NEJM : 1. Slate : 0

I think I need to stop reading the medical reporting at Slate.  It’s bad for my blood pressure.

This article by Kent Sepkowitz about reports of emerging drug-resistant strains of gonorrhea is completely worthless for both lay readers and medical professionals.  It takes an issue of legitimate concern for medical providers and spins it off in a bizarre direction in order to make points about arguments nobody is making.

Here’s the intro:

A recent paper in the New England Journal of Medicine called “The Emerging Threat of Untreatable Gonococcal Infection” suggests that gonorrhea is set to join the superbugs, the elite circle of nightmarish infections (MRSA, XDR-tuberculosis, NDM-1) that some fear will sweep civilization off its pins. The new breed of sexually-transmitted infection, first spotted in Japan, is resistant to the cephalosporin class of antibiotics, which puts it in position to run the table on available treatments and knock us back into a Fred Flintstone, pre-antibiotic world. [emphasis wearily added, here and below]

Those bolded bits pretty much tell you all you need to know about where the author is going.  Nobody is saying that human civilization as we know it will crumble because of this or any drug-resistant infection.  The author’s histrionic straw man is an odd additional to the pages of the NEJM, not known for its apocalyptic pronouncements.  This is a report of a specific kind of infection that is a specific kind of risk for a specific kind of patient, which will pose a problem for a specific kind of medical provider… like me.  Who is saying otherwise?

But I have to ask, people, why all the excitement? As a looming public-health calamity for John Q Citizen as he walks down Maple Street in Middletown USA, the threat is minuscule (particularly if John Q can remember to keep his pecker in his pants). As with the avian flu massacre that never was and the smallpox pandemic that never came, this Superbug fascination seems to be more about our peculiar love of fear itself (cf: Stephen King, Paranormal Activity, the Republican debates) than any sober consideration of the risk before us.

What excitement?  This is a report in the New England Journal of Medicine, meant for medically savvy readers.  It didn’t appear in USA Today under a screaming headline “You’re All Going to Die!”  Nobody is saying this is a threat to John Q Citizen.  But it is a real medical problem.

Gonorrhea strikes over half a million people in the United States every year.  Unchecked, it can spread throughout a woman’s reproductive tract (the consequences are often more dire for women) and beyond, leading to scarring, chronic pain and infertility.  Untreatably resistant strains are a legitimate concern for medical providers who care for high-risk populations, including adolescent medicine specialists. *polite cough*  It is of value for medical providers to be informed about the issue.  The general public?  Not so much.  Which is why they probably don’t read the New England Journal of Medicine, and would likely have been wholly unaware of this issue at all were it not for the Slate article debunking a non-existent hysteria.

The author then takes the opportunity to rhapsodize about human hubris and the perpetual wiliness of bacteria.  He scoffs at the recent worry about antibiotic resistance and points out that it has been a problem since the advent of antibiotics in the first place… a fact the authors of the NEJM report point out in the introduction to their article.  He concludes thusly:

Rather we are pawns in a game between bits of microbial DNA, crude chemical structures, and a human body with more bacteria in and on it than that person’s number of normal human cells. Our insistence that we are the ones driving this enormous complex over the cliff disregards the basic facts. More disturbingly it reveals an all-too-familiar Master of the Universe insistence that we are the cause of everything on the planet, good and bad. It’s too bad there is no biological phenomenon like drug resistance to undo the suffocating certainty of the narcissist.

I have this image of the authors of the NEJM article scratching their heads and wondering what on earth this guy is talking about.  Who is insisting anything?  Their rather dry academic article blandly reports the very microbial mutations Sepkowitz mentions without any strange rants about who or what is Master of the Universe.  (My vote?  This guy.)  I don’t dispute that humans are a somewhat self-absorbed species, but a report about drug-resistant gonorrhea seems an awfully odd and unrelated jumping-off point.

I am left wondering what the point of this article was.  Medical reporting in a lay publication is only of value if it reports on something that has relevance to the public at large, a claim that the NEJM article doesn’t even begin make.  The Slate piece seems nothing more than an excuse for the author to pontificate about a subject that nobody would be talking about if he hadn’t brought it up in the first place, and to loftily pronounce on themes only tangentially related to its purported topic.  If the author is truly concerned about the suffocating effect of narcissism, a step in the right direction would be to avoid writing more articles like this one.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. Would that some civilian would write a decent article on the dangers of a certain class of Idiotic Persons not taking the full course of prescribed antibiotics. Or that class of Idiotic Doctors who prescribe antibiotics for viral infections, knowing they will do no good. Or that even-more-godawful phenomenon of street vendors selling powerful antibiotics next to the ball point pens and plastic toys in some Third World situation.

    But noooo, that sort of reporting might actually alarm people in some productive way. Better to terrify them with tales of Superbugs. It’s the misuse of antibiotics which has led to the phenomenon of the Superbug in the first place.

  2. +1. Crazed rant against a straw man.

    A question. I’ve heard that claim that there are more bacteria in the human body than cells. Is that my number or by mass or both?

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