Antibiotics: Medicine’s Double-Edged Sword
“Misuse and overuse of antibiotics are now threatening to undo all their early promises and success in curing disease. But now the greatest threat is complacency… Action must start now, if we are not to return to the bad old days of incurable diseases before antibiotics were available”
-Lord Soulsby, House of Lords Select Committee on Resistance toAntibiotics, 19981.
Throughout the last half century, medicine has been transformed by a neglected revolution of bacteria resistant to the miracle drugs of our era: the antibiotics. Now, physicians worldwide are being confronted with the problem of curing patients with bacterial infections resistant to most antibiotic remedies, and resistant organisms are running rampant and creating trouble forpublic health officials and disease control specialists. Despite our quickly worsening situation response has been weak, and in many countries “a virtual paralysis against effective action has prevailed”2. How is it that after over fifty years of knowing that the unyielding use of antibiotics could cause problems, our policies regarding antibiotic resistance reflect the idea that we were taken bysurprise? Why have some countries successfully stymied the emergence of resistant bacteria, while others are meeting with disaster? I will discuss the history of the once euphemistically called “Age of the Miracle Drug” to evaluate why antibiotics emerged with such force as the glorified “magic bullet” of medicine, and how the ensuing rise of resistant bacteria that still plagues us today arose andcould have been avoided3. I will also scrutinize the efficacy of interventions that have already been attempted, and the possibility of current strategies working if proper motivation existed. Finally, I will propose solutions to hinder the demise of the usefulness of antibiotics, in the hope that in the future antibiotics can once again be viewed as medical success in lieu of medical excess.References to the healing powers of penicillin date back to Hyssop plants in the Old Testament that people were recorded to have used for healing4. While historical data imply that antibiotic derivatives have always been used to remedy the sick, it wasn’t until the 1900s that scientists discovered the true potential of antibiotics. In the 1920s while studying the antibacterial properties ofdifferent substances, the Scottish scientist Alexander Fleming was particularly surprised by Penecillin notatum, a mold that inhibited pathogenic bacteria more potently than anything he had studied5. As Fleming witnessed before him “a phenomenon where one organism was targeting the destruction of others around it to improve its own chances of survival”, he associated it with a similar process that hadbeen named “antibiosis” by the French scientist Viullemin6. As such, Penecillin was dubbed the first “antibiotic” by Fleming in 19297. Unfortunately, Fleming did not do a particularly stellar job of relaying the importance of his discovery, so it took the ensuing decades and the support of other scientists for antibiotics to become commercially available. However, when the idea finally did hitindustry in the 1940s, a “seemingly endless flow of new antibacterial agents… of genuine benefit in helping to transform the treatment of infectious disease” was produced8. Obviously, pharmaceutical and chemical firms did not waste time in investing in research for a field that had the word lucrative written all over it. This was despite the warning by Fleming himself in 1942 that “some germs weregoing to prove resistant to antibiotic effects”9. His pleas and those of a few others fell on deaf ears as practically every new antibiotic from the period of 1942 to 1958 was “heralded as part of the growing consortium of wonder drugs that promised to halt the few remaining infectious diseases that had been the scourge of previous civilizations”10.
By the mid 1940s the antibiotic “magic bullets”...
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