article). Maybe all the cool microbiology kids are freezing me out?
Well, it turns out there’s a rebranding effort going on (boldface mine):
“I think naming has a real function,” said Lance Price, director of the Antibiotic Resistance Action Center at George Washington University’s Milken Institute of Public Health. “People don’t want us to use terms like carbapenem-resistant Enterobacteriaceae producing OXA-48-like carbapenemases, and we need people to pay attention.”
He calls the news that a superbug gene recently found in China that has already infected someone in Denmark the worst he’s heard in a long time.
The term “Phantom Menace” conveys the way “this bug and others of its ilk spread around the world unnoticed until they reach a critical mass,” Price said.
I would have thought ‘superbug’ would have conveyed the same point. But I think this is actually an incorrect description, since there’s nothing phantom-like about CRE. We know it’s a problem–and it’s a walk up to you, kick you in the nuts and then whack you in the head with a two-by-four kind of problem. We knew it was a problem when we discovered it.
Rebranding isn’t the issue here: policy makers do recognize this as a problem. Unfortunately, they do very little in concrete terms to do anything about it. Hell, between 2009 and 2014, agricultural antibiotic sales in the U.S. rose 23 percent–at that time, we did know drug-resistant bacteria were a problem.
This problem didn’t sneak up on us, it was recognized while it was happening, but governments world-wide failed to act. It’s too much trouble to impose controls on agriculture and higher standards in clinical care, all the while lobbyists played the ‘we need more study’ card.
Rebranding isn’t going to fix that. Pushing legislators on specific proposals will. (In the U.S., if there were only these things known as political campaigns where one could ask questions of candidates…). We don’t need another report describing the problem, as we had plenty of those fifteen years ago. What we didn’t have is a concrete set of proposals and political muscle behind it (Democratic Rep. Louise Slaughter and the late Sen. Ted Kennedy along with former Republican Sen. Bill Frist tried–and failed. None of them were political lightweights).
Existing public health and medical organizations have to make the problem of drug-resistant bacteria a top priority–and a rebranding won’t do that either.
It does sell newspapers though.
For the record, I didn’t coin the term “Phantom Menace” for CRE, but I do like it. Many of the most important superbugs, including CREs, are colonizing opportunistic pathogens (COPs) that spread asymptomatically. Most people carrying antibiotic-resistant COPs aren’t ill, so we can’t prevent them from getting on airplanes using questionnaires or body-temperature monitors. Because of this, COPs move around the world undetected until they infect enough people with compromised immune systems that clinicians finally notice. So while these insidious epidemics are certainly a solid kick in the proverbial jewels, the transmission of CREs is more like a phantom than a two-by-four to the head.
I totally agree that this problem is the result of our inability to enact science-based policies to prevent antibiotics from being abused in livestock production and overused in human medicine. But I would argue that using using terms like “Superbugs” and “Phantom Menace” opens people up to learning about antibiotic resistance and spurs them to advocate for public policies that protect antibiotics and prevent the emergence of the next bacterial version of a badass Star Wars villain.