30/11/2012 Newsnight

Tonight, imagine a world in which diseases you thought were curable

suddenly cannot be cured, treatable infections become untreatable, and

cancer therapy and surgery leads to new dangers.

That is the medical nightmare of a new breed of superbug, resistant to

antibiotics, and threatening to overturn some of the best hopes of

modern medicine. 21st century medicine, the hip replacements and

cancer chemotherapy, they won't be possible, because patients will be

succumbing to infxs that were treatable. We will hear whether our

doctors need to cut down drastically on the prescription of

antibiotics. Labour holds on to three parliamentary seats, and UKIP

does well, and claims to be the nation's third party. Is any of

that credible. From the celebrations last night,

you would think coming second of the new coming first. But remember,

UKIP haven't yet got one MP. We will ask if they are really

keeping David Cameron awake at Good evening. Some of the miracles

of modern medicine are in danger. We come to take for granted

treatments for cancer and hip replacements, the stuff of dreams a

few decades ago. Many of these advances depend on antibiotic,

which have been used to fight infection since the 1940s. Many of

them are losing their effectiveness. At a rate that is both alarming and

irreversible. -- irreversible. That is from Britain's Chief Medical

Officer. We have talked to the teams at the frontline in the fight

against drug-resistant bacteria, or superbugs. And just as scientists

thought they were gaining the upper hand, a new threat is emerging, and

this next wave could be what the Chief Medical Officer describes as

one of the greatest threats to modern health.

At the frontline, in the battle between man and miebcob, each new

anti--- microbe, each new anti- biotic we create has an army of

resistance. Antibiotics underpins all areas of 21st century medicine.

If we allow them to proliferate, we undermine all those advances.

Bacteria that constantly evolve are evading our best weapons. One year

your house is a mile away from the cliff age, with coastal erosion,

come back ten years later, and the cliff edge is only 100 yards away.

That is the position we are now in with antibiotic resistance.

arrival of antibiotics in the 1940s, revolutionised healthcare, until

bacteria began to fight back. Now, doctors and scientists are warning

that ever-evolving, resistant strains, are putting modern

medicine at risk. For antibiotic- resistant organisms you might have

heard of, like MRSA, doctors and scientists have been making

headation, there is a new group of bacteria gaining ground now. It is

a fresh challenge, and there is a lot at stake. Nick Brown has to

deal with the reality of resistant bacteria every day on the hospital

ward. Often it is as simple as keeping patients apart. Hospitals

are continuously bombarded by the introduction of antibiotic

resistant bacteria from patients transferred from other hospitals

and overseas, therefore, we have to take precautions to segregate the

patients from others, and take infection control precautions to

prevent the organisms spreading. At her Birmingham lab,

microbiologists, Laura Piddock, is trying to understand resistance, to

see if there might be better ways to counter it. She says bacteria

become resistant in a process that is a form of revolution, where the

fittest bacteria survive. The ones that can withstand antibiotics, and

the more we use antibiotics, the more we unwittingly encourage those

resistant bacteria to thrive. So what is it about these bacteria,

that makes them resistant? We can boil it down really into two wave,

first of all, they can share small pieces of DNA and transfer in

bacteria population. That might allow them to produce an enzyme to

chew up the drug. The bacteria has the genetic material to overcome

the drug, and produces the mechanism of resistance. There are

two main groups of bacteria called ground-positive and ground-negative.

It is the second group causing concern to microbiologists. Ground-

negative bacteria have a double- cell ball w biological pump

inbetween. In ground-negative bacteria here, this is the joud

site of the cell and this is the inside. They have these two

barriers, which ground-positive bacteria doesn't have. They are

very clever, they have a three-part system that works like a vacuum

cleaner. Any drug that gets in, immediately just pumps it straight

out. This built-in pump means ground-negative bacteria can spit

out our best antibiotics, making it harder to design one that will

destroy them. There are six resistant bacteria that worry

microbiologists most. Two are ground-positive, all of the rest

are ground-negative. The one that is demanding attention right now is

Klebsiella. Klebsiella is seen in renal infections. It has resisted

antibiotics and we have had to return to the reserves, carbopenins,

2% of Klebsiella are resistant to carbopenin antibiotics, it has shot

up in parts of Europe and the US. You only have to go to southern

Europe to see what can happen. As early as 2008, there were problems

in Greece. 40% of Klebsiella resistant to cabopenin. Watch Italy

n2008 it is between 1-5%, no worse than our present problems. But come

forward to 2010, and already Italy is up to 17%. And come now to the

most recent data, Italy is now up to 30%. It is vital that we in the

UK avoid going down this trajectory. If we lose cabopenins, against

bacteria like Klebsiella, we are forced to use what are really

rather poor, toxic, not very God antibiotics, we are down to the

bottom of the barrel. It is a potentially lethal

infection that is resistant to treatment...$$NEWLINE It is the

most vulnerable patients who are at risk. MRSA, for example, the drug-

resistant ground-positive bacteria, is harmless to the many healthy

people who carry it, but not the weak. When it was found in the

special care baby unit at Addenbrooks last year, the hospital

turned to the latest in genetic technology for help. A few miles

from the hospital, in the Cambridgeshire countryside, is the

world-famous Sanger institute. started 15 years ago, references

bacteria. Scientists here helped decode our DNA blueprint, in the

human genome project. Now they are using a similar approach to

identify and track the most threatening of bacteria. Two things

may be going on in the hospital, the strains may be brought in

independently or transmission in the hospital. Current typing

techniques find it difficult to differentiate strains at high level.

The genome sequencing we are trying to use here, allow very fine

discrimination of strains. This approach will work with any

bacterium, we have shown it working with MRSA, it will almost certainly

allow the hospital to differentiate outbreaks of Klebsiella from

independent introductions of Klebsiella, and knowing there has

been an outbreak and transmission is key to any intervention to

prevent transmission. How important might these new

sequencing technologies be where it really matters? There is potential

for the new gene sequencing technologies to enable us to better

understand the epidemiology of the spread of ground-negative

antibiotic resistance. Therefore, we would be able to target our

isolation facilities, and the infection control precaution that

is we use to prevent further spread within the hospital environment.

But, it will be years before we can contain every outbreak quickly. So

the warning now is that we must stop resistant strains reaching

patients in the first place, to avoid the unthinkable.

For -- For those who get an infection by a ground-negative

bacterium, it will be increasingly difficult to treat it. We will see

the day where we have untreatable infections. In some wards in the UK

it has already happened F we don't sort out, these wonderful medical

advances we take for granted, the hip replacements and cancer chemo

therapy, they won't be possible, because patients will succumb to

infections that were previously treatable. Unusually, Professor

Piddock and other specialists like her, are campaigning to persuade

Governments and industry to do more to preserve current antibiotics and

find new ones. Their concern that we overuse these drugs, most

recently, by buying them via the Internet.

It is not like other types of medicine. If I have a headache, I

would take a tablet for my headache. If I take an antibiotic, all of the

bacteria in my body are exposed to that antibiotics, I would be

selecting drug-resistant strains and sharing them. I may not need an

antibiotic. We are saying use them sparingly and preserve their use

for as long as possible until we get new drugs.

Bacteria breed quickly and in situation that can surprise the

experts. No-one can say for sure what the next big resistant threat

will be. Only that there will be more. And that we may not always be

confident that our antibiotics will work.

Professor Alan Johnson is a consultant clinical scientist at

the Health Protection Agency in England and an expert in resistant

antibiotics. How serious is this? We have a large number of bacteria

can cause infections and a range of antibiotics. The extent of the

problem depends on which range of those you are looking at. At one

end of the spectrum we have some strains of bacteria causing

infections that are becoming virtually untreatable already, at

the other end of the spectrum we have some strains of bacteria that

cause infections that remain readily treatable. We have some

time, but there are lots of parts to the puzzle. How important is it

for doctors to say to us as patients, you really don't need

antibiotic, I won't give them to you, even though hur whinge ago

bit? The key issue in the report, is cannotitybiotics are unlike

other drugs used in medicine, the more you use them, the less

effective they become. The key part of the strategy at the moment,

because of the lack of new drugs in development, is to make sure that

the drugs we currently have, and are active at the moment, remain so

for the future. And doctors play a part in that? In order to do this

we need to cut back on unnecessary and inappropriate prescribing.

speaking as a patients, must of us think these are wonder drugs, we

think they cure a lot of things. My demand to a doctor would be please

give it to me? We know that is one of the problems, there is good

evidence from studies that doctors, unfortunately, do prescribe

inappropriately, because of the pressure put on them by patients,

who have a high expectation of getting a drug. One of the key

things at the moment is attempts to try to educate patients. That

antibiotics are not harmless, as we thought. If you take an antibiotic

unnecessarily, you get what we know as collateral damage, you end up

possibly colonising superbugs. Educating doctors about that.

Indeed. You can get them on the internet, before I came in, I

checked, it is easy to get a whole range of antibiotics? That is an

appalling development. It goes totally counter to global efforts

to optimise and reduce prescribing as much as possible. If they are

made freely. Another thing to be aware of, what you buy over the

Internet is sometimes counter fit drugs. You are not only use theing

the drugs inappropriately d counterfeit drugs, you are not only

using the drugs inappropriately. They will tend to promote

resistance if the does aj isn't what you think -- does aj isn't

what you think it is. -- dosage isn't what you think it is.

The message isn't getting through? There are initiatives to redress

this. In terms of doctors' education, because of the advances

in modern medicine, if you are a trainee doctor, the sheer amount of

knowledge that you have to accumulate during your training is

vast. There is a problem that at the moment, in terms of the medical

curriculum, the amount of time that trainee doctors have lectures on

infection, let alone the use of antibiotics, it is a tiny part of

the medical curriculum, and colleagues, I know who are

interested in education, say that has to change, there needs to be

more much focus on how to use antibiotics properly.

Thank you very much. Now, there is nothing unusual about

Governments taking a beating in by- elections half way through a

parliament, nor is there anything unusual about an opposition holding

three safe seats, as Labour did yesterday. But, the UK Independence

Party say recent elections amounts to sea change in British politics.

UKIP, they claim, and not the Liberal Democrats, are the third

party. They claim to be going on in future elections to possibly

reshape things. We report on whether any of this is

justifiable or political dreaming. The morning after the night before

in Rotherham, sees normal life continue apace, and it is business

as usual in affairs of state too. The local Labour Party retained the

constituency last night in a by- election, comfortably, but beneath

the surface, basking in winter sun, quite some disturbance was caused.

Last night it wasn't the winning that counted, but the coming second

that seemed to matter. In the European elections, in cities like

Hull, we came first, in the local elections last year in Sheffield,

we got more votes than the Conservatives. We have just

performed creditably well in the Police Commissioner elections. The

general election, two-and-a-half years ago, UKIP scored 3% of the

vote, the last opinion poll put us on 11% nationally you are looking

at a very different party, and a confident party.

Add to that, last night's positions, in Rotherham UKIP secured 21.79% of

the vote. Its highest showing in a Westminster by-election, elsewhere,

in the two other by-elections of Middlesborough and Croydon t came

in second and third respectively. This triplicate of positions for a

party, once teased by the Prime Minister, appeared sweeter than

winning. For the celebrations last night by UKIP, you would think that

coming second in a by-election is the new coming first. Remember,

UKIP doesn't yet have its own MP at Westminster. That goes to the heart

of the strategic questions being asked, if not by the party itself,

then being asked about the party. Why are they not digging deep in

one constituency, trying to get the MP, instead of the mini-explosions

they are letting go off around the country. I think they are not

inclined to go for the MP, why should they bother, a -- as it

stands they are scrambling the signal of UK politics. At the

beginning of this year they started to overtake the Liberal Democrats

as the third part. The Liberal Democrats have done well as a

protest vote sometimes. Now they are in Government they are not the

natural receiving of protest votes, and that is what we have seen in

Rotherham. Does it mean they are wiped out because they came eighth?

No, but it does show they are squeezed. What drove up UKIP's vote,

two issues repelled loyalists from Labour. Who did you vote for?

Why? Because what is on the Labour council, old-time Labour voter,

disillusioned with them. Denis MacShane with the scam he pulled on

everybody, and also with, what I heard about the foster carers.

That one-time Labour loyalist confirmed UKIP is not just a

problem for the Conservative Party. A larger proportion of UKIP

supporters in 2010 would go Tory, but there are Labour-inclined

voters too. If you drill into UKIP's numbers, there is something

else going on. When we look back at the data of people who say they

support UKIP, what is interesting about them, is yes, they are

interested in Europe, they are as interested in immigration and race.

Where as one person in five in Britain says that immigration is

the key issue, problem, facing the country, amongst UKIP voters, in

our recent analysis, the figure is 49%. We have stumbled across the

well named new Labour MP for Rotherham, Sarah Champion, she will

probably keep the seat at the next election, this place a Labour

stronghold. But, as we have seen this morning, she and her party

will have a lot to do on immigration.

According to the office of national statistics, last year, Rotherham

was home to 237,000 British inhabitants, and 15,000 non-British.

These figures are clearly blunt, and may not reflect the actual

community. But on the ground, there did appear to be some of the anti-

immigrant feeling driving UKIP's surge, diagnosed by the pollsters.

We had been at Eastwood, two life- long Labour loyalists, took us to a

car park, where they say the children of eastern European

immigrants gather nightly and Iraqously, our pair had organised

to resist them -- racausly, our pair had organised to resist them.

Do you equate how upset you are in your community and the by-election?

A lot of people have decided to vote for someone else definitely.

You were a Labour voter? Yes. it a difficult decision? Yes, I

have voted for somebody else this time, definitely. I didn't vote

UKIP, I stuck to being a Labour voter. But I think the voters of

Rotherham have sent a message in the result that came through. Help

us out, do something for us. You know, let's help each other to

improve the area. They discuss how they vote with their friends Saber,

the secretary of the local mosque. Why didn't you go for UKIP? If it

was the same MP I wouldn't have voted, I would have gone for UKIP.

Would you have voted UKIP? possibly would have, because their

policy applies to myself as well, therefore, I have to be careful

when I'm voting. Anecdotes on the ground aside, it

was Labour that did well yesterday. The two parties in Government are

spinning last night's result as mid-term blues, more blue than

usual in the chill weather of November. But all minds in

Government are turned to next Wednesday's big economic statement

of intent. In the knowledge that, at root, the prospect of a triple-

dip recession, caused last night's triple-boost for UKIP. With me is

the editor of the Spectator, and Steve Richards from the Independent.

We hear from Jeremy Batten an MP for London from UKIP. Well done for

not winning anything, 70 piers of the people didn't vote, you are not

the third force in British politics? We have been doing this

for 20 years now. It has been a slow progress, because we are up

against the first pass the post electoral system, that is very

difficult to breakthrough in. We have 100 years of entrenched

tribunal voting we are trying to make -- tribal voting we are trying

to break down. You did well in 2009, European elections, came second,

2010, no Westminster seats. Which Westminster seat are you within a

sniff of winning? We would give away our strategy if I tell you

that. We will fight as many seat as we K we are look to go do the whole

of the 645 we will be targeting seats as well. Deciding which ones

to put the most effort into. many will you win? I can't make

those kind of predictions, I don't know. I have never underrated how

difficult it is. The reason we are doing so well, is because we have a

flavour of that from your intervoos, is because we actually rep --

interviews, is because we represent the centre of British opinion. The

old parties don't actually appeal to what the ordinary voters want.

They were talking pretty much about local issues, the kids causing a

row, talking about what is going on in Rotherham council, and a

disgraced local MP. Not the kinds of things that are your policies?

Some maeings the Government -- so many of the things the Government

wants to do they can't, because our laws are made in the European Union.

Controlling immigration, we can't control it, because the EU sets the

laws. Is there any chance of you forming an electoral pact with the

Conservative Party, or even undermining them, given that,

actually, even if everybody voted UKIP last time, it wouldn't have

helped them a great deal? It is the myth that we only take Conservative

votes. We have always taken Labour votes, if you look at the figures

back 20 years, to 1994, the first elections we took part in, we do as

well in Labour as Conservative seats. Would you do pact with the

Tories, given the current leadership, you know what David

Cameron said about you four years ago, "fruitcakes and loonies"?

got endorsed by Peter Mandelson last year -- week. I wouldn't say

endorsement. What about a pact? don't know what the pact is. If the

Tories want that they can announce it. It would kill you off? They

could announce the policy that they have decided to withdraw from the

European Union. I don't see what the pact is supposed to deliver for

us or them. We fight because we know, clear and simply, what we

believe in and what we want. If they want to try to undermine us,

all they have to do is say they will withdraw from the EU or offer

a referendum. How big a problems is UKIP for David Cameron, or is the

problem an historical problem for the Conservative Party about

Europe? The problem is a third of the public only want to stay in

Europe now. There is no issue in British politics where there is a

bigger gulf between the public opinion and the mainstream

Westminster opinion. What UKIP will do, by consistently getting 10% of

the vote, it will remind the parties they are out of line.

much more than that? It is still more than the Liberal Democrats.

Isn't that the big story, the Lib Dems are nowhere, what is happening

to them is exactly what happens to parties in coalitions from Ireland

through to Germany. The smaller parties lose out. No question. One

of the things by-elections do is fuel a sense of doubt and security

within a party. The specific events, the specific seats, soon fade. But

that kind of fear of potential electoral oblivion, will shape, to

some extent, the way they calculate and think. They seem robust in this

election. Even after coming eighth. But coming eighth will be traumatic,

especially to MPs who are worried about keeping their seats at the

next election. It will play a part in the thinking over the next few

months and years. Talking about the thinking, the big story this week

presumably will be the Autumn Statement and what the Chancellor

will do, for all of us. It looks a pretty grim 2013. Yes, and 2014, 15,

16. They will come out with a forecast. The fact is there is not

much growth in the economy now. Nor is three predicted to be. What

George Osborne hoped to be a recovery in time for the next

election, will be belt-tightening and austerity for the foreseeable

future. He will have to come to terms with the fact that telling

the public that, after having served them cuts in the last

election but there will be in the next election too. That won't go

down well. It is not a great vote- winner. The one thing he can do is

say Labour's best hope is to talk down the economy, that nothing

turns up? I don't think that is a very effective argument when people

are feeling down about the economy. They will feel more down after

Wednesday? What he will do, he has already said it, he wrote an

article about following lessons from the Obama campaign, he will

try to blame what has happened, again, on the Labour Government.

And the recent past. Rather than his attempts to address the

situation. So far, that has had some impact on Labour's ability to

get its message across, it hasn't helped him at all electorally, or,

as we were talking about earlier, the Lib Dems who pursue the same

message, that it isn't their fault. What women see this week is

incredibly important, in terms of the dynamics of the Government and

the future of the parliament T won't change the debate, it is

already framed. It will be bleak, they were argue it is worth it, and

make it far bleaker than it need be, we are already at that point.

terms of options, tax rises, more austerity, and more cuts, the

deepest cuts haven't happened? There is another option he could

take, which he won't, I suspect, is to come up with a radical pro--

growth package. What he has done is not enough, cuts are not enough,

austerity not enough to get the economy moving. We have seen other

countries abroad do deficit finance tax cuts. Swede just did a major

one in the last budget. That is new thinking and it is working. I don't

think politically the Conservatives are there yet. I think they believe

they are stuck in a groove of relatively bleak economic activity.

The only question is, who gets the blame for this, and they are hoping

that Labour still hasn't got the credibility to blame the

Conservatives probably. That is the battle, that is what most people

talk about, and just saying get out of Europe would solve everything

isn't playing? More and more people are realising that you can't

actually address the problems inside the European Union. Look at

the countries outside the European Union, Norway, Switzerland, Canada,

Austrailia they all have higher living standards. So has Germany.

That is held back by the European Union. If we left the European

Union we would get our own destiny back, we could be a more prosperous

country, a freer country, we could control the big issues people care

about. Our message is going home to people f you want to address those

issues, there is no point in voting for the old parties. If I may say,

the Lib Dems are now becoming irrelevant in that they are no

longer the party of protest. much like the politics of the 70s,

economic gloom in or out. Close decisions. If we made the right

decision in 1975 we wouldn't have these problems.

On I'm joined by Bennett Miller, Hadley Freeman and Christina

Patterson, for the latest baseball film, this one starring Amy Adams

and Clint Eastwood. Valentino sweeps in with show-stopping frocks.

Spike Lee has made a film pulling Michael Jackson back up on to a

president das tell as a musical genius. And a grandfather who

modelled his granddaughter's clothes, that is love.

There is flash photography coming up, leaving you with Freddie