Don’t let the superbugs bite

But don't despair - we might be struggling but we are not beaten yet.

Evolution continues to be a bitch. Recently scientists gathered in Kensington, London, to have a good moan and to plan what can be done about it. “Superbugs and Superdrugs” is a great title for a meeting. Unfortunately the bugs seem to be more super than the drugs.

While that meeting went on, the US Centres for Disease Control and Prevention (CDC) issued a warning that we are entering a “nightmare” era. The CDC’s problem is a killer bacterium known as CRE, which is spreading in the US. Some strains of CRE are not only resistant to all antibiotics; they are also passing on that resistance to other bacteria, creating drug-resistant strains of E coli, for instance. On 11 March, Sally Davies, the UK government’s chief medical officer, asked the government to add the superbug problem to its “strategic risk register”, which highlights potentially catastrophic threats to the UK.

For a while, it all looked so good. When scientists discovered penicillin, then ever more weapons for our antibiotic arsenal, it seemed that bacteria had been defeated. The problem is, they fought back.

For all the worry over CRE, perhaps nowhere is this antibiotic resistance more evident than with tuberculosis. In the west, we won the war on TB so convincingly that receiving the BCG vaccine against it – once a waymark in British childhood – is no longer routine. Only in certain inner-city communities where migrant populations increase the likelihood of encountering the TB bacterium are children routinely immunised. However, in 2011, the World Health Organisation marked London out as the city with the highest TB infection rate in western Europe.

Many resistant bacteria originate in hospitals, where pharmaceutical regimes kill off the normal strains, making space in which bacteria that are naturally resistant can proliferate. Yet you can’t always blame the drugs. Research published at the end of February shows that drug resistance can arise even when the bacteria have never encountered a chemical meant to kill them.

In the study, E coli bacteria were made to suffer by exposing them to heat and restricting the nutrients in their environment. According to conventional wisdom, this should have kept proliferation in check – but it caused a spontaneous mutation that made the E coli resistant to rifampicin, one of the weapons in our antibiotic arsenal. What is worse is the observation that there was good reason for this mutation to arise: it made the stressful conditions more survivable. Bacteria with the mutation grew much faster.

Bacteria are survivors – if they can’t magic up a spontaneous mutation, they’ll pick one up in the street. A sampling of puddles in New Delhi showed that almost a third contain the genetic material that allows bacteria to produce an enzyme that destroys a swath of antibiotics. The NDM-1 gene is particularly evil. Its tricks include forcing itself into gut bacteria such as E coli that are incorporated into faeces; as a result, the resistant strains travel between hosts with ease.

Many infections involving a bacterium carrying NDM-1 are untreatable. GlaxoSmithKline is reportedly developing a drug to deal with it but it is years behind the curve. In the autumn, an EU project to mine the seabed for so far undiscovered antibiotics will start up, but it will take years for that, too, to bear fruit.

Let’s end on a positive note. Superbugs might be evolving in fiendish ways but they’re doing it blind and they’re up against evolution’s greatest invention – the human brain. We might be struggling but we are not beaten yet.

The EHEC bacteria. Image: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 25 March 2013 issue of the New Statesman, After God

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Understanding anxiety – my inside view of a debilitating disorder and how to control it

Following a number of recent anxiety attacks, I set out to learn why this happens to me.

As I stepped out of the office one evening after a routine day at work, I found myself glued to the floor. Legs bolted, knees quivering, heart racing – I was cemented into the ground by something paralysing.

I had to work out what was happening, and fast. Was a looming deadline holding me back from leaving? Was an unread message on my phone stopping me in my tracks? Perhaps fatigue had set me on edge. Or that passerby with an unsettling stare caught me off-guard. Maybe it was something more surreal; maybe a sense of dread had taken over, as I started to perceive each onlooker as a potential source of fear. Whether it was all of those things or none of those things, I eventually realised that the sticky situation I had found myself in was the onset of an anxiety attack.

Anxiety is a disorder of varying forms. People may be affected by generalised anxiety disorder – characterised by excessive worrying (often without an identifiable trigger), a specific phobia or panic disorder, in which terror can overwhelm a person without warning. The sufferer experiences physical and mental symptoms of distress that include a feeling of restlessness, shortness of breath, and agitation, exacerbated by the uncontrollable spiralling of their thoughts, which can often be self-deprecating and debilitating.

I had been in this situation before. The rising tension makes for an overwhelming and often paranoid experience, but my awareness of the fact that I was indeed having an anxiety attack was enough to know that this feeling wouldn’t persist for an indefinite amount of time; it would eventually pass, as all anxiety attacks do.

After roughly half an hour of concentrated breathing, conscious changes in thought patterns and eventually moving to a quieter spot, I had managed to calm down.

Though I had managed my anxiety attacks before via similar means, I was curious to know – what exactly was happening during my attacks? What can specifically be done while they’re happening? And could the panic and jitters of anxiety ever be beneficial?

The biology of an anxiety attack

The biological basis of an anxiety attack is tied to the actions of the body’s autonomic nervous system – a division of our nervous system that, without conscious control, regulates our bodily organs and systems.

When stimulated, the autonomic nervous system kicks into gear, causing the release of adrenaline into the bloodstream. And that’s when things flare up.

Pulses of adrenaline are produced in response to a stimulus  one that causes the body to kick into a defensive fight-or-flight mode. With anxiety, these stressful stimuli include excessive thoughts, heightened worries, trauma triggers and objects posing as threats. Even subconscious phenomena have been proposed as provokers; it is known that sufferers may wake up from a night’s sleep in a bout of panic. The stimuli add to the existing level of distress, making a person’s breath shallower, often inducing profuse sweating, and initiating a dark foreboding, all in the space of a moment.

Combating anxiety

According to the NHS, there are a number of techniques that can be employed to manage the distressing symptoms of an attack. Staying in a fixed spot, deep breathing and actively issuing a challenge in your mind to the fears on which you may be fixating are crucial things to do in the immediate stages. I wasn’t sure whether in my latest case I had done this instinctively or out of habit from past struggles. Either way, the methods were relieving.

The end of an attack is reached through an eventual depletion of adrenaline, which tells the body that it no longer needs to be on high alert. It brings with it tiredness but a welcome passing of the crisis. However, without a longer-term, pragmatic approach to tackling the disorder, it’s almost certain that an individual will face another intense period of anxiousness. So how should anxiety sufferers manage the issue over a longer period of time?

This is where therapy can be an extremely useful form of intervention. Cognitive behavioural therapy (CBT) is the most common form of therapy for the disorder, with research demonstrating its effectiveness in treating the closely related disorders under the umbrella of anxiety. CBT focuses on a reconfiguring of thought patterns, shifting perceptions and a redefining of negative sources of fear.

Recently, I spoke to David Potts, a CBT therapist, to discuss how therapy can be of benefit. He said: “In therapy we'd work on specifics. It would involve telling yourself what the triggers are. Often people have very negative views about what's happening to them [during an attack]; they'll think I'm having a heart attack or I'm going to die and those kinds of thoughts form a vicious cycle and the panic gets worse.”

According to Potts, being attuned to the occurrence of an anxiety attack is essential in taking active steps to overcome it. It can facilitate the process of calming down, allowing the person in the midst of an attack to separate the thoughts in their mind from the reality of a particular situation.

Therapy can also offer an individualised approach to understanding a person’s anxiety. Potts told me: “Often, from a therapy perspective, we are considering what’s happening to them [the patient] in their lives that lead them to be more anxious than other people. It could include things they’ve experienced in childhood, it could be ways that families are, or it could involve ways that they’ve learnt to manage different emotions.”

Beyond therapy, medication is available to aid anxiety. Appropriate to a disorder that can affect people in various ways, there are different types of medication. Selective serotonin reuptake inhibitors (SSRIs) are the most common form of medication. SSRIs are antidepressants that seek to increase levels of serotonin in our brains – a neurotransmitter thought to be central to the maintenance of mood. Other drugs available (in case of side effects from SSRIs) include serotonin and noradrenaline reuptake inhibitors (SNRIs), pregabalin and benzodiazepines. Though alleviating, medication is something that should supplement forms of therapy, as the pills themselves won’t solve the social triggers and problems that cause anxiety.

As people have increasingly moved towards holistic lifestyles, emphasis on exercise and dietary intake has been elevated. Eating healthier has been linked to reduced symptoms of anxiety, while exercise has been proven to reduce levels of stress in the long run. Reduced stress equates to a reduced risk of an anxiety attack.

Changes to the brain from exercise have been documented too. Researchers at Princeton University found that physical exercise generates excitable new brain cells in the hippocampus – an area of the brain involved in emotional responses. Though the excitability of the neurons would generally be unfavourable (priming the brain for anxiety), researchers found that the impact of exercise was one which had a calming effect, as the exercise was able to switch off the newly-generated, excitable neurons at times when they weren’t required.

When just a ten-minute walk has been shown to offer benefit, there seems to be very little to oppose the implementation of exercise as a form of therapy for anxiety.

Living with anxiety

Perhaps surprisingly, anxiety can be harnessed as a tool of empowerment for some. When it occurs at a smaller scale, it can serve as an informative warning against stressors, and help an individual focus and pinpoint their attention.

As a sufferer, acknowledgement of anxiety seems to be the key to unlocking the resources that can dull its impact. With carefully paid attention, responsibility and mindfulness, the waves of anxiety threatening to drench you can be reduced to smaller, more manageable ebbs and flows.