Recently Vinny Burgoo encouraged me to write an article on the risk posed to mankind by the rise in antibiotic-resistant infections. The presupposition would be that this is yet another of those risks that is actually rather serious but far less notorious than the old chestnut of climate change. It’s not a subject with which I have any familiarity, and so to meet the challenge I was going to have to do quite a bit of research. Unfortunately, my studies were to be cut short because, rather than comparing the two risks, the very first paper I consulted firmly attributed the first risk to the second: Growing antibiotic resistance will, in fact, be the inevitable consequence of climate change. So you can just add it to the list of evils that are set to befall mankind as a direct result of its love affair with fossil fuels.

The author is an MD, and the reasons he proposes for a climate-induced growth of antibiotic resistance are many and varied. They range from the treatment of lung damage caused from forest fires, to an increase in sewage-related disease resulting from flooding. Drought also gets a mention because this would cause people to huddle ever more closely around the dwindling water supply, thereby encouraging increased transmission of disease. You might think the last-mentioned example to be rather far-fetched, but this is as nothing compared with the author’s take on the effect that warming can be expected to have on his fellow doctors:

“Another underexplored consequence of higher temperatures is the effect it will have on human behavior, including prescribers, as higher temperatures increase irritability and reduce critical thinking. Telemedicine, increasingly used for all types of medical encounters because of the COVID-19 pandemic, has been associated with increased unnecessary antibiotic prescriptions (visits unrelated to the COVID-19 pandemic), which may be a result of time pressure as visits are shorter when antibiotics are prescribed and patients are more satisfied. As increased use of unnecessary antibiotics and local prescribing practices are known risk factors for antibiotic resistance, the association between temperature and behavior could have significant ramifications.”

Just to be clear, an MD is saying here that climate change is going to make doctors so hot and bothered that they are likely to prescribe antibiotics just to get you out of their surgery, or off the phone. This, it is predicted, will have ‘significant ramifications’ for the growth of antibiotic resistance. We are going to see a lot more death and destruction just because doctors are going to get more irritable! I think we can all look forward to the BBC’s coverage:

They said that Dr Shipman was a 1 in 100 years event. Worryingly, however, attribution studies have shown that this sort of extreme behaviour was not possible without climate change and such events are going to get much more frequent.

Intrigued by the above, and somewhat concerned for my future medical care, I decided to investigate the paper’s author, a certain Jason P. Burnham MD, only to discover that his pet likes include ‘sci-fi and speculative fiction’.

I’ll say no more.

24 Comments

  1. Great catch.
    Fanaticism seems to be a form of narcissism. This nonsensical paper exemplifies the idea:
    A climate fanatic has to put the faux climate crisis at the center of everything. The self-importance they get by being able to manipulate and command people by way of the object of their obsession, no matter how tenuous the connection to reality, the most important thing.
    In the Gulf Coast region of Texas it actually gets pretty hot. The high humidity makes the heat of a given temperature more intense. The largest medical center in the United States, some say the world, is in Houston, Texas. Today’s expected high for Houston is 93oF, with 60% humidity. Literally thousands of doctors work there, along with a total of over 106,000 employees.
    Now where this kook climate witch doctor might be remotely accurate is if he and his fellow fanatics were to succeed in deconstructing the modern world and replacing it with their anti-scientific dystopia low energy nightmare, then yes: millions upon millions will die. Due to the “climate crisis” that is the manifestation of the mental health crisis at the heart of the climate obsession.

    Liked by 1 person

  2. This is great fun, but on a more serious note, I would urge everyone to read the paper that John has linked to. It seems to me that the introduction alone would sit very comfortably in the Guardian, for instance.

    This may also be of interest:

    https://magazine.metaphorosis.com/authors/2020/it-came-from-jason-p-burnham/

    “Jason P. Burnham’s story “Revitalized” was published in Metaphorosis on Friday, 3 April 2020.

    The inspiration for this story was climate anxiety and a general fear for our world and our species. Since 2016, the constant bombardment of daily desperation has worn on me. I worry constantly about what the future might be like for us and for our children, particularly the disadvantaged ones who will be the first to suffer the effects of progressive global catastrophe.

    This story takes place in one possible future, wherein we have obliterated society as we know it. The Orwellian Big Brother exists (the Resource Engagement Officers), but their surveillance serves to identify and control clean water. This focus lines the pockets of their wealthy puppet masters. By keeping absolute control of clean water during a prolonged global drought, they keep all the cards, hold all the power. The REO doles out water to the plebeians as they see fit, also enforcing water larceny punishment with extreme malice. This, of course, is untenable to those underfoot. Revolutions have and will continue to occur, but are not successful. The story’s desperate hopelessness finds its origins in this world.

    One of the most unsettling parts of this future scenario is that it isn’t that far off for many parts of our planet. Already marginalized groups face water and food scarcity on a daily basis. Most of us have never seen it, nor will, but it is there. Their voices are never heard. There could be a Cenessa out there right now being killed over a pittance of [insert life-sustaining resource here].

    I hope that we can avoid this future and change our present so that the Cenessa’s of the world never face the label waterlarcene.”

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  3. Mark,

    Thank you very much for taking the trouble to track down an example of the good doctor’s ‘speculative fiction’.

    Anyone who does read Jason Burnham’s paper will see for themselves that he is a fully signed up climate activist with a passionate concern for social justice. The antibiotic resistance stuff just seems to have been co-opted for the purpose. It’s as if he asked himself, “As a doctor who specialises in infection, what scaremongering can I contribute to the good cause? I know…”

    What follows is a masterclass in stretching a point.

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  4. never mind “his pet likes include ‘sci-fi and speculative fiction”

    He loves his pet dog – aahaa

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  5. On the original point, I dunno whether there is a potential antibiotic-resistance apocalypse in the wings. I’ve not looked into it in detail. Of course I have seen dozens of alarmist stories about it. But one of my correspondents suggested that antibiotic resistance imposes a general fitness cost on bacteria such that in the absence of the antibiotic, such strains are outcompeted by wild types. That makes sense to me. But it’s one of a long list of things I need to read up on.

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  6. Jit,

    As far as antibiotic resistance is concerned, I’m not sure whether one should refer to ‘alarmism’ or simply ‘alarm’. Certainly, the word ‘crisis’ is often used, as per the following paper (‘The Antibiotic Resistance Crisis’):

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/

    In it you will find the following passage:

    “Many public health organizations have described the rapid emergence of resistant bacteria as a “crisis” or “nightmare scenario” that could have “catastrophic consequences.” The CDC declared in 2013 that the human race is now in the “post-antibiotic era”, and in 2014 the World Health Organization (WHO) warned that the antibiotic resistance crisis is becoming dire.”

    Whatever the scale of the problem, I don’t think there is any reason to believe that climate change is in any way a causative factor. As I understand it, the resistance is as a result of:

    a) Over-prescription

    b) Antibiotics entering the human food chain as a result of agricultural practice

    c) Lack of new antibiotics due to a combination of underinvestment and regulatory barriers

    Nowhere is there the suggestion that increasing temperatures are causing bacteria to develop resistance. Admittedly, any pre-existing resistance will have a greater impact if the level of bacterial infection rises, but that is a different point. Trying to place climate change in the causation chain for the development of resistance is a desperate measure. Dr Burnham’s suggestion that over-prescription will result from climate change is just one particularly risible attempt.

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  7. These fabricated titles to our articles must be toned down.
    I started to read this current article with high expectations that I would be informed about the heat crisis creating a host of crazed physicians; the high temperatures causing them to abandon their Hippocratic oaths en mass and run amok. I know that these tendencies are deliberately curtailed in operating theatres by turning the temperatures way down.
    Oh to be so massively disappointed.

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  8. Thanks, John.

    I was going to add a (d) to your list of causes but it turns out that one of the few things I know about antibiotic resistance might not be true. I used to be annoyed by people who didn’t take all of their prescribed antibiotics, deeming them very selfish for putting the pills to one side once they felt a bit better. But, from 2017 in the BMJ:

    ‘The antibiotic course has had its day’

    The first few paras:

    URL:www.bmj.com/content/358/bmj.j3418

    A complete pre-pub version:

    URL:discovery.ucl.ac.uk/id/eprint/1567708/1/Walker_Llewelyn%20et%20al%20%20BMJ%20Revision%20FINAL.pdf

    The reason given is that there’s no evidence that stopping a course early increases antibiotic resistance but there’s plenty of evidence that the more we use antibiotics the more likely resistance becomes.

    The rapid responses are worth a read – or a skim, anyway. There are lots of them and some are almost as long as the article itself.

    Many welcomed the article but offered pragmatic reasons for not letting patients decide when to stop taking their medicines. Others were more negative, saying the article used wrong methods, wrong science. At least one rapid-responder agreed 100% with the article, this being because he had written the same thing decades ago.

    There does seem to be something to it, even if the authors overstated their case.

    *

    Re temperature and antibiotic resistance, several papers have found a correlation without being able to prove causation. Eg:

    URL:www.ncbi.nlm.nih.gov/pmc/articles/PMC6201249/

    URL:www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.45.1900414

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  9. Well, I stand corrected, Vinny. Maybe there is a suggestion of a causal link between temperature and resistance after all. However, the first paper cited doesn’t do me any favours by conflating two factors in its analysis:

    “…we show that increasing local temperature as well as population density…”

    I’ll have to read the paper more carefully to satisfy myself that the two factors have been properly isolated. Also, the temperature effect seems very modest:

    “…an increase in temperature of 10oC across regions was associated with increases in antibiotic resistance of 4.2%, 2.2%, and 2.7%”

    I wonder about the statistical significance of such results. And I certainly don’t know whether such a sensitivity justifies the conclusion that:

    “…current forecasts of the burden of antibiotic resistance could be significant underestimates in the face of a growing population and climate change”.

    Even so, I clearly need to be more careful before dismissing the temperature effect.

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  10. And, of course, I should have added the kicker statement made towards the end of the study:

    “As previously noted, due to the nature of this descriptive ecologic study, and potential for ecologic bias, we cannot infer causality.”

    Absolutely. So why did they insist on making links with climate change?

    Liked by 1 person

  11. Alan,

    I make no apologies. It’s a cut-throat world and I need to do everything I can to attract attention. Remember, this isn’t about saving the world. It’s about me. 🙂

    Liked by 2 people

  12. ““…an increase in temperature of 10oC across regions was associated with increases in antibiotic resistance of 4.2%, 2.2%, and 2.7%”

    Well I haven’t even looked at the papers. But I’d be pretty surprised to discover that even with very large population samples in different climatic locations (if they are proceeding via real-world data rather than lab simulations), one could unambiguously determine increases in anti-biotic resistance that are down at only 4% or even 2%. What are the error bars on those? Yet at any rate, given that this is across 10oC, and the upper bound of the IPCC range is 4.5oC for the current doubling, which will likely take us up to the end of the century or thereabouts, and of which we’ve already had about 1oC, then also assuming proportionality, I don’t think 1.5% or 0.8% increase of resistance to anti-biotics over the next 60 to 80 years say, is going to be any kind of issue anyone should worry about. This is likely less than the noise on other factors. I think some focus on finding, or if already found some action regarding, the main 2 or 3 social and medical factors that are likely to be several times bigger than this and within 6 to 8 years let alone 60 to 80, would be far more productive than worrying about the tiny ripple that if you stare at it hard enough might turn into a wave long after you’re dead. As to the obligatory ‘current forecasts could significantly underestimate…’ that adorn the end of practically every work predicting CC effects, my usual question is what is so uncertain about the science that it could be so significantly underestimated in the place? Especially given that we are generally asked to believe in the accuracy of the X, Y, Z percentages / units originally quoted. What is the wider picture / other factors that introduce this significant uncertainty, and if they’re not bounded how do we know which direction they’ll work in? In this particular case are such factors explained? (kind of rhetorical question, I don’t need anyone to answer it and I can’t be bothered to read the papers. But if someone already has then feel free to say this is or isn’t covered).

    Liked by 1 person

  13. Andy,

    I share your concerns regarding the study’s statistical analysis but I too have yet to read the paper carefully. I’ll try to find the time over the weekend. In the meantime, we need to consider what science, if any, may be behind a climate related increase in antibiotic resistance, i.e. what are the possible mechanisms. I think we can dismiss Dr Burnham’s mad doctor hypothesis quite easily, but he does mention a few other possible mechanisms that could, perhaps, be taken seriously. In his study, Burnham claims:

    “Horizontal gene transfer, a major mechanism for the acquisition of antibiotic resistance, is increased by increasing temperatures.”

    Unfortunately, as evidence, he cites the paper that we are currently debating, i.e. a paper that demonstrates a very weak effect and admits that no causation may be inferred.

    The only other mechanism offered is through the pollution of water following storms:

    “Nitrogen fertilizers increase antibiotic resistance and therefore, floodwater pollution by nitrogen fertilizers during severe flooding due to climate change will increase antibiotic resistance. Eutrophication, which can be worsened by flooding, increases antibiotic resistance and can lead to dissemination of resistant pathogens and antibiotic-resistance genes.”

    Similar statements are made with regard to heavy metals:

    “…metals in soil are known to increase antibiotic resistance.”

    Finally, there is this:

    “Microplastics increase gene exchange in bacteria in water sources, which could lead to increased dissemination of antibiotic resistance. As the climate warms, one can envision a nightmare scenario in which Vibrio species increase in prevalence and range due to oceanic warming, become more antibiotic resistant due to microplastics, and lead to outbreaks of antibiotic-resistant cholera and necrotizing fasciitis.”

    The rest is just about making a case for increases in microbial infection in general and, by implication, antibiotic resistant infection in particular.

    Liked by 1 person

  14. John, thanks for the extra info. Seem plausible or at least possible contributions, albeit some are likely modest. But from this information there appears to be no case that these contributions would be significantly let alone scarily worse given an IPCC worse-case scenario of ~3.5oC extra temp over the next 80 years. If any such contributions are eventually proven to be a major problem, then reducing metal or microplastics or fertilizer pollution would be the things to concentrate upon (all of which probably have much larger reasons to work upon anyway rather than their contribution to anti-bacterial resistance), not worrying about the potential incremental increase of such factors due to climate-change. With a driver of less than 0.05oC per year worst case, this must be vanishing. If the pollutants are really a problem, by concentrating on CC we’d all be dead of bacterial disease long before it could make a difference.

    I once had to research a little about horizontal gene transfer, once again I seriously doubt that increase in temp due to CC will make a blind bit of difference. The largest factors are likely the availability of the chemical enablers that facilitate this process, which we may be altering in nature via our industrial output (but whether to make it better or worse is the question). Given that needful processes in nature rely upon this mechanism, we probably better hope we’re not making it worse. But anyhow, given that there are already lots of very hot places in the world where, if the proposed issue is truly a problem, it will already be working overtime, we should easily be able to detect the increased production of resistance in such places (the factors of industrial process now exist in many hot places). (And given too that bacteria which have become resistant to anti-bacterial agents can spread, we will already be experiencing this resistance far outside the places where it originated). As due to CC the poles are meant to warm much more than the equator, there wouldn’t be much increase in the worst places where this process must already be occurring.

    There are plenty of reasons to worry about pollutants and their many effects. But hanging this particular effect on CC seems like a huge stretch to jump on a bandwagon. If these issues are a significant problem, they’d be a problem in their own right that needs no PR amplification from 0.05oC a year.

    Liked by 1 person

  15. The Telegraph informs me today that “killer doctors” were not so far from the truth. Documents have emerged that indicate that the NHS proposed that treatment was to be refused for elderly patients (>70) and “end of life” pathways were to be offered instead. This probably explains why my hospital bed had a DNR notice above it, and why my wife was told that I would not be moved to an intensive care ward if my condition deteriorated. Nice to know.

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  16. Alan,

    That’s right, but I’m not sure about the ‘documents have emerged’ bit. I remember, not so far into the pandemic, coming across the NHS guidelines for determining the appropriate course of treatment for Covid hospital cases. It was a scoring system based upon medical history and age. If you scored above the threshold you were destined to be placed on the ‘end of life’ pathway. I performed the calculation and determined that I was one point short of the threshold.

    This wasn’t a secret document, it was part of the public domain stuff you could access on line. I forget the URL though.

    Anyway, since then I have been placed on further medication that takes me over the threshold. As you say, nice to know.

    Liked by 1 person

  17. “This probably explains why my hospital bed had a DNR notice above it…”

    Whatever the NHS guidelines say, I though that this was simply not legal without the patients permission??

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  18. Andy,

    Okay, I’ve read the study more carefully now, and the following has emerged:

    Firstly, in the body of the report, statistical significances are quoted. Furthermore the authors do appear to have taken steps to isolate temperature and population effects:

    “After adjusting for acquisition source, prescription rate (available for a subset of tested antibiotics), population density, and laboratory standard, we found that a 10 °C increase in minimum temperature across regions was associated with an increase in antibiotic resistance of 4.2% (p<0.0001), 2.2% (p<0.0001), and 2.7% (p=0.21) for E. coli, K. pneumoniae, and S. aureus, respectively.”

    Secondly, the authors seem to think that the effects are significant enough to raise concern:

    “Based upon our findings, a 10oC increase in temperature, a conceivable scenario for parts of the United States by the end of this century, could yield additional increases in resistance on the order of 10% for certain antibiotics … If the relationship between minimum temperature and antibiotic resistance is indeed present and increasing over time, this could support a more rapid progression towards a ‘post-antibiotic era’.”

    Finally, the mechanisms are still a matter for conjecture:

    “While the mechanisms underlying the observed associations between resistance and temperature require further elucidation, several hypotheses are proposed.”

    The authors proceed to offer three possibilities, including:

    “…potential temperature effects may be rooted in more complex factors (e.g. behavioural, social) occurring across humans, animals, and agriculture/environment, as embodied by the OneHealth perspective.”

    The bottom line remains that this is a study that measures correlation and so is significantly limited as causal analyses go.

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  19. John surely if resistance of up to 10% to some antibiotics for a temperature increase of 10oC did occur, this would not be controversial or even new information. It should be a well-known fact that, within the USA say, resistance would vary significantly between, say Idaho and Nevada, or between winter and summer, or even between hot and mild days. How could such variations have been missed?

    Liked by 1 person

  20. Thanks for digging, John. I remain just as skeptical.

    “…a 10oC increase in temperature, a conceivable scenario for parts of the United States by the end of this century…”

    Well apart from the fact that regional downscaling is generally acknowledged to still be very immature, to put it politely, I presume the above could only come from the discredited RCP8.5 or indeed worse. Which may be conceivable, but then lots of things are conceivable if you bend the needle beyond max. And I presume also that ‘on the order of 10%’ over 10oC, is a an overstuffed pillow for their actual results of 4% and 2% over the very same temperature rise. Plus, it remains the case that unless they’re talking about Alaska, the average rises due to CC will be far less away from the poles.

    But in any case, even if we take everything they’ve written as gospel, including everything turned up to 11 and all causation as primarily CC, they’ve *still* only managed 10% in a whole eighty years! So in other words, we can completely forget it compared to the other (also, almost certainly way more addressable than global CC) few main issues that are likely to have more than this effect in 8 years, not 80. And if there aren’t such, then this isn’t really a major societal problem compared to many others anyhow. [And of such main issues 1 or 2 could even be *their* issues, the CC worseness of which is irrelevant compared to the immediate action / remedy]. And not to mention that in 80 years, direct genetic manipulation will long since have replaced primitive anti-bacterial resistance; we probably wouldn’t worry about 100% worse let alone 10%.

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  21. Alan,

    Yes, I think that was a point that Andy made. There are already regional variations that do not seem to be troubling anyone particularly. As soon as the variation becomes temporal we are all expected to panic.

    Andy,

    I don’t disagree. Antibiotic resistance is the problem. Not antibiotic resistance slightly exacerbated in a scenario that requires a hugely pessimistic take on climate change.

    Liked by 1 person

  22. Vinny Burgoo: I first read a paper suggesting the same re: antibiotic resistance almost 30 years ago. I have mentioned it to a few people over the years and been told “no doctor could be persuaded of this”. Occasionally I have mentioned the term “selection pressure”…their eyes glaze over.

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