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Last Days of the Wonder Drugs

Discover, Nov, 1998 by Peter Radetsky

Years of overconfidence made us vulnerable. Now, in the deadly arms race between people and bacteria, the bugs are winning.

WELLS SHOEMAKER IS A pediatrician in a small California town. Not too long ago he saw a patient new to the area, a little boy with a runny nose.

"It's the same story every time," his mother complained. "He starts out with a cold, and then his nose starts running green stuff, and then he gets an ear infection. He's only two years old, and he's already had four ear infections."

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Shoemaker examined the child. He had a cold, all right, but his nasal fluid was clear, and he had no fever or bulging eardrums. No hint of an ear infection or any other bacterial attack. As Shoemaker offered his diagnosis, the mother interrupted: "The only thing that keeps him from getting an ear infection is antibiotics. My previous doctor used to give him antibiotics at the beginning of a cold. They worked great!"

"Antibiotics fight bacteria," Shoemaker explained. "Your son's cold is caused by a virus. He doesn't have an ear infection. But let's keep close tabs, and if he does begin to develop an infection, then we can turn to an antibiotic."

"But sometimes the doctor just prescribed them over the phone."

"Well, an antibiotic might prevent an infection, but it might not. It could even make way for a more aggressive germ that might cause an ear infection from hell. Then we'd have to resort to very, very powerful drugs with unpleasant side effects that have to be given by injection."

By this time the mother had heard enough. "I don't care! I know my child better than you do. I want antibiotics now!"

"I can't give them to you," Shoemaker replied. "In all good conscience, I just can't."

"Then I'm going to find another doctor, a doctor who cares about children!"

STUART LEVY WOULD HAVE been proud of the beleaguered pediatrician. Levy, a Tufts University School of Medicine microbiologist, is one of the world's loudest voices decrying the misuse of antibiotics. He writes books and articles about the problem, researches it in the lab, organizes conferences about it, presents it on TV. He's the founder of a worldwide network called the Alliance for the Prudent Use of Antibiotics. "We're in the midst of a crisis," he says, his baritone rising an octave. "We have to change things."

The mother's conduct at the clinic was typical of what Levy laments: a patient demanding antibiotics for an illness that doesn't require them. What was not typical was that Shoemaker refused to give in. Many doctors do. And, like the child's previous pediatrician, many prescribe without ever being asked--even if antibiotics are not a suitable treatment. "At least half the human use of antibiotics in the United States is unnecessary or inappropriate," Levy says. "Either antibiotics are not indicated at all, or the wrong antibiotic is prescribed, or it's the wrong dosage or the wrong duration."

That leads to a lot of unneeded drags. More than 50 million pounds of antibiotics are produced in the United States every year. Some 40 percent of that total is given to animals, mostly to promote growth rather than treat disease. Antibiotic use is also rampant in agriculture--for example, the drugs are sprayed onto fruit trees to control bacterial infections. Another little-recognized application is in antibacterial household cleaning products, soaps, toothpaste, and even plastic toys and cutting boards, which incorporate bacteria-killing substances too potent to be used in the body. The upshot of this massive exposure is the increasingly familiar predicament the world now faces: disease-causing bugs that resist the drugs that once thwarted them. We are experiencing an alarming resurgence of common but no longer curable infections from bugs that developed their resistance in our antibiotic-filled bodies, in animals, in fields, even on our antibacterial-soaked kitchen counters. It's what Levy calls "the antibiotic paradox." The miracle drugs themselves are destroying the miracle. And it may be too late to do much about it.

The magnitude of the problem is startling. At least two dozen different kinds of bacteria have developed resistance to one or more antibiotics. Some strains of three life-threatening species--the blood poisoners Enterococcus faecalis and Pseudomonas aeruginosa, and Mycobacterium tuberculosis, the TB bug--now frustrate every single antibiotic known, more than 100 different drugs. Ubiquitous pathogens such as Streptococcus, Staphylococcus, and Pneumococcus, which among them cause ear, nose, and throat infections, scarlet fever, meningitis, and pneumonia, are becoming widely resistant. The possibility that these common childhood diseases might become completely unresponsive to treatment is a physician's--and a parent's--nightmare.

Hospital records suggest the scope of the problem. While there are no figures on how many people enter hospitals already infected, over 2 million fall prey to microbes once they get there, in this country alone. Some 90,000 die. About 70 percent of those are infected by drug-resistant bacteria. Costs for treatment of these infections approach $5 billion a year. Overall, the yearly toll exacted by drug-resistant infections in the United States is estimated to exceed $30 billion. "The multiresistant organisms of the 1990s are a grim warning of the possibility of the post-antibiotic era," states the Centers for Disease Control and Prevention (CDC) in Atlanta.

Last Days of the Wonder Drugs

Discover, Nov, 1998 by Peter Radetsky

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