抗生素的抗藥菌- (2)-

抗生素的抗藥菌- (2)-

突顯出我們過度使用全球共享的資源

《編按》

在台灣抗生素的誤用和濫用，約開始於1960年代。最多使用的藥劑以盤尼西林最多，但常因過敏導致死亡病例增多，很多醫生改用其他藥，如Tetracycline, Kanamycin, Erythromycin (紅黴素-俗稱Ilosone-對喉痛發炎有奇效) ，隨後Lincocin盛行，它對支氣管炎有效。後來1970-80很多醫生改用Keflex，到了1990年代，出現Amoxilin等。當時美國新抗生素一出來，台灣立刻可購得(即使無醫生處方)，但在美國買不到。原因不在台灣較美國人先進，而是美國人『怕死』。因新藥的副作用除破壞腸胃外，其他未知的大小風險一概由先用者去承擔。而一旦嚴重意外(malpractice)發生，台灣人不懂打醫療官司，現在也不懂，更無此風氣…...。

The idea of the commons is deeply woven through the history of the English countryside. Shakespeare captured this idyllic approach to nature’s wealth in “As You Like It,” when the shepherd Corin explains to the cynic Touchstone the joys of his life. “I earn that I eat, get that I wear,” he says, adding that “the greatest of my pride is to see my ewes graze and my lambs suck” — in the unowned, readily shared Forest of Arden.

經由英國鄉村的歷史，公共用地的概念被根深蒂固地編織起來。當牧羊人科林向憤世嫉俗的試金石解釋他生活的樂趣時, 莎士比亞在他 "皆大歡喜"的戲劇中，捕捉到了這種獲取田園詩般自然財富之途徑。『我吃我賺得到的, 我穿我得到的,』 他說, 並補充說,『我最大的驕傲是，看到我的母羊放牧，和我的小羊吸奶』-在這座無主, 隨時提供眾人共用的阿登茂密的森林內。

There can be trouble in such an Eden, as Hardin pointed out in an influential 1968 paper. Hardin asked what would happen if access to a commons were truly unfettered — if Corin and every other villager ran as many sheep as they could there. In such cases, Hardin argued, the endgame is obvious: Too many animals would eat too much fodder, leaving the ground bare, unable to support any livestock at all.

正如哈丁在一篇有影響力的1968論文中指出的那樣，在這樣一個伊甸園裡可能會有麻煩,。哈丁質問, 如果科林和其他每一個村民，都能像他們有一樣多的綿羊, 能真正無拘無束地進入公地, 那麼會發生什麼事？哈丁認為, 在這種情況下, 結局是顯而易見的: 太多的動物會吃掉太多的飼料, 使地面裸露, 以致根本無法養活任何牲畜。

The evolution of resistance to antibiotics fits that story perfectly. The first modern bacteria-killing drug, penicillin, came into widespread use in 1944, as American laboratories raced to produce millions of doses in time for D-Day. The next year, its discoverer, Alexander Fleming, used his Nobel Prize lecture to describe precisely how this wonder drug could lose its power, telling the sad tale of a man who came down with a strep infection. In his tale, Mr. X didn’t finish his course of penicillin, and his surviving microbes, now “educated” (Fleming’s term), infected his wife. When her course of penicillin failed to eradicate these now-resistant microbes, Mrs. X died — killed, Fleming said, by her husband’s carelessness. It took just one more year for this fable to turn into fact: In 1946, four American soldiers came down with drug-resistant gonorrhea, the first such resistance on record.

抗生素抗藥性的演變完全与這個故事吻合。第一個現代殺菌藥物-盤尼西林(青黴素), 在1944年開始廣泛使用, 為 d-day (1944年的諾曼地登陸) 作準備，美國的實驗室競相生產數以百萬計的劑量,。第二年, 它的發明者亞歷山大. 弗萊明利用他在諾貝爾受獎的機會時發表演講，準確地描述，這個神奇的藥物會如何失去它的藥效, 並講述一個男人得了鏈球菌感染的悲慘故事。在他的故事中, 某位X先生沒有完成他的青黴素療程, 而他體內倖存的病菌, 現在『教育』 (依弗萊明的用字), 並感染了他的妻子。當她的青黴素的療程無法根除，這些現在具有抗藥性的細菌時, X夫人死了, 弗萊明說, 死放她丈夫的粗心。又經過一年多時間，這一寓言變成事實: 在 1946年, 四美國士兵得了抗藥性的淋病,這是首次抗藥性的記錄。

Since then, human decisions, most importantly the overuse of antibiotics in agriculture and over- and mis-prescription of the drugs for human patients, have created the future that Fleming feared.  Multi-drug-resistant tuberculosis is a global scourge, and the first recorded deaths from TB untouchable by all known agents occurred in 2003. In 2015, E. coli displaying a novel resistance mechanism to the antibiotic colistin showed up in pigs, in raw meat, and in a handful of human By Thomas Levenson GLOBE CORRESPONDENT  MARCH 05, 2017.

從那時起, 人類的決定, 最重要的是，在農業上過度使用抗生素，和為人類患者誤開与濫開的藥物, 造成了弗萊明所恐懼的未來。能抗拒多種藥物的結核病，是一項全球性的禍害, 而首次因所有已知的傳染物所引起的肺結核，在2003年發生其死亡之病例記錄。在2015年, 大腸桿菌顯示了一種，新的抗藥性機制的抗生素出現在豬, 生肉, 並在少數人類中，在2017年3月05日由湯瑪斯利文森發表在環球通訊。

In 2015, E. coli displaying a novel resistance mechanism to the antibiotic colistin showed up in pigs, in raw meat, and in a handful of human patients in China — and colistin-resistant microbes have since spread to countries around the globe, including the United States.

在 2015年,顯示出一種對抗生素產生，新的抗藥性機制的大腸桿菌，出現在豬, 生肉, 和中國的少數人體內-而對大腸桿菌具抗藥性的細菌，已經蔓延到世界各國, 包括美國。

This is potentially disastrous. Colistin is a drug of last resort for several classes of infections. In the language of the commons, we have drastically overgrazed our communal field of antibiotics, and humankind will pay the price. A team of experts convened by the British government reported last May that the evolution of resistance in microbes kills at least 700,000 people worldwide each year. Unremedied, that toll will worsen. By 2050, the same study warns, the loss could balloon to 10 million a year — more than the expected death toll from cancer.

這是潛在性的災難。主要用以治療肺炎的克痢黴素，成為拿來治療若干類型感染的最後劑藥。以公地的語言來說, 我們已經徹底、過度地放牧了我們共同的抗生素領域,(漫不經心地濫用) ，因此人類亦將付出代價。去年 5月, 英國政府召集的一組專家報告說, 細菌抗藥性的演變，每年造成全世界至少70萬人死亡。若無解藥，死亡人數將會惡化。到2050年, 同樣的研究警告說, 這一死亡可能會激增到每年 1仟萬--超過預期的癌症死亡人數。

ANTIBIOTICS ARE not the only modern-day commons at risk. The atmosphere is another. It can be disrupted at the local level — just ask the masked pedestrians making their way through literally deadly air pollution in any number of megacities. Globally, the cumulative impact of every drive to work, each cooking fire, and every gallon of oil burned to heat a home can be read in the daily measurements of atmospheric carbon dioxide at the observatory on the flanks of the Mauna Loa volcano in Hawaii: 408.28 parts per million as I write this, up from 404.2 a year ago (and 315 as first observed in 1958).

抗生素並不是當今唯的一共同危險。另一個嚴重的氛圍是可能在地方層面上暴出來的危險。問問看任何一位，蒙面行進在致命空氣污染的特大城市中的行人就知道。就全球而言, 綜合累計的衝擊包括，每次開車去上班, 每一個做飯生的火, 燃燒每加侖的油，使家庭取暖，因這些而排出的二氧化碳量，可以在每日測量大氣二氧化碳, 位於夏威夷的一座火山側翼的天文臺內可以閱讀出其數據: 我寫這篇文章時, 每一百萬有408.28 份, 從一年前的 404.2增加 (和1958年相比，第一次觀察到的僅 315)。

While the full consequences of this use — or abuse — of a truly global commons will only emerge over time, new risks emerge with ever passing year: increasingly damaging storms, droughts, and floods. Yet more fundamental shifts in the earth’s climate system are in sight, too. Potential changes in the circulation of the ocean or atmosphere would radically alter the weather patterns on which human societies have come to depend.

雖然真正全球性的公地上，這種使用或濫用的全部後果，將會隨著時間的推移而出現,但新的風險在過去的一年中出現: 包含破壞性越來越多的的風暴、乾旱和洪水。然而, 地球氣候系統的更根本的變化也在眼前。海洋或大氣環流的潛在變化，將從根本上改變人類社會一直賴以生存的氣候模式。

未完

Justin Lai編譯

12/082017