The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics
Language: English
Pages: 328
ISBN: 1421415933
Format: PDF / Kindle (mobi) / ePub
In The Antibiotic Era, physician-historian Scott H. Podolsky narrates the far-reaching history of antibiotics, focusing particularly on reform efforts that attempted to fundamentally change how antibiotics are developed and prescribed. This sweeping chronicle reveals the struggles faced by crusading reformers from the 1940s onward as they advocated for a rational therapeutics at the crowded intersection of bugs and drugs, patients and doctors, industry and medical academia, and government and the media.
During the post–World War II "wonder drug" revolution, antibiotics were viewed as a panacea for mastering infectious disease. But from the beginning, critics raised concerns about irrational usage and overprescription. The first generation of antibiotic reformers focused on regulating the drug industry. The reforms they set in motion included the adoption of controlled clinical trials as the ultimate arbiters of therapeutic efficacy, the passage of the Kefauver-Harris amendments mandating proof of drug efficacy via well-controlled studies, and the empowering of the Food and Drug Administration to remove inefficacious drugs from the market. Despite such victories, no entity was empowered to rein in physicians who inappropriately prescribed, or overly prescribed, approved drugs.
Now, in an era of emerging bugs and receding drugs, discussions of antibiotic resistance focus on the need to develop novel antibiotics and the need for more appropriate prescription practices in the face of pharmaceutical marketing, pressure from patients, and the structural constraints that impede rational delivery of antibiotics worldwide. Concerns about the enduring utility of antibiotics―indeed, about a post-antibiotic era―are widespread, as evidenced by reports from the Centers for Disease Control and Prevention, academia, and popular media alike. Only by understanding the historical forces that have shaped our current situation, Podolsky argues, can we properly understand and frame our choices moving forward.
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social context, as, e.g., through the New York Academy of Medicine’s Institute of Social and Historical Medicine. See Iago Galdston, ed., The Impact of the Antibiotics on Medicine and Society (New York: International Universities Press, 1958). 141. Cf. Stephen Harbarth and Matthew H. Samore, “Antimicrobial Resistance Determinants and Future Control,” Emerging Infectious Diseases 11 (2005): 794, with Félix Martí-Ibañez, “The Next Half Century in Antibiotic Medicine and Its Effect on the History
Ruegsegger, 7/13/50, both in Box 15, “Lederle Laboratories, 1950–1952,” WSP. Such “interference” had been noted even in the pre-antibiotic era by researchers working with anti-trypanosomal chemotherapeutics; see C. H. Browning and R. Gulbranson, “An Interference Phenomenon in the Action of Chemotherapeutic Substances in Experimental Trypanosome Infections,” Journal of Pathology and Bacteriology 25 (1922): 395–97. 15. Mark H. Lepper and Harry F. Dowling, “Treatment of Pneumococcic Meningitis with
“Misuse of Antibiotics,” Wisconsin Medical Journal 51 (1952): 881. 13. Henry C. Sweany, “The Use and Misuse of Antimicrobials,” Missouri Medicine 53 (1956): 1068. 14. Dr. Covode, in “Use and Abuse of the Antibiotics,” 582. 15. Dr. Schaffer, in “Use and Abuse of Antibiotics: A Panel Discussion,” Journal of the South Carolina Medical Association 52 (1956): 35. 16. Erwin Neter, “Use and Abuse of Antibiotics,” Virginia Medical Monthly 81 (1954): 362. 17. For acknowledgments of patient pressure
and 1962.65 This represented both a question of interpretation regarding whether such drugs should be subjected to review and a question concerning the daunting logistics entailed in the actual evaluation of the drugs in the event of such a review. The 1962 amendments empowered the FDA to remove such drugs from the market only after October 10, 1964.66 However, because the FDA had long been empowered to approve the potency (which, as sometimes construed, implied efficacy) of certain antibiotics,
been vitiated. Indeed, Finland himself appears to have temporarily burned out much of his moral ardor with the passage of the Kefauver-Harris amendments in 1962. That year, the AMA’s Council on Drugs, with Harry Dowling on its roster, at last decided to wage a “campaign” against the “abuse of antibiotics.” Long-time collaborator Dowling wrote to Finland about the keynote article for the campaign, stating that “we all believe that you are the man to write this article, since you stand for ‘Mr.
