From hand sanitizers to antibiotics, humans are waging a war on germs. But is that a battle we should be fighting? It looks like our well-meaning attempts to protect against germs and bacteria have toughened them, rendering our strongest antibiotics ineffective. And a mounting body of research suggests that these tiny microbes are not detrimental but rather good for our health. Science writer Jessica Snyder Sachs, author of "Good Germs, Bad Germs," joined us on Tuesday, Oct. 23, at noon, ET, for an hour-long discussion on why germs may be an ally rather than enemy. Read the transcript below.
Jessica Snyder Sachs: Hi all. Thanks for dropping in during your lunch hour.
While the discussion's designated topic is "Can Germs Keep Us Healthy?" I've spent equal time following the researchers who study bad guys such as Staph. aureus (especially MRSA) and Clostridium difficile, a truly nasty bug that can invade when antibiotics knock back our protective bacteria. Besides, the title of my book (out this week—plug, plug) is "Good Germs, Bad Germs: Health and Survival in a Bacterial World." So I'm glad to open things up to the bad and the ugly, as well as the good.
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Miami, FL: What do you think will be the scenario if we continue to kill germs as we do today?
Jessica Snyder Sachs: Talk about getting right to the point!
First, there's the question of sanitation driving immune disorders such as allergies and allergic asthma. On that front, the research suggests that we're reaching a plateau of sorts in the developed world. The skyrocketing increase in allergies and asthma that we've seen over the last century has started to level off.
In terms of the way we currently use antibiotics to kill bacteria, the news is worse. Bacteria are getting drug resistant faster and faster. This makes sense because they accumulate genes for resistance and share their collections with each other. There are salmonella (food poisoning) bacteria out there with genes making them impervious to 15 or more antibiotics—and in a matter of minutes they can share these genes with previously susceptible bacteria. So the bugs are becoming resistant faster than scientists can develop new antibiotics.
Antibiotics are life-saving miracle drugs. But we have to use them more wisely. Moreover, they're short term solutions. Bacteria will always evolve around them. So we need other, longer-term solutions as well.
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Sante Fe, NM: When did research like this start? And when do you think research and public opinion on germs will align, if ever?
Jessica Snyder Sachs: Research on good germs? Over 150 years ago, Pasteur predicted that animals, including humans, could not survive without their beneficial microbes. Many scoffed at him at the time.
Over the last 15 years, Jeffrey Gordon, at Washington University in St. Louis, has been working with germ-free mice to study the varied activities of our intestinal bacteria.
More recently—in just the last five years--immunologists such as Harvard's Dale Umetsu have started deciphering exactly how harmless bacteria CALM the immune system.
Unfortunately, it's taken the terrible crises of deadly, unstoppable infections to wake up the medical community, both in hospitals and out. Doctors are starting to realize that the body's good bacteria have always been our best defense against disease and that antibiotics should NOT be used with a "what can it hurt?" attitude.
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Agoura Hills, CA: If hand sanitizer and antibiotics are causing all these problems, how did they become so commonplace to begin with?
Jessica Snyder Sachs: It's only been 150 years since medical science fully embraced the idea that infectious diseases come from microbes (not invisible "miasmas" floating through the ether). In our zeal to defeat infectious diseases, we started viewing "germs" as synonymous with disease.
Understandably, we were spending little money and attention on studying harmless microbes. The good news is that our understanding of the bacterial world is growing more sophisticated. We're realizing that 99 percent of bacteria DON'T make us sick, but play important roles in maintaining our health.
But I want to add that alcohol based hand sanitizers are NOT necessarily a bad thing. I use them after I've put my hands someplace where hundreds, even thousands, of other people have had their hands that day—like when I ride the NY subways. Especially during the cold and flu season.
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Elk Grove, IL: What motivated you to start writing this book?
Jessica Snyder Sachs: In a strange way, my interest sprang from my first book: Corpse: Nature, Forensics and the Struggle to Pinpoint Time of Death. That book explored the ecosystem of the human body after death—the bugs, plants, and microbes that colonize a human corpse and how their activities can be used to determine time of death. I was likewise fascinated by the ecosystem of microbes that colonize the human body during life—i.e. the Good Germs and Bad Germs.
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Colubmia, MO: The title of your book is "Good Germs, Bad Germs." How do you differentiate between the two?
Jessica Snyder Sachs: Good question. If we want to get philosophical, good and bad are entirely subjective. In the book, I differentiate them as "Good Germs" help keep you health, "Bad Germs" can make you sick.
What's trickier is how to add back the good guys without the bad. No rational person would want to go back to the bad old days of unsanitized water and epidemics of cholera, typhoid, and dysentery. Probiotics are a start, but only a few have been tested and that's been enough to show us that they're not all created equal. If you're going to lay down good money for a probiotic, I'd look for labeling along the lines of "clinically proven to be effective to do WHATEVER."
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Waverly, WV: What is the most important action the ordinary citizen can take to prevent overkill of the beneficial bacteria, while protecting ourselves from the harmful ones?
Jessica Snyder Sachs: Initiate a discussion with your doctor when he or she prescribes an antibiotic.
First, ask whether you really need an antibiotic? Many doctors still tend to overprescribe with a "just in case" attitude, even in situations such as viral upper respiratory infections and uncomplicated ear infections—where new medical guidelines now advocate careful "watching and waiting" before prescribing antibiotics.
Second, if you need an antibiotic, ask your doctor to prescribe one that's least disruptive to your "good bacteria." Again, many doctors needlessly reach for the "big gun" antibiotics, when a more targeted "sniper bullet" would do the trick.
Oh, and one more thing: From what I've learned, I strongly recommend avoiding antibacterial soaps and cleansers containing triclosan or triclocarban. Research shows that these chemicals work like antibiotics, unlike, say, alcohol or bleach, which simply obliterate microbes on contact. We know that triclosan promotes drug resistance in test-tube bacteria. Will it do so in real life? We don't know. But studies show that consumer products containing these antibacterial chemicals don't prevent infection any better than does ordinary soap and water. So if there's no benefit, why take the risk?
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New York, NY: Can you tell us about some of the most interesting research being done in this area? Any particularly groundbreaking experiments or scientists?
Jessica Snyder Sachs: By "this area" I'm going to assume you mean our designated topic, "How Can Germs Keep Us Healthy?" As I mentioned, Jeffrey Gordon, at Wash U, is doing fascinating research. His graduate students use DNA microarrays to follow the genetic and biochemical chatter that goes on between intestinal bacteria and cells in the body. His lab is probably most famous now for the finding that some microbes direct our abdominal cells to store extra calories as fat. This may have helped save people from starvation in leaner times. Clearly, our intestinal bacteria have other functions in addition to helping us extract and store calories. We need more research on how they prime our immune system and perhaps reduce our risk of cancer, especially colon cancer.
I'm likewise fascinated by the immunologists who are deciphering how bacteria and immune cells interact to tame damaging inflammation throughout the body. On a practical level, this gives us probiotic treatments for such things as inflammatory bowel disease. We also have bacterial vaccines in development that have a similar calming effect against allergies and asthma.
As a microbiology wonk, I particularly love the emerging understanding of how certain immune cells biochemically "shake hands" with bacteria passing through the digestive tract in food and swallowed dust particles. If the bacteria are judged "friendly," the result is a body-wide immune calming response.
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Greenwich, CT: Don't you think that that antibiotics have done more good than harm? Surely more people have been saved by antibiotics than those who have died from antibiotic-resistant infections.
Jessica Snyder Sachs: Absolutely! Antibiotics have done far more GOOD than harm. I think I'd be dead a few times over without them.
The point is that we need to preserve their effectiveness. And this means using them more wisely! Tuft University's Stuart Levy calls it the "Antibiotic Paradox." The more bacteria you kill with antibiotics, the more drug-resistant bacteria you get. It's like spraying an herbicide that kills everything but one kind of poison-resistant weed. Pretty soon that's all you have. (I don't happen to mind weeds, but that's another story.)
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Palo Alto, CA: How did this whole anti-germs thing get started?
Jessica Snyder Sachs: As previously mentioned, "microbe hunting" began with the discovery that SOME microbes make SOME people sick. How did we end up going so overboard? Some would blame Donna Reid's spotlessly clean kitchen. Certainly the makers of antibacterial cleaners and cleansers promote the idea of "nasty" germs lurking in your home, ready to attack you and your children.
And I can't blame people for being worried about superbugs such as MRSA (methicillin-resistant staph aureus). It's nasty. But it's here, and getting germaphobic isn't going to help and could hurt if we end up making this bug even MORE drug resistant. So we need to take reasonable precautions—like getting a flu shot to reduce your risk of MRSA pneumonia on the heels of the flu.
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Hamilton, ON: Can you tell us a bit about your background before this book? What led you to become interested in this subject?
Jessica Snyder Sachs: Good question. Who the heck am I to be spouting off like this?
Way back in the late 1970s, I started out as a biochemistry major (on the Canadian side of the border, in fact, at the University of Victoria). I discovered I liked learning and writing about science more than I liked spending my days in a lab. For the last 20 years (yikes), I've been making my living as a science journalist.
As per a previous post, I was fascinated with the idea of the human body (live or dead) as an ecosystem of sorts.
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Oyster Bay, NY: How did you go about researching this book? What were the key things you we're trying to get at?
Jessica Snyder Sachs: I dogged the heels of dozens and dozens of scientists—spending time in their labs, pestering them with questions over the phone, reading their research.
I wanted to understand—and help readers understand—this dynamic relationship between Homo sapiens and this ocean of bacteria in which we live.
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Washington, D.C.: Antibacterial soaps play a role in everyday hygiene routines of millions of people. They are used safely and effectively and are regulated by government agencies around the world. I understand that there are different points of view in the medical and academic fields about these products but the fact is that evidence of their effectiveness in non-health care settings exists. What do you think of that information?
Jessica Snyder Sachs: The only studies that I've seen that show benefits in CONSUMER products are studies on triclosan in toothpaste, which may help people suffering from gingivitis. Studies show that antibacterial soaps—as used by consumers—don't prevent the spread of infections better than does washing with ordinary soap and water. On the other hand, studies show that antibacterial cleansers can help prevent infections as used in hospitals as surgical scrubs.
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Bend, OR: What do you think is the best way to address the problem of antibiotic resistance in our country? What steps could we take to tackle such a large issue?
Jessica Snyder Sachs: It looks like we need to tackle this on several fronts. We have to use existing antibiotics more wisely, develop new ones, and more importantly for long-term success, develop other ways to deal with infectious disease. Antibiotics are short terms solutions as they always breed resistance. There are other fascinating ways to disarm, co-opt, and otherwise co-exist with bacteria. But these innovative approaches remain in the very early stages of development. More research!
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Seattle, WA: What was the most interesting thing you came across while writing you book?
Jessica Snyder Sachs: Hmmm. For some reason I absolutely love that there there are these little "meet and greet" tissues on the other side of our small intestines. Bacteria flowing through our body get pulled into these tissues—called Peyer's patches—and get checked out by immune cells there. What's interesting is that the bacteria are "presumed" friendly unless there's some damage going on. And the more "presumed friendly" bacteria that our body encounters, the more calming effect this has on our immune system.
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San Antonio, TX: Do you think Americans will ever warm up to the idea of germs as healthy?
Jessica Snyder Sachs: Good question. I hope so. We're sure downing "probiotic" yogurt and popping probiotic supplements as never before. Will we start seeing past the advertisements that tell us we have to douse ourselves and our homes with antibacterial soaps and cleaners? Don't know. Guess it's time for companies to develop and advertise products that infuse your body and your home with "good germs." Maybe that will win us over.
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Kent, WA: What is next for you? What other current events in science do you find particularly intriguing?
Jessica Snyder Sachs: Thanks for asking. I'd love to further explore the controversial subject of vaccines: Controversial right now because of the anti-vaccine movement and its belief that childhood vaccines cause disorders such as autism … and sure to be more controversial in the future because researchers are developing vaccines that to do more than prevent infectious disease. There are vaccines in development, for example, that turn off the allergic response in an effort to cure hayfever and asthma.
This is all very exciting, but potentially dangerous… because mucking with the immune system is like poking a sleeping dragon.
At the same time, this is a tremendously promising field of study. Unlike antibiotics and sanitation—which wipe out bacteria good and bad—vaccines are discriminating. They prime our immune systems to launch a highly targeted attack against one type of disease-causing microbe, or even one strain of that microbe. And because vaccines don't spur drug resistance the way antibiotics do, I think they MAY be a longer-term solution to infectious disease. I'd love to spend time researching and reporting on this in-depth.
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Jessica Snyder Sachs: Thanks everyone. It takes fortitude to spend your lunch hour posting and reading about germs. Thanks also to Newsweek for hosting this forum. If you have further questions, please feel free to post them as feedback on my website: www.goodgermsbadgerms.com or www.jessicasachs.com. I also appreciate suggestions for new blogging topics (same web address) and feedback on the new book—Good Germs, Bad Germs: Health and Survival in a Bacterial World.
Be well. ~JSS