Al Gore on the Policies That Fuel Antibiotic Resistance

; Al Gore

Disclosures

March 07, 2014

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Editor's Note:
In this segment of One-on-One, Medscape Editor-in-Chief Eric Topol, MD, talks with former Vice President Al Gore about the importance of precision medicine and why health policy has not properly addressed the growing problem of antibiotic resistance.

Eric J. Topol, MD: Hello. I'm Eric Topol, Editor-in-Chief of Medscape. I'm here with a One-on-One interview with former Vice President Al Gore, and we're going to be talking about precision medicine.

It's really terrific to have a chance to talk with you and to get into your phenomenal book, The Future: Six Drivers of Global Change, especially the part that discusses the reinvention of life and death.

Al Gore: Thank you for doing this interview. And thank you for helping me with the chapter in which I delved into life sciences and genomics.

Dr. Topol: I want to talk about something you discuss in your book, about how the United States may have the most difficulty in making the transition to precision medicine because of the imbalance of power and unhealthy corporate control. What are your thoughts on that?

Mr. Gore: In another chapter in this book, I write extensively about what has happened to the balance of power -- political power, decision-making power, economic power -- inside the United States. The US rose to be the most powerful and respected nation in the world for a lot of reasons, but maybe the main one is that we made better decisions over time than any other country because we had a free flow of ideas and a focus on values. We maintained the ability of people who felt strongly about the deepest human values to speak up and gather agreement from others who also shared that commitment, and then have an influence on the shaping of public policy. But over time, for a variety of reasons, chiefly the influence of money in our political system, corporate interests and other powerful organized special interests have come to dominate the decision-making processes in our country. I hope that doesn't sound like a politically radical statement. I think, unfortunately, that it's pretty widely agreed upon across the ideological spectrum now, and it's really a shame.

Let me give you a quick example of what I mean. Antibiotics have been such a wonderful blessing for humankind, and our policy that guides the use of antibiotics should be dominated by the public interest. Let's not overuse them. Let's use them appropriately. Let's allocate sufficient R&D to continue discovering new antibiotics even if they don't necessarily shape up as a big profit center for the companies that develop them.

But what are we doing instead? Well, 80% of the antibiotics used in the United States today are fed to livestock in subtherapeutic doses, which inoculates the bacteria against antibiotics. And now there are proven examples of bacteria that are vulnerable to antibiotics in humans, that jump to livestock, and are then dosed constantly with the antibiotics and become immune to them. Then they jump back to humans. Now, there are other factors that have contributed to the looming threat of a post-antibiotic world, but that's one of the main ones. Public policy should address that. It's a no-brainer, but because of the dominance of wealthy special interests, it's just not even considered politically possible.

Dr. Topol: It's amazing. It really is. It's so sad. Giving antibiotics so broadly is the opposite of what should be done. We're so imprecise.

Getting back to precision medicine, the promise of genomics, sensors, and other related things could change medicine, but do you think it's going to wind up being done outside of the United States because of some of these obstacles we have?

 
Our democracy has been hacked
 

Mr. Gore: I hope not, but at this point we are likely to see the new models that unlock the potential for precision medicine or individualized medicine developed first in other countries.

The powerful presence of pharmaceutical companies, device manufacturers, hospitals, caregivers, and also insurance companies has such control over the development of policy and the making of political decisions, that any new models that are introduced here in the US to unlock this potential for precision medicine -- but impinge on the profit centers of these organized interests -- will encounter tremendous political resistance. Our democracy has been hacked, and public policy makers and elected officials now feel as if they have to spend the majority of their time catering to the wishes of these powerful interests because they provide the money that determines the outcome of elections and primaries. Of course, there are a lot of good people trapped in a bad system, so there are exceptions to that rule.

Dr. Topol: This has been fantastic. You have a truly unique perspective from the governmental side and as a real scholar transcending climate change. We really appreciate it.

Mr. Gore: Thanks for your kind words, and if you continue to be willing to teach me, I'll keep on trying to learn.

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