Overusing Antibacterials Seems To Be Contagious...

Green: Money and Sustainability Working Together Part 8 of 10: Antibiotic Abuse

tl;dr: We are overusing antibacterial and antibiotic products.

Because sustainability is holistic, almost every aspect of society should be examined to ensure that we are acting in the most responsible ways possible. While I have pointed out several ways that the average American is incredibly irresponsible when it comes to sustainable consumption - including excess electricity usage, selecting the worst options when it comes to transportation, willfully wasting finite water resources, etc., there is a consumption that is problematic not because it doesn't consume limited resources faster than we should, but rather because it is making that resource less and less effective. The resource I am talking about is antibiotics and antibacterial products.

We are overusing products that either eliminate or limit the impact of bacteria, and this is a serious problem. Why is this such a big issue that a sustainability consulting firm is blogging about it? Well, it's because of three reasons:

1. In 2021, the US spent $4.3 trillion dollars, or about $12,900 per person on healthcare. We spend at least 40% more on healthcare than any country in the world.

2. $345 billion was spent by state and local governments on healthcare, or about 10% of general spending. Some of this spending is avoidable by using preventative measures that are not being adopted on the municipal level.

3. 2.8 million Americans are infected by antibiotic-resistant bacteria, and 35,000 people die every year. This number will go higher.

Simply put, we cannot afford to keep spending more and more money on healthcare. It isn't sustainable at current spending levels, so if the costs continue to trend upward, it will dramatically weaken our financial outlook. Our national healthcare situation is a very complex issue with an unbelievably large amount of contributors and factors that have created the hot mess that we have today. I am focusing on the issue of antibacterial usage because that is one of the most dangerous yet also one of the most simple to address.

Antibacterial products were already overused before the COVID pandemic, and have exploded in popularity afterward. Today, products that have "antibacterial" properties range from the standard soaps, lotions, and disinfectants to more esoteric things like toothpaste, garbage bags, plastic wrap, textiles, and carpets. The most common antibacterial compound found in all of these products is triclosan. According to the CDC's Fourth National Report on Human Exposure to Environmental Chemicals, triclosan was detected in the urine of nearly 75% of all the people tested. If that isn't an indicator of overuse, I'm not sure what is. Unfortunately, because there are loose interpretations of what is considered an antibacterial product, there are situations where there is enough triclosan present so that the company can claim that it is antibacterial, but not enough of it that it makes any real difference. More and more studies are indicating that what ends up happening is that surviving bacteria just become increasingly resistant to triclosan, which will create a very big issue in the not-so-distant future. This issue is called AMR, or Antimicrobial Resistance, and health organizations are becoming very alarmed about what the future holds. The Australian government issued a pretty terrific video about AMR, which you can enjoy here.

Overusing or improperly using antibacterial products is only half of the microbial issue. The other part is antibiotics. Antibiotics have saved countless lives, at least numbering in the hundreds of millions over our history. Although Alexander Fleming's discovery of penicillin in 1928 opened up an entirely new world of deliberate usage of these incredible compounds, ancient Egyptians were using antibiotics when they put mouldy bread on wounds or used other plant extracts to treat ailments. Penicillin is the most common and most powerful antibiotic used today, but other common antibiotics include tetracycline, cephalosporin, fluoroquinolone, and rounding out the top 5 antibiotics currently used, lincomycin. The big problem with antibiotic abuse is that they are improperly used as a generic solution to the anti-infectant issue. Athlete's foot is a fungal infection, so an antibiotic will do absolutely nothing to get rid of it. The flu and COVID are viral infections, which means these maladies also won't be conquered by antibiotics, even though many of us will certainly try. You might not have been aware that a sore throat, a common symptom of illness, is more likely to have been caused by a virus than bacteria. Antibiotics are not the cure-all for our ailments, and we need to stop treating them like they are.

Antibiotics are the indicated and correct treatment for many illnesses, which is why they are so popular. Surprisingly, among the most common uses for antibiotics is acne. While no one desires an acne breakout, we're using the only tool that we have for bacterial outbreaks on something that is nowhere near life-threatening. Just as antibacterial products increase bacterial resistance, so does overusing antibiotics. Can you see the problem of overusing antibiotics for cosmetic issues like acne or improperly using them for viral, fungal, or protozoal infections?

So how do municipalities address AMR? Well, it should not surprise you that most small towns and cities do not think about this one bit. Much of the healthcare system has been privatized or is being provided by a university system. Local government spending has been largely dominated by COVID prevention and vaccination attempts in recent years. This actually could be a catalyst for launching new sustainable programs that have a direct correlation to these efforts, but unfortunately, many municipalities are either running out of and/or cutting funding for healthcare services now that COVID is over (please read with sarcasm).

Greenheart's answer to the over usage of antibiotics and antibacterial products is to introduce a broad portfolio of low-cost solutions that are community-based. One of the greatest preventers of illnesses is vaccines, and a mobile vaccination clinic (think blood donation buses but for vaccines) could facilitate deeper participation in vaccination in neighborhoods that don't have access to these services. At Greenheart Partners, we are working on some initiatives that would blend the use of heat and UV light in a direct-to-consumer program using non-perishable food items as the preferred payment for disinfectant services that would then be donated to local food banks.

We are also looking at more homeopathic remedies that have existed for thousands of years. Garlic has been recognized for its preventative and curative properties since prehistoric times. Honey, ginger, and echinacea all have proven antibiotic benefits. There are many situations where the first step of treatment could be natural ingredients like the ones mentioned, and only if the problem gets worse do we introduce prescription antibiotics. Many of you have seen little libraries pop up around certain neighborhoods. They often look like birdhouses, and people are free to deposit or take books that are of interest to them. Why not use the same concept and instead of books, have containers of honey, garlic, and other natural products inside them?

The lesson that we seem to have completely rejected during COVID is the practice of wearing masks. Many East Asian countries have been using masks for decades because it is considered rude to be sick and potentially infect others. Any time someone is not feeling well, the mask goes on. Sadly, in the US, many people made it political and considered wearing a mask to be the most un-American thing you can do, and that is one of the main reasons why the US had far more COVID deaths than any other nation. The absolute best tactic for local governments to address sustainable health practices is to promote and normalize mask-wearing. The good news is that many towns have massive stockpiles of masks, so the cost of making mask-wearing a common practice is much lower than it could be.

Once serious effort is actually directed toward AMR, I believe that creative and sustainable solutions will explode all across the country. Surely we cannot be the only ones thinking of solutions that address this issue on a local government level. Innovation and ingenuity can flourish with the right guidance. After that, sharing what works and also not being afraid to share what doesn't will enable many municipalities to take a proactive, cost-effective approach to reduce AMR risk for their residents. AMR is just one of the challenges we face regarding health and well-being. In the field of sustainability, public health is so important that it is literally the third Sustainable Development Goal provided by the UN. There are few things more unhealthy for our society than to be incompetently reactive when it comes to overusing antibiotics and the sooner we realize that antibiotics aren't the one size fits all solution, the safer we will be in the long run. When all you have is a hammer, everything starts to look like a nail, and that is how we become screwed.