The (confusing!) language of AMR: ChatGPT tries to help!

You don’t have to be a linguist to realize that translation is going to be a big deal! Some of those phrases are really long!

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Part 2. Metaphor is a powerful tool

If those terms are so inadequate, are there other options? In her lecture at Uppsala Antibiotic Days, Eva turned to a 2011 PLoS One paper by Thibodeau and Boroditsky. Entitled “Metaphors we think with: the role of metaphor in reasoning,” this paper shows that even brief use of metaphor can strongly influence thinking and behavior. She noted, for example, that likening COVID-19 to smoke conveyed a message of “better ventilation is a good idea!”

So, to that end, she mused about the possibility of finding metaphors to convey the ideas of antibiotic resistance (ok, I will try to stop using AMR!).

Two metaphors that we already have are “Antibiotics are the Fire Extinguishers of Medicine” and “Diagnostics are the Smoke Detectors of Medicine.” I’ve found these to be very useful for English-language speakers, but will these translate to all settings? Unknown … and needs to be examined!

We don’t (yet) have any new answers but excitingly Eva and Marc Mendelson (the lead author of paper #3 cited above) are now starting a project called the ALARM Study: Advancing health Literacy about Antimicrobial Resistance through use of Metaphor. Great idea!

Eva and Marc are keen to involve stakeholders in their research. In fact, they’ll be conducting a so-called Delphi study, which will involve an expert stakeholder panel rating existing metaphor ideas and contributing their own suggestions. If you’d like to get involved or learn more about the project, please check out the project site (https://le.ac.uk/psychology-vision-sciences/research/health-and-wellbeing/alarm) or email Eva directly at emk12@le.ac.uk.


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Part 3. ChatGPT got creative with this!

OK, so I’ll admit I got very excited about this lecture and idea of metaphor. Seeking a bit of inspiration, I turned to ChatGPT and asked it for help! The full transcript is below my signature but here’s the summary:

1. Explain antimicrobial resistance using a metaphor
   1. Medieval kingdom under siege
   2. Garden infested with weeds
   3. City overrun by crime
   4. Computer under attack by viruses and malware
2. Give me some alternative metaphors to describe antibiotics
   1. The repair crew for your city
   2. A team of pest exterminators
   3. Snowplows
   4. And it was interesting that for all 3 of these, ChatGPT extended its text to talk about failure of (say) the repair crew as a metaphor for antibiotic resistance
3. Give me some alternative metaphors for diagnostics
   1. The compass of medicine
   2. The roadmaps of medicine
   3. The detectives of medicine

Fascinating! Snowplows and kingdoms under siege didn’t do much for me but I rather liked the idea of diagnostics as a compass or map … I can see this as telling you which to go to become well. In that metaphor, you then choose a particular road (antibiotic) for your journey. Is antibiotic resistance then a washed-out road? Hmmm. Getting pretty complicated here!

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Part 4. Closing comments

Well, that was a sobering diversion! AMR is not a good phrase for lay audiences, but to some extent we are stuck with it in the technical literature. I don’t think, for example, that I am going to rename AMR.Solutions!

But, I do think we should look hard for better communication vehicles and I am excited for the project that Eva and Marc are undertaking! And if this interests you, then please reach out to help them per the details above.

And with that, we come to a close in our consideration of the:

Metaphorically yours,  –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

Metaphors for antimicrobial resistance
[Me] Explain antimicrobial resistance using a metaphor.
 
[ChatGPT] Imagine a medieval kingdom under siege. The kingdom represents the human body, and the invaders are harmful bacteria. The kingdom’s defenses are the antibiotics. Initially, these antibiotics are like highly skilled knights who can defeat the invaders with ease.
 
However, over time, the invaders start to adapt. They learn the knights’ fighting techniques and develop armor and tactics to counter them. This adaptation is akin to bacteria developing resistance to antibiotics. The once effective knights (antibiotics) now find it harder to win battles, as the invaders (bacteria) have become stronger and more resilient.
 
Eventually, if the invaders continue to evolve and the kingdom doesn’t develop new strategies (like new antibiotics or treatments), the defenses will fail, leading to the kingdom being overrun. Similarly, without effective antibiotics, bacterial infections become much harder to treat, posing a significant threat to health.
 
 
[Me] Can you give me another for antimicrobial resistance?
 
[ChatGPT] Sure, think of a garden infested with weeds. The gardener uses a special herbicide to kill the weeds, which represents antibiotics fighting bacteria. Initially, the herbicide works well, and the weeds are kept under control.
 
However, some of the weeds start to develop a resistance to the herbicide. They mutate and become tougher, able to survive despite the gardener’s efforts. Over time, these resistant weeds spread, and the herbicide becomes less effective. The gardener has to use more herbicide or switch to a stronger one, but the weeds keep adapting.
 
If the gardener can’t find new ways to combat these resistant weeds, they will overrun the garden, just as drug-resistant bacteria can overrun the human body if new treatments aren’t developed.
 
 
[Me] Love it! Can you think of another?
 
[ChatGPT] Imagine a city with a powerful security system designed to catch and stop thieves, representing antibiotics targeting bacteria. In the beginning, the security system works perfectly, catching almost every thief that tries to break in.
 
However, over time, some thieves learn to bypass the security measures. They become more cunning, finding ways to sneak past cameras, disable alarms, and avoid detection. These smarter thieves are like bacteria developing resistance to antibiotics.
 
As more thieves learn these tricks, the security system becomes less effective. The city has to upgrade its security, but the thieves keep adapting to the new measures. Eventually, if the security system can’t keep up with the increasingly clever thieves, the city will be overrun by crime, much like how infections can become uncontrollable when bacteria become resistant to antibiotics.
 
 
[Me] Those are great! Can you think of a 4th metaphor for antibiotic resistance?
 
[ChatGPT] Sure! Picture a computer system that is constantly under threat from viruses and malware. The system has a robust antivirus software (antibiotics) that initially detects and eliminates these threats efficiently.
 
However, the malware creators are always looking for ways to outsmart the antivirus software. They develop new, more sophisticated versions of their malware that can evade detection. This process is similar to bacteria developing resistance to antibiotics.
 
As the malware evolves, the antivirus software struggles to keep up. The malware starts infiltrating the system more frequently, causing disruptions and damage. If the antivirus software isn’t updated or new protective measures aren’t developed, the computer system will become increasingly vulnerable to these persistent threats. This mirrors how bacteria can become resistant to antibiotics, making infections harder to treat.
 
 
The fire extinguishers of medicine
[Me] It’s been said that antibiotics are like fire extinguishers. Can you think of another metaphor to describe antibiotics?
 
[ChatGPT] Certainly! Think of antibiotics as a specialized repair crew for a city’s infrastructure. The city (your body) occasionally experiences damage from natural disasters like storms or earthquakes, which represent bacterial infections.
 
When a disaster strikes, the repair crew (antibiotics) is dispatched to fix the damage and restore the city to its normal functioning state. They are highly effective and efficient at their job, quickly repairing roads, buildings, and utilities.
 
However, if these natural disasters become more frequent or severe (more resistant bacteria), the repair crew has to work harder and longer. If the repair crew encounters damage they’ve never seen before and for which they don’t have the right tools or knowledge (antibiotic resistance), they struggle to make repairs. Over time, without new tools or methods, the city’s infrastructure may deteriorate beyond what the current repair crew can handle, leading to widespread disruption and decay. This is similar to how infections become difficult to treat as bacteria develop resistance to antibiotics.
 
 
[Me] Great! Can you think of a 2nd metaphor to describe antibiotics?
 
[ChatGPT] Certainly! Imagine antibiotics as a team of expert exterminators in a large house, where the house represents the human body and pests represent bacterial infections.
 
When the house gets infested with pests, the exterminators are called in to eliminate them. Initially, they have the perfect tools and methods to get rid of the pests effectively.
 
However, some of the pests start to adapt and become resistant to the extermination methods. They find new hiding spots, develop immunity to the chemicals used, and multiply despite the exterminators’ efforts. This adaptation is akin to bacteria developing resistance to antibiotics.
 
As the pests become more resilient, the exterminators have to use stronger chemicals or find new techniques, but the pests keep evolving. If the exterminators can’t keep up with the increasingly resistant pests, the infestation will grow, making it much harder to control. Similarly, bacteria that become resistant to antibiotics make infections more challenging to treat.
 
 
[Me] Ok! Do you have one more?
 
[ChatGPT] Of course! Think of antibiotics as a fleet of snowplows tasked with clearing the roads in a city during a heavy snowfall, where the snow represents bacterial infections.
 
When a snowstorm hits, the snowplows are deployed to clear the streets, ensuring that traffic can move freely and safely. Initially, the snowplows are very effective, quickly removing the snow and keeping the roads clear.
 
However, over time, the snowstorms start to change. They become more intense and produce a type of snow that is harder for the plows to handle. This change in the snow represents bacteria becoming resistant to antibiotics.
 
As the snowstorms continue to evolve, the snowplows struggle to keep the roads clear. They may need to work longer hours or use new techniques and equipment. If the snowplows can’t adapt to the increasingly difficult conditions, the roads will become impassable, causing significant disruption. Similarly, as bacteria become resistant to antibiotics, treating infections becomes much more challenging.
 
 
Diagnostics are the smoke detectors of Medicine
[Me] It had been said that diagnostic tests are the smoke detectors of medicine. Can you think of another metaphor to describe diagnostics tests?
 
[ChatGPT] Diagnostic tests can also be thought of as the “compass” of medicine, guiding healthcare professionals toward the right diagnosis and treatment direction.
 
 
[Me] That’s great! Can you think of another metaphor for diagnostic testing?
 
[ChatGPT] Diagnostic tests can also be considered the “roadmaps” of medicine, helping doctors navigate through symptoms and signs to reach the accurate diagnosis and optimal treatment plan.
 
 
[Me] Ok! Can you think of a 3rd metaphor for diagnostic testing?
 
[ChatGPT] Certainly! Diagnostic tests could be likened to “detectives” in medicine, uncovering clues and piecing together evidence to solve the mystery of a patient’s condition.
 


Further resources
While researching this newsletter, I also found these fascinating articles:

1. Haenssgen MJ, Charoenboon N, Zanello G, et al. Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia. BMJ Open. 2019 Aug 20;9(8):e028224. https://doi.org/10.1136/bmjopen-2018-028224. PMID: 31434769; PMCID: PMC6707701.
2. Charoenboon, N., Haenssgen, M.J., Warapikuptanun, P. et al. Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages. Palgrave Commun 5, 23 (2019). https://doi.org/10.1057/s41599-019-0226-9.
3. Djerf-Pierre, M., & Lindgren, M. (2021). Making sense of “superbugs” on YouTube: A storytelling approach. Public Understanding of Science, 30(5), 535-551. https://doi.org/10.1177/0963662521989251.