Antibiotic Abuse — We Are Creating Monster Epidemics

I remember when I was very tiny, getting a TB (tuberculosis) skin test as part of some public school campaign.  It was negative.  My parents were pleased with me, but they never had any doubts that I would be “clean.”  They said something about poor people with poor hygiene being at risk, but not nice middle class folks like us.  No problem.

Fast forward to a far more vivid memory.  I had to get another TB test in France when I attended medical school there.  It was a hassle, as I had to get someone to take class notes for me while I went to a cavernous and overwhelming public health office.

I was in line with all the rest of the “aliens” as the laws required me to be.  There were people who looked more terrified than I — young mothers from North Africa with four or five young children orbiting around them like out-of-control satellites.  Unlike this frightened young lady, at least I knew what they were going to do to me — even though I was only a first year med student.  They called it a “scarification.”

There was a very petite nurse who had to reach up to give me some scratched parallel lines on my left shoulder.  It was the BCG, the “Bacille de Calmette et Guerin.”  They told me that it was a strain of tuberculosis that had been developed in Lille, a few miles to the north of Amiens where I was, and that it was a gift to the world.  It was a benign form of tuberculosis that would give me immunity.

I remember the municipal health official, who learned I was an American studying medicine in Amiens and gave me many warm wishes of good luck, as well as wishing that God would have mercy on my soul, as I was in for all sorts of “hell.”  I had to return to get a skin test and to have it read, a ritual which would prove the immunity had “taken.”  It did.

I was set up for a lifetime where many future skin tests showed false positive, which forced me to get chest x-rays every time I got a new job.  To complicate matters, as I am a fairly restless soul in terms of moving about and tackling new things in life, there were lots of X-rays, and a “shadow” which I believe to have been a primo-infection of histoplasmosis I picked up in Cincinnati, OH and which, like all of this, was totally benign.

But the BCG was a very good idea, as I did a brief rotation in a service called “pneumophtisiologie” which basically was a tuberculosis service.  People coming from other countries brought in a couple of dozen cases a week.  There were antibiotics for those who had it and for those who were exposed.

Although the antibiotics sometimes had side effects, there was a feeling that if we could get the people as they came to la belle France, it could be controlled, and things pretty well were.  But when I came back to the states to practice and went through the chest X-rays (In the early 80’s I simply carried my own chest X-ray in the back of my car, to show people how lovely and clear it was) people laughed at me, and told me I had gone to medical school where things were “primitive,” and in the States we did not use the BCG because we had fought the good war, and infectious diseases were pretty much eradicated.

Flash forward a couple of decades, and I had relocated to Southern California. San Diego has the busiest international border crossing in the world, a portal joining Tijuana, Mexico to this fair city.  I heard some vague reports of people buying Mexican antibiotics without prescriptions, and how their self-medicating  for everything from STDs to the common cold was bringing about treatment-resistant strains of tuberculosis.

I knew that the infectious disease colleagues were dealing with drug resistances, but did not understand the current magnitude of the problem until I found this article: Yes, America once considered infectious diseases conquered.  Now they are not.  Part of the problem may have been buying antibiotics without prescriptions.  But we cannot blame this problem simply upon Mexican antibiotics.  I believe it is, however, a man-made problem.

First, on the patient side.  As much as I like natural substances when there is one that works, Tuberculosis is not in that realm at all.  Some well-meaning folks are dead-set against prescription drugs, claiming that they don’t address the root problem – they just mask the symptoms.

Not so with antibiotics – they kill bacteria dead.  That’s the root problem and it works well.  In fact, its one of the most important discoveries in the history of medicine.

There are treatments both for those who suffer from the disease and for those who have been exposed to it.  In prisons, where I spent a hunk of my practicing career, I have seen these treatments refused, time and time again.  Knowing what I know — if I had been exposed — I would take the treatment.

I have never heard any “logical” reason to decline treatment, just that somebody did not want drugs or pills.  I do not know how many people in other treatment populations react this way.  Maybe it has something to do with the informed consents involved.  I hate to take away anything that involves personal civil liberties, but public health is a serious consideration, and there may be something brewing in this sector, if things get worse.

Second, on the doctor side:  General and family practice have tough enough jobs functioning in our ridiculous health system, so I cannot actually blame them if they had some respiratory cases where they did not think of tuberculosis. After all, our national health system has had the incredible hubris to believe we had totally “licked” infectious disease.

Well, I am afraid that time is gone.  I hope and pray that the generalists, who have more than enough to remember, remember that everything we say we conquered, we haven’t.  I blame these general doctors more for a totally different reason.

Antibiotics have been used excessively and gratuitously.  “Broad spectrum” or general antibiotics may be very justified in someone who is at high infection risk.  But they are too often given out without culture or specific testing.  Too often they are given out to please a patient who thinks he or she has not gotten adequate treatment unless they can leave the doctor’s office with a prescription.

Well, what is really happening here is that organisms are “getting around” these antibiotic treatments.  They are becoming resistant.

Back when America started telling the world that infectious disease had been beaten, we knew relatively little about what is really going on inside the cell of a bacterium, let alone a virus.  DNA and RNA have ways of recombining.  And whenever something happens with the right combination, it lives, and what lives, multiplies.  It is a Darwin-type “survival of the fittest”.

Evolution is real and it exists and it is not about just us.  It is about “them” — organisms that are part of our world whether or not we choose to think about them.  And if they infect us, we darn well better think about them.

There was never anything primitive about my French medical education, or the care offered French patients.

I remember vividly my brilliant professor of Bacteriologie.  She told us that doctors over-prescribed antibiotics.  She told us that it was necessary, really necessary, to know that every time we wrote a prescription we needed to know we were not just writing for the patient sitting in front of us, although their health and well-being always had to be our first concern.  We were also writing prescriptions for the whole Earth.

So now, both the human race and the entirety of the Earth are really part of what has been referred to as a “ticking time bomb.”  Drug companies have been cloning new antibiotics from old ones.  But guess what — it is not possible to make lots of money developing new drugs in this sector so help is a long way off.

This one is going to take some creative solutions.  Right now we have national barriers and we sometimes have things like disinfection stations in waiting lines for supermarkets and restaurants and I suspect we will have new things, some of which work better than others.

The real problem is to start thinking in a new way.  HIV, malaria, anything known to be communicable seems to be on the rise.

As usual, Walt Disney rules.  There is a wonderful scene in “The Sword and the Stone” where Merlin is recreating himself as all kinds of animals to try to kill a dragon and nothing works.  Suddenly, when no other animal is visible, the dragon breaks out in a rash, and Merlin says he is a virus.  It works.

Personal beliefs are irrelevant.  Whether somebody “believes” in science or in a religious Armageddon is of no import whatsoever.  We are all made of human flesh and susceptible to the weaknesses and diseases this brings.  For individuals, I would suggest requesting referrals to an infectious disease specialist for diseases treated by multiple simultaneous medicines.

For simpler illnesses, buying over the counter antibiotics may not make you well and may make it impossible to treat later if you get resistant strains.  For any illness for which you see a doctor, find out as precisely as you can what medicine you are getting and why.  You deserve an explanation, and it may be more than the pharmacist can provide when you pick up your ‘scrip.

Nobody said that being human and living on earth was going to be easy.  Be a responsible, intelligent human.  Length and quality of life are important.  Know and be true to thyself, including your body.