Last Days of the Wonder Drugs

But why? The answer involves equal parts complacency, economics, and simply the nature of nature. It's been known that bacteria can become resistant to antibiotics almost since the first one, penicillin, was discovered seven decades ago. In 1928, Alexander Fleming, a Scottish bacteriologist working in London, returned from a trip and noticed that one of his laboratory dishes containing colonies of Staphylococcus aureus was overgrown with mold. Instead of discarding the seemingly useless dish, Fleming made a historic decision: he examined it. All the staph around the mold was dead. The mold, he found, was secreting yellow drops of liquid that killed the bacteria. He had stumbled onto the first antibiotic. He called it penicillin, from Penicillium notatum, the name of the mold.

It wasn't until 1944 that penicillin could be produced in large enough quantities to make a difference, but what a difference it made: for the first time it became possible to cure deadly bacterial diseases that had plagued humans throughout history. "It was as if Prometheus had stolen fire from the gods," writes Levy in his book The Antibiotic Paradox. "The applications of this wonder drug seemed all but limitless." Soon other antibiotics followed. Medicine had entered a golden age.

Almost immediately, however, researchers noticed that previously vanquished bacteria could suddenly withstand the wonder drugs. Fleming himself observed that some bugs were beginning to evade his penicillin. Later, during the second clinical trial of the drug in 1943, one of 15 patients died from a strep infection because the microbe had become resistant to the antibiotic. And by the 1950s, epidemics of infection caused by resistant staph showed up in U.S. hospitals. But few people seemed to care.

"Geneticists certainly talked about the problem, but nobody was going to do anything about it until it slapped you in the face," recalls Rockefeller University molecular geneticist Joshua Lederberg, who has consulted for the pharmaceutical industry since the 1950s. "There were enough instances of the occurrence of resistance in this, that, and the other place, but it didn't seem that urgent."

IN THE MID-1970S, TWO DANGEROUS bugs almost simultaneously became resistant to penicillin: Haemophilus influenzae, which induces respiratory infections, and Neisseria gonorrhoeae, the cause of the venereal disease gonorrhea. In fact, not only did they become resistant but they developed the ability to flat out destroy the drug. And both bacteria displayed the very same resistance gene--most likely it had been transferred to them from bacteria living in the gastrointestinal tract. Gonorrhea resistance was initially discovered in the Philippines in servicemen suffering from venereal disease. From there, it was traced to prostitutes in Vietnam who had been given penicillin regularly as a precautionary measure. That overexposure engendered resistance. Today every country in the world is bedeviled by drug-resistant gonorrhea.