The year 1994 witnessed the birth of a new literary subgenre: the microbiological horror story.

It was inaugurated and defined by two bestselling nonfiction books, Richard Preston's The Hot Zone (whose takeaway message was that with Ebola, Marburg and other emerging viruses, "the earth is mounting an immune response against the human species") and Laurie Garrett's The Coming Plague (whose equally cheerful assessment was that in the war between microbes and modern medicine, "the microbes were winning").

The Killers Within, by Michael Shnayerson, a staff writer at Vanity Fair, and Mark Plotkin, an ethnobotanist, is the latest contender in this burgeoning field. The book tells the story of antibiotic-resistant bacteria, and essentially reargues Garrett's thesis, claiming that if we humans aren't sufficiently careful in the future, "The microbes [will] win." In support of this argument, the authors show how the overuse, misuse and even the proper use of antibiotics have caused disease microbes to evolve defenses that make them immune to the antibiotics that had once killed them.

The mechanism involved is simplicity itself - Darwinian selection. While a given antibiotic is busy killing off pathogens, some of the bacteria undergo mutations that enable them to escape the lethal force of the drug. These mutant bacteria survive, prosper and multiply, and then wage a renewed assault on their host. Because the new strain of the old microbe is now immune to the original drug, another type of antibiotic must be used against it, whereupon the process starts all over again. Sooner or later, it appears, we are doomed . . . so goes the story as told by Shnayerson and Plotkin.

Theirs is generally an exciting narrative. And, in an effort at fairness, the book does give voice to the loyal opposition, i.e., those microbiologists who are not so sure as the authors seem to be that the rise of drug-resistant bacteria is just possibly, "the eventual cause of the extermination of human beings from the planet."

But there is ample reason to doubt the truth of such conclusions. For one thing, although microbes mutate, not all mutations are advantageous to the organism, and many wind up killing it. Indeed, not all bacteria have followed the canonical script to drug-resistance.

The global medical community is aware of the problem, and physicians are revising their drug-prescribing practices accordingly. Pharmaceutical companies are developing new antibiotics, some of which may kill all targeted organisms before they have a chance to develop drug resistance.

Finally, there are new therapies, well-described by the authors, which do not rely on antibiotics, but instead make use of naturally occurring viruses that kill bacteria.

So is the rise of drug-resistant bacteria yet another catastrophe for us to have nightmares about, along with terrorist attacks and visions of resurrected Elvis clones? No.

The Washington Post