Will Byrnes's Reviews > Biography of Resistance: The Epic Battle Between People and Pathogens

On January 13, 2017, a brief article from Washoe’s [Washoe County, in Nevada] public health officials was published in the Centers for Disease Control’s Mortality and Morbidity Weekly Report, and it sent shockwaves around the world. It was the first report of its kind—never before had a US county public health official written about a complete failure of every single antibacterial drug that they had available to them.

It was darkly serendipitous that I was reading this book in March, 2020, and that the book would find its way to bookstores in April, when, no doubt, we would still be facing considerable personal and global, medical and economic challenges from what must be deemed public enemy number one, COVID-19. If you will indulge me, I would like to talk a bit about the current [2020] crisis which, while very much related to the book under review, is only one element. I promise to get to the actual book review part before too long.

The SARS epidemic began in 2002. According to the National Health Service in the UK “There’s currently no cure for SARS, but research to find a vaccine is ongoing.” Tick tock, guys, I mean eighteen years is not enough? It gives you some idea of the level of concern about COVID-19. Even the nomenclature can be a bit confusing. “CO” is for “corona,” the type. “VI” is for virus, duh-uh. “D” however, may not be obvious but will be after you read this. Disease. See? The “19” is not the 19th iteration of this malady, but represents the first year in which it was identified, or 2019. You will not find a COVID-18. The actual virus is called “severe acute respiratory syndrome coronavirus 2”, or SARS-CoV-2 by the International Committee on Taxonomy of Viruses. And Yes, it is very much related to the earlier SARS virus and disease.

Two days before my wife was due to return to NYC where she worked several days a week, the first case was confirmed in Manhattan. She still went in. Work is work. In the absence of a corporate ok, most people were reluctant to just call out. How many other people were faced with the same challenge? Go in or stay home? How can one judge the risk if there is no good information yet on how vulnerable one might be to picking up the virus at, say, the Port Authority Bus Terminal, or at Grand Central Station or on the A train, or on the local bus? Maybe your Uber or taxi driver is a carrier and does not even know it. Paranoia can be understandable at such times. For myself, I do not need to interact much with the world, relatively. A good thing, given that I am in the age group most susceptible to the worst results from the virus. But the world does come to me. My wife’s trips to NYC stopped for now, corporate encouraging employees to work from home as much as possible, but we still have a truck-driver relation in the house on a daily basis, and we still have to shop, for food, meds, and other things.

COVID-19 is a global peril because there are currently no drugs available that can dispatch it. [well, there weren't in 2020] Forget a vaccination that is probably well over a year away, if even then. The best one can hope is that, if you get it, you can endure the flu-like symptoms for the duration of the infection, and that your symptoms do not become severe. For the optimistic, The National Institutes of Health reports that they are testing a possible treatment. No date was offered on when the test period would end, or when a decision could be made as to the efficacy of the treatment, the drug Remdesivir, nor, if proven effective, how long it might be before production could be scaled up to provide the vast volumes of the drug that will no doubt be needed.

It used to be that afflictions were named for the place where they were first discovered. MERS, or Middle East Respiratory Syndrome, comes to mind. And it should be known that the Spanish flu actually originated in Kansas, but was first copped to in Spain. Locality use in nomenclature for diseases is now considered unacceptable, as stigmatizing. Of course, there are cynical folks on the right who are deliberately attempting to distract political attention from the colossal failure of the Trump administration in the face of this crisis by poking racist nerves and referring to COVID-19 as the Chinse flu, the Wuhan flu or the Wu-Flu. The hope is that it will prompt Dems to go after them for their racism, and then they could be talking about the attack by Dems and not the administration’s lies, failures, cover-ups, and cluelessness.

This week, the World Health Organization declared COVID-19 a global pandemic. My wife did not travel to Manhattan, but worked the full week from home, and will (and did) until directed otherwise. But the reality of the threat continues to grow (the NBA just postponed the entire 2020 season), MLB has postponed all games, Spring training and regular season, a pointless ban on travel from most of Europe has been announced, and tests for COVID-19 remain in mortally short supply here in the USA. If you can’t test anyone, you can’t confirm an increase in the number of cases, or so I expect the thinking goes in some quarters.

Thanks for indulging me, now on to the book.


Muhammad H. Zaman - image from NTNU

Returning to the opening quote from the book, people and bacteria have been engaged in an arms race for a long time, or it might be better called an AMRs (Antimicrobial resistance) race, and it appears that the microbes are one up on us at present.

This is a biography. One might think of it in terms that some of us of a certain age might associate with a TV show from the way-back, This Is Your Life. A celebrity guest would be introduced, then we watched her or him react to a procession of people from their life, usually teachers, old friends, mentors maybe, arresting officers, whatever. I suppose one might think of Biography of Resistance in a similar vein. We are told at the beginning that a malady has been found (see opening quote) that has proved resistant to all known antibiotics. The bug in question was a CRE (carbapenem-resistant Enterobacteriaceae). Many Entero bacteria are harmless, but this family member was Klebsiella pneumoniae, the culprit behind not only many a UTI, but life-threatening sepsis and pneumonia, as well. All known antibiotics (26 at the time) were tried. The patient died of sepsis. So how did this particular bacterium come to be, or, more importantly, how did this level of resistance come to be?

We travel back to when we first found out about our previously unseen fellow Earthlings, and track the advance of our knowledge of them through the centuries. From seeing them at all to understanding that not all our fellow passengers were benign. The action picks up in the mid-late 19th century, as, now recognizing some true enemies, means are found to do battle with them. Then they develop longbows, and we develop armor-plated vehicles, and they develop rocket fired grenades and we develop aircraft and on and on it goes. This history is often fascinating.

One of the things that many popular science books do is to use people as vessels with which to deliver historical and scientific information. (Maybe like inserting a curative virus inside a friendly-looking bacterium in order to slip past defenses of the malignant microbe?) We can more easily relate to other people than we might to raw descriptions of science. And if the scientists in question sometimes have oversized personalities, so much the better. It makes for better story-telling. Some of the names here will be familiar, particularly to any who work or dabble in the life sciences. Maimonides, for example, nailed a description of pneumonia symptoms in the 12th century. Robert Locke’s Micrographia, published in 1665, showed that there is an entire world of living things inside the smallest objects. Antonie van Leeuwenhook built a better mousetrap microscope to significantly boost the resolution of our view. Were he a Python, I suppose he could have founded a Royal Society for Seeing Living Things Inside of Other Things. Louis Pasteur showed that fermentation was done by microscopic animals. (little red bulls maybe?)

Where there is discovery there is often ego, sometimes to the point of personal, professional, and decidedly dickish competitiveness. Some early work in the examination of pneumonia descended to this level, sadly.

You will learn about Robert Koch, a German microbiologist who, in addition to doing breakthrough work on fighting the black death, ran an institute that produced world class international researchers as if he had found a magic way to clone genius. You will also learn of household-name science icons who were not above fudging data when necessary to prove a point.


Robert Koch was the Professor Xavier to a generation of microbiological superheroes of the late 19th and early 20th centuries, training such household names as Kitisato (a household name in Japan), Julius Petri, yes, of that dish, and Paul Ehrlich, notable for his concerns about population growth, finding a cure for syphilis, and a for being the father of chemotherapy. - image from NobelPrize.org

It is worth knowing how antibiotics actually work, what it is that they do, and how they do it. (Teachers and classmates report how the biographed bac snuck off the schoolgrounds and got into all sorts of trouble, while somehow maintaining top grades) Zaman offers a very readable description of ways in which antibiotics (ABs) go after bacteria and utterly fascinating material about the defenses, some of which are remarkably complex, that bacteria have developed (evolved) to fend off such attacks, including using antibiotic attackers as food. He also reports on different sorts of ABs that have been developed over time, things like bacteriophages, (bacteria eaters) aka phages, sulfa drugs, and a kind of fungus that disarms bacteria.

One large surprise is that bacteria develop antibacterial defenses independent of the presence of humans. (Brothers and sisters appear on stage, telling about what a rotten sib the bacterium was) It would appear that we have joined a battle that has been raging for as long as bacteria have been on the planet. Another is the sources that are used when looking for new AB materials to bring to bear in the ongoing war. It was also heartening to learn of a particular confluence of disparate scientific disciplines joining forces to advance our knowledge, and hopefully enhance our armory.


Actually, resistance, despite some temporary setbacks, seems to be working out pretty well for pathogenic (hostile) microbes

(Lifelong friends, business associates and rivals offer some final praise for the guest of honor) Bringing us up to the present, Zaman catches us up on the dangers we face in the globalization of infection, the misuse of antibiotics as a contributor to the growth of AB resistance, the latest insight on how resistance is replicated, and delves smartly into sociopolitical elements of international health care politics and economics. Some of this is unsurprising, as companies that make their money selling antibiotics lobby against any restrictions, and too many have reduced or eliminated investment in AB research and development, because such products are less likely to earn an optimal ROI than drugs intended for regular, ongoing use. He points out how important it is to involve people other than scientists in the drive to develop new defenses. Economists, politicians, social scientists, anthropologists, writers and more all need to play a part in helping us find ways to survive in what has become, and what we have helped make, a hostile environment. Mother’s milk for policy geeks.


Chart is from AMR review

Gripes - I did not keep a running total, but the sheer number of named researchers did seem a bit encyclopedic at times, as if the author felt compelled to incorporate as many people as possible into his narrative. I expect, in reality, he was pulling hair out because of having to leave so many other scientists out of the narrative, but the number left in seemed a bit excessive. I doubt this can be defended as a gripe, more of a personal preference, really. But I find that science writing is hugely enhanced by the presence of a degree of levity. Mary Roach is the most stunning example of the application of (often jejune) humor to otherwise serious popular science narratives. You will be in no danger of having your latte shoot through your nose as you are ambushed by something totally hilarious in this one. Sip on in confidence.

At the very least, The Biography of Resistance will give you some perspective, a more informed look at just how challenging it is for medical science to keep ahead of (or more accurately catch up to) the resistance that diverse, harmful bacteria keep coming up with to make us ill. Doctor Zaman covers a lot of territory in this very readable, relatively brief (263 pages) book. From the history of our learning what microbes are to showing how antibiotics attack bacteria, and how bacteria fight back, to showing the impact of antibiotics in the world, showing how their overuse has worsened an already challenging problem, pointing out what is currently being done, and offering a broad strategy for moving on, incorporating diverse disciplines. You will learn a lot, and I cannot imagine a timelier book as we try to make our way through what could well be called by future historians 2020: The Year of the Plague

If nothing changes, and we continue on the path we’re now on, by 2050 the world will lose 10 million people a year, every year, to resistant infections.

Review first posted – March 13, 2020

Publication date – April 21, 2020

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