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'Antibiotic resistance is due to a breakdown in communication’

An interview with Prof. Robert Clancy, Clinical Immunologist, University of Newcastle, Australia

Q: As an immunologist working on this whole issue for so many years and having so much experience, how do you look at the human body? If you had a third eye, which could look at microbes not just with a microscope but with the naked eye, what would the human body look like?

A: Yes, a very interesting question. The body would look like a very active-interactive organism. As a very large organism with lots of smaller organisms and we happen to call these smaller ones the microbes. And, there is a very active communication process between all the parties. In reality, the creation of antibiotic resistance and infections that are not responding to antibiotics are an outcome of the breakdown of this communication process.

Q: In that sense, it would look like an eco-system altogether?

A: Absolutely, absolutely. It is an eco-system. And, it is the perturbation or disturbance of the status of this eco-system that allows the unwanted outcomes.

Q: And do you think that the visualisation of the human body in ecosystem terms and not like what it is/as it is visible to the naked eye…would that make a difference in how people perceive microbes and perceive antibiotics, would that bring about a change in behaviour?

A: Yes, I think so. Most people, not just the people having antibiotics given to them but also the people who prescribe antibiotics, see antibiotics in a very narrow stage. They don’t see the use of antibiotics as really a small part of the management of the host-parasite relationship. I have spoken about the incredible importance of public health measures, and the incredible importance of immunisation strategies. And it has been those great breakthroughs in the latter part of the nineteenth century and in the early part of the twentieth century that have changed the face of infectious disease in our society.

Antibiotics changed in time and, of course, that made fantastic differences to individual infections. If you look at infections in terms of society, the number of infections occurring is much less and we must give credit to all these other interventions, and quite often, to non-medical changes, in creating a good outcome. And, I think that part of the antibiotic resistance problem has been created by us for ourselves.  Part of handling it is to go back and learn lessons from the past and add to those lessons the importance of maintaining the host capacity, to do the job itself.

And, if you put public health issues together with the immunisation issues and maintaining of the capacity of the body’s own mucosal surfaces to control the bacterial colonising processes, we can go an enormously long way to require much less by way of antibiotics and, as a result, much less of the emergence of antibiotic resistant strains of bacteria.

Q: In other words, do you think there are a large number of cases in which antibiotic use can be eliminated?

A: Absolutely. I am certain that many if not most of the situations that we see can be eliminated. But, in saying this, the process should be a generic approach from all of us. It is hard to look at an individual case where a particular person has a particular infection, may be, an artificial knee joint or when they are about to lose a leg. It is very hard to look and dissect these mechanisms in that particular case. But if you are to look at the bigger picture. In all those cases, you very often find a breakdown in terms of management strategies and you would know that they have not been properly adhered to.

Q: Could you please very briefly tell us about your specific area of work, on mucosal surfaces, and how that played a role in understanding this?

A: My interest over many years has been in understanding the control mechanisms of protection at the mucosal surfaces. I was part of a team some years back that described the communication systems between different mucosal systems of the body. My contribution is to look at the ways of manipulating that system for the benefit of the host and we found that by a very simple procedure of presenting killed bacteria to the ‘factory’ that makes the cells which go to various surfaces for protection purposes, those bacteria can stimulate a level of immunity that causes a vast reduction in the need to use antibiotics. So essentially we have adjusted this host-parasite relationship, that I was talking about, to the benefit of the host by maximising the protective mechanisms at those mucosal surfaces in a very safe, simple and effective manner. So that has been my passion.

One more thing. What I was talking about was specific activation of these protective mechanisms. Another area I have been interested in – and I think it is very underutilised – is the non-specific enhancement of these protective mechanisms. In my own case, we have been using normal bacteria that are harmless but in fact can provide help. These bacteria are called probiotics. These probiotics can be very effective in certain circumstances. But, unfortunately, there has not been a lot of interesting new research, and it is very hard to get a patent in probiotics.

I think the interest of this non-specific enhancement of mucosal protection, relates to many of the natural therapies produced in Ayurvedic medicine in India, the traditional Chinese medicines, the traditional aboriginal medicines in Australia, and aboriginal medicines in many of the developing nations around the world. These practices have been given scant attention and yet at times are the very essence of the active principles that we prepare and purify and synthesise in our own life and society. These traditional practices have been tested over many thousands of years sometimes and, I think, they provide very effective enhanced barriers for protection. And, it is very important for us to start rediscovering some of these important medication works.

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