Book Review: Overkill

Each square centimeter of skin harbors around 100,000 bacteria, and a single teaspoon of topsoil contains nearly one billion bacteria. The thought of these tiny creatures permeating every aspect of our daily life makes most of us uneasy, even a little queasy. Consequently, Americans spend $540 million on antibacterial soaps, hand cleaners, and detergents each year, and in the past year, more than three hundred million prescriptions for antibiotics were issued in the United States. A study in Pediatrics reported that 50% of pediatricians have been pressured by parents to prescribe antibiotics for sick children, when in doctors' opinions, antibiotics were not medically necessary. After years of misuse and overuse of antibiotics, bacteria are becoming antibiotic-resistant, resulting in a potential global health crisis. The recent increase in the use of antibacterial agents has also been implicated in the growing resistance problem.

While so much of our environment is made up of both good and bad bacteria, we find ourselves focusing solely on the bad bacteria and doing everything in our power to eradicate their existence engaging in overkill and subsequently, bacteria have learned to outsmart our most powerful drugs. Dr. Kimberly Thompson, associate professor of risk analyst at the Harvard School of Public Health and an ACSH advisor, in her new consumer-friendly book, Overkill: How the Nation's Abuse of Antibiotics and Other Germ Killers is Hurting Your Health and What You Can Do About It, acknowledges the growing resistance problem and shows us what we can do about it.

Overkill is a comprehensive guide, which helps readers determine their own personal risks for contracting germ-related illnesses and offers strategies to reduce risks. We must understand that the use of antibacterial agents and antibiotics cannot insure a zero risk that is an impossible goal but we can make choices and take actions that will protect our health and the health of the populace.

The history of germs can be broken into four epochs, shedding light on how we reached our current health situation. First, we lived in the Age of Ignorance, where we knew very little about the cause and transmission of infectious diseases the number one cause of death in 1900 and attributed their existence to evil spirits or an angry God. Then, we moved into the Age of Discovery, where we became capable of killing and controlling germs and infectious diseases, finally understanding the mechanisms of infectious diseases. With the Age of Miracles, we saw the development of new drugs that fought off germs and infectious disease and saved innumerable lives. Currently, we are living in the Age of Overkill, where bacteria are outsmarting our greatest defense: antibiotics. Today, more than 40% of staph infections are resistant to every drug but one, and doctors and microbiologists are beginning to witness staph infections resistant to even this last conventional antibiotic. As reported in the May 7th New York Times, scientists have identified the first cases in the mainland United States of a strain of gonorrhea that is resistant to multiple drugs, including some of the most powerful.

Protecting Yourself with Fewer Antibiotics

Readers may now find themselves questioning how at-risk they are and what they can do to protect themselves. Overkill attempts to provide answers. In a series of fifty questions focusing on personal and family characteristics, current health status, personal hygiene, home care practices, food preferences and preparation, and occupation and leisure activities readers will be able to analyze their own risk factors for infection and assess their personal risk quotient (RQ). If you score a 1, then you are at the lowest risk for contracting a bacterial infection and if you score a 5, you are at highest risk and should visit a doctor at the first sign of illness.

Throughout the rest of the book, your score is used to identify the best approaches you can use to ensure good health. For example, I have an RQ of 2, which means that while I have a relatively small risk of bacterial illness, there are still some changes I can make to my health, lifestyle, and hygiene habits. I live in an older apartment that I don't clean very often, live in a big city, and eat out a little too often. In order to reduce my risk for bacterial infection, I could clean a little more often and eat out a little less.

Dr. Thompson moves on to identify thirty-one common illnesses that are often treated and mistreated with antibiotic regimes. Each illness is described (causes, signs, symptoms, etc.) and followed by prevention and treatment advice for the various RQ scores, advice that can make the use of antibiotics unnecessary. For example, as an avid runner, I often get painful blisters. By reading the prevention and treatment suggestions for RQs 1 and 2, I learn that I should be staying well-hydrated; eating a well-balanced diet, which includes lots of fruits, vegetables, and good sources of protein; upping my intake of essential fatty acids, as found in flaxseeds and fish; and using calendula ointment and a loose bandage to protect my wounds. By following these suggestions, according to Dr. Thompson, I should be able to avoid visiting a doctor and taking antibiotics, which would only increase the likelihood of bacterial resistance to these drugs.

For parents, Dr. Thompson offers four special steps to keep kids healthy: (1) Immunize your child. While there is growing publicity about the safety of immunizations, Dr. Thompson reassures us: "As a risk analyst and parent, I believe that the health benefits conveyed by vaccination far outweigh the risks." (2) Choose a healthy childcare center. (3) Manage your child's environment. (4) Finally, teach your children proper handwashing. Thompson also describes common childhood diseases and how parents should best treat these illnesses without resorting to antibiotics.

It's also important, she argues, to manage our home environment. A 1998 University of Arizona at Tucson study found that the highest bacteria count in homes was found in sponges and dishcloths (7 billion bacteria per average-sized sponge), kitchen faucet handles (229,000 bacteria per square inch), and cutting boards (62,000 bacteria per square inch). Surprisingly, something you might think of as a hotbed of bacteria and germs actually scored low on the germ scale: the toilet. In fact, there is more fecal matter in the kitchen sink than there is in a toilet. Dr. Thompson offers strategies on how to manage these different areas of your home and also gives recipes for safe and effective homemade cleaning agents that you can use in place of current antibacterial cleaning agents.

New Risks, Old Risks

We find ourselves facing new fears and threats on a daily basis. Nine months ago, few of us thought twice about the threat of bioterrorism, but now it looms large in our minds. Following last fall's anthrax scares, nearly 2 million Americans took Cipro as a precautionary measure and now their bodies may harbor antibiotic-resistant bacteria as a result. We should avoid this overkill lest antibiotics become ineffective and the leading causes of death in the past become the leading causes of death in the present.

Instead of buying antibacterial soap, we should learn to properly wash our hands (nearly 80% of infectious diseases are transmitted by touch). Also, we should avoid taking antibiotics for every cold or sore throat. Dr. Thompson offers this reassuring thought: "If you take care of yourself with a nutritious diet high in phytochemicals, plenty of physical exercise, healing sleep, and a minimum of stress, you can stay well and avoid chronic illness to a remarkable degree." The Centers for Disease Control offer these suggestions for reducing risk: frequently wash your hands, get immunized, routinely clean and disinfect home surfaces, use antibiotics appropriately, and handle and prepare food safely. People are always looking for ways to take greater control of their health, and Dr. Thompson's book helps readers do just that.