I watched this happen. It was amazingly stark in its simplicity. I'm an aquarist. Have been since I was 6. And the last time I set up a giant tank (72 gal) I was using the filters that everybody loves. They're expensive. They circulate poorly, however. In short, they suck. One of the problems with poor circulation is you get anaerobic areas in your tank - where cyanobacteria can spring up. It looks like algae, except it's an unnatural green. It also stinks - it smells like spinach that's been in the fridge too long. So I asked the local fish store what do. "Hit it with a half-dose of erythromycin," they said. Erythromycin is a panacea in freshwater aquaria. It cures all sorts of things. So, okay. Whenever we see cyanobacteria, we hit the tank with a half-dose of antibiotics. Probably happens once, twice a year. This went on for three years. Year 4 my entire tank was taken down by thermonuclear crud that absolutely, positively would not respond to antibiotics. Killed every fish in it. It occurred to me then that: - I was solving a circulation problem with medicine - I was following the advice of people that never kept stock more than a couple weeks - I had been diligently and vigorously been breeding antibiotic-resistant bacteria for three years. So I ditched the Eheim, cleaned out the tank, and never visited that fish store again. Now, when I see cyanobacteria in a tank, I re-arrange. I put a social worker through grad school. She ended up at a hospital dealing with people bouncing out of nursing homes. One of their primary reasons for bouncing? Medicine-Resistant Staphylococcus Auraeus (MRSA). You get a run of that in your nursing home and it's like cyanobacteria in your tank. My daughter goes to daycare in near-squalor. There's a parrot, chickens, rabbits, and lots and lots of dirt. And I like it that way.
Great analogy with the fish tank. Reports are very conclusive that there are effective ways of vastly limiting hospital infections that have literally nothing to do with more or better antibiotics (interestingly, as Semmelweiss [sp?] pointed out in the 19th c., nothing beats hand washing). The trick is to figure out ways of self policing, to encourage a culture of compliance rather than a do-this-or-get-fired mandate, which doesn't work, no matter how rough the incentives are. As for the other elephant in the room, agriculture, good luck getting them to "rearrange" anything that costs them one dime or one second. The problem there is that good agriculture policy is DOA in Congress and the White House due to our silly electoral system. Also, on a side note, the institution at which I work has been pioneering epidemiological work in exposure to animals among young children. As you obviously don't need to be told (but the community may not be aware), there are many heath benefits to exposing your kids to animals, especially decreased incidents of asthma and allergies (and I suspect, although there hasn't been enough time to study the issue, we will find that autoimmune diseases have lower rates in people who have pathogen exposures while young).
My wife and I make a point not to buy antibiotic soaps or hand cleansers for our home and always ask the doctor if a prescribed antibiotic is truly necessary. We've left doctors before because we felt they overprescribed antibiotics before. We don't mind letting a cold run it's course. Sometimes you're just too sick and an antibiotic makes sense but our society today seems obsessed with them. Just look at the line for your favourite bathrooms and there will be an antibiotic gel there.
Beyond the resistance stuff there seems to be mounting evidence that giving kids antibiotics effects their health down the road. Not giving them here and there when they might really need them but prescribing them frequently. My kid is two and a half and still hasn't had antibiotics which I'm pretty happy about. She has had frequent winter colds colds and a few earaches but nothing we haven't gotten through. Her doctor seems pretty hesitant to prescribe them as well, she always get the bad news demeanor when she tells us she thinks we should just trudge through an illness while we are absolutely on the same page.
I don't know if you've checked out this article but I found it interesting that doctors are starting to look at how bacteria and the human body function together to maintain our health.
Microbiology has gotten really cool of late. For years, nobody could get some species of bacteria that are naturally found in our bodies to grow in culture. It was recently discovered that some of these bacteria need different species of bacteria to grow, presumably whose waste products they need to survive. So we have a situation where the bacteria need each other, and we need them. It's fascinating. Always remember, 90% of the cells you carry on you aren't human cells.
This article points out problems within the U.S., but only touches on the fact that the U.S. is a country that has millions of visitors and immigrants, many of whom come from countries where antibiotics are handed out too often. In many parts of the world, pharmacies aren't as tightly regulated or monitored and often sell medication upon request rather than prescription. In my experience, lots of people head to the pharmacy instead of the doctor, because the doctor or hospital will make the diagnosis and then either issue a prescription, which can be filled in-house or filled at a pharmacy at a lower cost. Pharmacists usually have little medical training, if any and simply note what prescriptions are filled and for what ailment. People that head to pharmacies tend to tell pharmacists their symptoms and then the pharmacists will generally sell the person several medications in the hope of catching it and from what I've seen, since tetracycline antibiotics have become less effective lately, pharmacies are regularly selling heavy-duty stuff like Cipro. Another thing that I saw in Vietnam, was that hospitals don't provide food or water to patients and so families either bring food and drink in, or patients go out to eat at street stalls or get food from street vendors just outside the hospital. Often, these places don't really wash the dishes off, instead opting to rinse them off in a tub of water since there is no real access to water on the street. Not surprisingly, Vietnam is a country where antibiotic resistant TB is flourishing. Unfortunately, this model of food and beverage service is not confined to Vietnam, but is fairly common in SE Asia. I'm not sure about China or India, but I think it's likely to be similar. When all this is added to the amount of people travelling in and out of the U.S., concern is definitely justified.