Introduction
Antimicrobial resistance (AMR) – the resistance of bacteria, parasites, viruses and fungi to antimicrobial drugs previously effective for treatment of infections they caused – is now a serious worldwide threat to public health. Dr Keiji Fukuda, WHO’s Assistant DirectorKGeneral for Health Security recently said that AMR is occurring in every region of the world, potentially affecting anyone, of any age, in any country. He warned that, if measures were not taken immediately to counter AMR, the implications will be devastating. Without urgent, coordinated action by many stakeholders, the world is headed for a postKantibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill’.a In the light of this, this paper describes how the sector of Complementary and Alternative Medicine (CAM) can make a significant contribution to reducing the problem of AMR.
The CAM perspective on health and disease is essentially different from the conventional biomedical perspective. It is not just a difference in the technology and instruments used, but in the underlying paradigms, basic concepts and philosophical perspective. Although CΑΜ represents a variety of different medical systems and therapies, the CAM modalities have a common denominator, i.e. their individualised holistic approach and their focus on promoting the individual’s health by assisting the person’s innate selfKhealing and healthKmaintaining capacity.
The CAM perspective on infectious disease also differs from the biomedical one. A short retrospective of the different scientific positions in the 19th century on the role of pathogens in infectious disease is helpful to understand this.
The German physician Robert Koch (1843-1910) argued that bacteria are the smallest but most dangerous enemies of mankind. His critic Max Josef von Pettenkofer (1818-1901) a chemist and hygienist, maintained that pathogens infect only the most susceptible (those with poor diet, constitution, etc.) and, proving his point, he drank a large cholera cocktail without falling ill.
In France a similar controversy existed between Louis Pasteur and Claude Bernard. Louis Pasteur (1822-1885), a chemist and microbiologist, took the position that microorganisms infecting animals and humans cause disease. Physiologist Claude Bernard (1813K1878) argued on the other hand that the body becomes susceptible to infectious agents only if the internal balance – or homeostasis as we now call it – is disturbed.
After all, there are billions of microbes and bacteria inhabiting our gut, our blood, in fact our whole system most of which are essential to good health. Pathological bacteria, fungi and viruses take root as disease when the terrain is weakened and susceptible to them. This explains why when a bacterial or viral agent is “doing the rounds,” some people become sick while others remain healthy.
History shows that the perspectives of Pasteur and Koch that focused on combating disease by directly killing germs have prevailed. There is no question that antibiotics have dramatically and successfully reduced illness and death from serious infectious diseases. However, the vital role of the host’s ability to repel invaders based on a properly functioning immune system, has been neglected. In reality, infection is always the result of two factors: exposure to a pathogen and the person’s susceptibility.
This oneKeyed approach which focuses only on the infecting organism is also reflected in research, which has been directed at finding the most potent way to kill the germs, whereas hardly any research investigates ways and means to raise the effectiveness of the immune system.
In fact, both approaches have their merits. In a patient who is seriously ill and affected by highly virulent bacteria, there is no argument, that antibiotics can be live saving. On the other hand, antibiotics do not offer an adequate solution for a patient who has had recurrent infections and taken several courses of antibiotics, because in this case it is the patient’s susceptibility that needs to be addressed.
Lastly there is a growing awareness of the importance to health of the microbiome – the collective genomes of the microbes (composed of bacteria, bacteriophage, fungi, protozoa and viruses) that live inside and on the human body. The human body has about 10 times as many microbial cells as human cells. The microbiome plays an essential part in the immune system protecting us against infection, breaking down food in the digestive system to release energy and producing vitamins and helping in the elimination of waste. What is also now being understood is that antibiotics can have a disrupting and disturbing effect on the microbiome and may be causatively involved a number of the widespread chronic illnesses that currently affect us such as obesity, diabetes and cancer, e.g. a recent study revealed a connection between early antibiotic exposure in infants and the development of a tendency to obesity by the age of threeb. A large populationKbased study carried out in Finland showed a clear statistical correlation between the level of antibiotic exposure in early life and the likely development of cancer later in life.
This growing awareness of the how the microbiome is impacted by antibiotics adds another extremely important reason for why antibiotic use must be dramatically reduced to when they are absolutely essential. It also calls for other ways to treat and prevent illness that support and strengthen the health and resilience of the terrain of the microbiome which is being increasing understood to be so essential to our immune system and health generally.