30/11/2012 Newsnight


Will common medical procedures become too dangerous as superbugs learn to resist antibiotics? Is UKIP really about to be Britain's 3rd party?

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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


Will common medical procedures become too dangerous as superbugs learn to resist antibiotics? Is UKIP really about to be Britain's 3rd party?

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