In my previous column, I described my complicated relationship with antibiotics and antimicrobial resistance (AMR). As a cystic fibrosis (CF) patient whose pre-transplant lungs were severely affected by the lack of available antibiotics, I am one of many advocates fighting for a new pipeline of medicine.
Our society’s struggle reminds me of the musical “Titanic” as both show how a crisis affects people differently. The following is a breakdown of the musical’s characters, including how likely each group is affected by a crisis — whether it’s a sinking ship or AMR.
At the very bottom of the ship, we are introduced to the workers. These are the characters I identify with. I was born with CF, a genetic disease that allows for chronic infection. As such, I have spent much of my life avoiding and fighting disease. Keeping my everyday life running requires a lot of medicine, energy and effort. It’s hard work. Similarly, the workers on the lower levels of the Titanic must work hard to keep the ship running.
The workers are also the first to experience the effects of the iceberg. Unfortunately, as events such as the pandemic or the sinking of the Titanic have shown, those at the bottom of the social hierarchy tend to be treated as if they are useless. Like workers, chronically ill patients should feel protected, especially if we have been warned that the ship is sinking and we have developed AMR. Measures should be taken so that we do not have to look after ourselves.
Next we have third class passengers. They are the first passengers to see the effects of the iceberg. Some do not have access to the lifeboats, while others choose to stay on the ship to avoid the chaos. All this speaks of their lack of availability and protection. They have no choice and no voice.
I see these passengers as patients affected by health crises, but not as severe as some. With regard to the AMR crisis, CF patients whose access to Trikafta (elexacaftor/tezacaftor/ivacaftor) has limited their exposure to infection may fall into this group. Patients with short-term bacterial infections may fall into this category, along with newly diagnosed CF patients and older populations. In short, they may not have been part of this group since birth or need daily antibiotics, but they still need help.
On top of 2. act, after the ship has hit the iceberg, the stewards wake the passengers. They don’t have much information, but they take it upon themselves to warn guests anyway. Their proximity to the situation prompts their timely advocacy. If everyone spoke up when people are in danger, it could save lives.
These passengers are not yet affected by the crisis, but they know it is coming. They listen to people at the lower levels and the staff. They act as allies and advocates, selflessly and proactively. Narrators of the musical, I like to think of this group as researchers or health professionals.
The upper class passengers were more concerned about their afternoon tea than the health of the greater good. The upper class passengers did not see enough evidence that the ship was sinking to be concerned. Therefore, this group was the last to see the effects of the iceberg. They did not heed the warnings and they ignored the cries for help. In some cases, they refused to believe there was a crisis and tended to “more pressing” issues. Later, some gained access to a private lifeboat (let’s call this health insurance), which lessened their worry and urgency. Others thought only of themselves as the lifeboats began to board.
Is there a percentage of people who have to be affected or die before the “upper deck” of our society takes the AMR crisis seriously? Thanks to research by organizations like the Cystic Fibrosis Foundation, we have evidence that CF patients (among others) need antibiotics.
Titanic’s builders marketed the ship as unsinkable, but they were aware of the ship’s flaws. They prioritized things like first-class passenger experience over lifeboats, a protocol that benefits everyone. In some cases, the ship’s administration went out of its way to grant access to certain passengers and deny it to others. Decisions like these left the ship and its passengers vulnerable.
Often people think that the AMR crisis will not affect them. Then suddenly it does. I don’t want to mourn the loss of more people. If we can save the sinking ship, we must.
Think of the workers and those below deck whose need for antibiotics is beyond their control. Think of the stewards who went out of their way to spread a word of warning. Think of the upper class people who chose to believe there was no crisis. We can prevent another tragedy, but it will take us all. In the words of the stewards aboard the Titanic: “Wake up! Wake up!”
In my next column, I will discuss the Pasteur Law and the importance of antibiotic-related advocacy.
Note: Cystic Fibrosis News Today is solely a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of anything you have read on this website. The opinions expressed in this column are not those of Cystic Fibrosis News Today or its parent company, BioNews, and are intended to stimulate discussion on issues related to cystic fibrosis.