issue 165 - November 1986
Too much of a good thing
Antibiotics are perhaps the most reckless example of the misuse
of modern medicine to make a fast buck. David Gilbert explains.
Once upon a time the drug industry offered the world antibiotics; 'magic bullets' to cure infectious disease and save humanity. No longer need people suffer from bacteria-induced misery and ill-health. Thanks to laboratory research and the commitment of industry to human wellbeing, everybody would live happily ever after.
That's how the story began. But today it looks like there will be no happy ending as the wonder drugs are losing their potency through that same industry's over-promotion and the medications' subsequent misuse. For some bacteria are becoming resistant to the drugs that used to wipe them out and these are spreading. As these micro-organisms do not recognise national boundaries, we are all at risk.
When antibiotics fail to do their proper job, the consequences can be disastrous. Between 1968 and 1972 an outbreak of bacillary dysentery caused by an antibiotic-resistant strain led to thousands of deaths in Central America.
Often the bacteria resistant to treatment are strains that used to be relatively harmless but have become killers thanks to the misuse of antibiotics. Some drugs can eliminate competing bacteria, leaving the body vulnerable to previously naturally controlled bacteria strains.
Ironically those most at risk of infection could be those in medical institutions where antibiotics are widely used. The hospitals of eastern Australia have seen hundreds of patients infected and die since the late 1970s. Earlier this year British doctors were alarmed to discover a germ resistant to virtually all common antibiotics. Known as 'Super Staph' (or Methicillin-resistant staphylococcus aureus bacteria-MRSA), it has been found in at least 32 London hospitals and is already blamed for dozens of deaths. 'The potential is frightening,' believes Dr Richard Smith, assistant editor of the British Medical Journal. 'The bacteria are only susceptible to one antibiotic, vancomycin, and could eventually become resistant to that too.' If this happens then medicine may be put back 50 years to the days when even minor infections could kill.
The World Health Organization says that problems of bacterial resistance to antibiotics have been recorded in about 20 countries. 'The problem is global. . the result of widespread and indiscriminate use of antimicrobial drugs in man and animals.'
For all over the world antibiotics are given where they are not needed; for coughs and colds, fevers, diarrhoea and a host of other symptoms which the body's natural immunities would have dealt with. In the US in 1983, over half the three million people who saw doctors for the treatment of the common cold were given an antibiotic, wasting over $15 million, increasing the risk of side-effects and paving the way for the development of resistance.
The problems are worse in developing countries, The threat of infection through poverty, malnutrition and poor sanitation mean antibiotics have a huge role to play. However in reality things have gone outrageously wrong. Due to non-existent regulations, gross and irresponsible over-promotion and people's unreal expectations that there is a pill for every ill, there is the most appalling misuse of antibiotics for the mildest of complaints.
The examples are legion. According to the WHO, 'Antimicrobial drugs are not indicated for the routine treatment of acute diarrhoea.' They are of no therapeutic value, needlessly expensive and often harmful. Yet the drug industry flouts medical opinion all over the world by promoting antibiotics for diarrhoea. Nearly 65 per cent of antidiarrhoeals on the market in eight regions of the world contain antimicrobials, usually in irrational combination with other ingredients.
In Peru during 1983 the Italian firm, Carlo Erba, marketed a drug containing chloramphenicol and tetracycline in a formulation for children with chocolate flavouring as a treatment for diarrhoea. The drug, Quemiciclina, was so popular that it became known as 'Erba' or 'candy for diarrhoea'. However tetracycline should not be given to children under 12 and chloramphenicol is a potentially dangerous drug which should be reserved for the treatment of life-threatening infections. Yet in Georgetown, Guyana, one doctor was reported to have written nearly 60 prescriptions for chloramphenicol in a single afternoon.
There is no sign that the misuse will stop. For the industry apparently there is apparently no reason why it should. With sales of antibiotics topping $15,000 million a year and rising fast, too much is at stake. As fast as common-sense pharmaceutical controls are imposed in some markets, the corporation sales teams are transferring their efforts elsewhere. For instance while the tetracycline market is expected to decrease between 1980 and 1990 from $70 million to $47 million in the US and from $65 million to $51 million in Europe, in the rest of the world an increase is projected from $47 million to $74 million.
Such a grossly profligate use of a precious medical resource, leading to widespread resistance, has also fuelled industry's research into 'better' antibiotics. The myth is that research and development will solve the problem by producing 'wonder drugs' to beat the 'super bugs'. We should not be so easily fooled. Since misuse is the problem, stopping it is the answer. Yet the logic of the marketplace means that industry has shown no sign of self-restraint in marketing new antibiotics.
Where a particularly virulent strain of MRSA bacteria swept through the wards at the Royal Melbourne Hospital in Australia, Dr Harvey, the Director of Microbiology commented, 'We may look back at the antibiotic era as just a passing phase in the history of medicine, an era in which a great natural resource was squandered and where the bugs proved smarter than the scientist' And the pharmaceutical industry might be proved the least smart of all, ending up as the bug's best friend... and ruining the end to the fairy story.
The Information in this article is based on Problem Drugs by Andrew Chetley and David Gilbert,
Health Action International, The Hague, 1986.