Peter Kelly
A NUMBER of years ago, I was working with a newly qualified pharmacist in Ireland. Academically this girl was very impressive. She got full marks in her school exams before acing her way through her pharmacy degree. On completion of that degree, she was offered a two-year scholarship to study for a postgraduate degree which included a living expenses grant. It is safe to assume that this girl is in the top percentage of intelligent people in the world.
One day she came to work with cough and cold symptoms. Upon discussion, we decided that she had a virus and that all she needed to do was drink plenty of water and rest and relax as much as possible and all would be better in a week.
Much to my surprise, the next day she arrived to work a few hours late, clutching a prescription from a doctor. The doctors’ appointment cost her 50 euros.
She said the doctor, agreed with her assessment that she had a virus, however he had provided her with a prescription for an antibiotic ‘just in case’.
At the time I joked with her that she must be cheating in her exams and that she had just wasted 50 euros for nothing. She told me that she agreed with me and that she felt slightly embarrassed. She then asked if I would dispense the prescription for her. I laughed said I would and told her that she was just throwing good money after bad. The antibiotics cost her 14 euros.
I asked her, was she going to take the antibiotics? She said yes. I said, what about antibiotic resistance? She said, she knew she shouldn’t take them, but with a resigned shrug, she said she was going to take them ‘just in case’.
Antibiotics have zero effect against viruses. The overwhelming, vast majority of the time you get a cough, cold or a sore throat, it is caused by a virus. You do not need treatment. You do not need to see a doctor. You need to drink plenty of water, rest and relax as much as you can and your body will sort it out. Do this and you will be right as rain in a weeks’ time. Better still, follow my 5 Simple Steps to Healthy Living, and you may avoid getting viruses in the first place.
The scenario I described above of a patient with a virus going to see a doctor to get an antibiotic happens every single day in every single surgery in the UK. Everybody who works in health knows that giving out antibiotics for viruses is a waste of time, is a waste of money and is a waste of precious resources. But worse than that, it is dangerous. It is dangerous to the public health of everybody on the planet. It puts my life at risk, it puts your life at risk. It puts everybody in your families’ lives at risk, it puts every single one of your Facebook friends at risk, regardless of where they live in the World.
I am being, a little overdramatic here but I am not wrong, because I am talking about antibiotic resistance.
We are in a perpetual war with bacteria. We kill them with drugs, they kill us with infections. And by and large in modern times, we have been winning that war but we got sloppy and we forgot just how formidable an enemy bacteria are.
The black death killed at least 25 million people in Europe in the 1300s, TB killed a quarter of Europes’ population in the 19th century and a recent UK Government review predicts that if we carry on as we are, antibiotic resistance or ‘superbugs’ are they are sometimes called will kill 10 million people per year by 2050.
So what can we do?
We need to invest now and develop new antibiotics. There has been talk of this for a while and there is some political will, but what we need is serious action, leadership and investment sooner rather than later.
The other thing we need to do is, change the culture of overusing antibiotics and particularly the inappropriate and unnecessary use of antibiotics.
How do we do that?
There have been many feeble attempts in the past to curb the use of antibiotics for viruses. Everybody who works in health knows about this problem and has done for decades. So maybe the solution is simple is it is the doctors fault, they write the prescription, we should punish the doctors until they stop. The truth is, it’s not that simple and I have a lot of sympathy for doctors in this situation. They are under huge pressure from the public to supply a remedy to treat their illnesses.
Coughs, colds, sore throats, insect bites, eye infections, strains, sprains, sore knees, spots, cold-sores etc etc etc, will go away in roughly a week regardless of whether you see a doctor, get a prescription, do nothing, see a witch doctor, book a session of acupuncture or take an antibiotic.
This is a universal truth known amongst healthcare workers, however we can’t convince people to do what we do when we have an ailment, give it a week and see what happens. If it goes great, if not seek professional advice. Sometimes we can’t even convince ourselves, as my example earlier showed.
I believe the reason is that drug companies persuade the population that need treatment for illnesses ASAP. This wastes loads of resources and is a major factor, although not the only one, in the alarming development of antibiotic resistance. We need to change this culture before events like the black death go from being a possibility to being a probability.
Therefore, I believe we need to ban drug companies from marketing and advertising their products.
Peter Kelly is a pharmacist based in London. He recently started a public health campaign, ‘5 Simple Steps to Healthy Living.’ He runs healthy living workshops in London Colleges with his friend and qualified personal trainer Shea Jozana, you can follow their progress on the Facebook page: The friendly pharmacist
A tenuous link perhaps – I don’t fully understand how the author drastically drew this particular conclusion. Maybe he could follow up with more detail? For example, the point that new antibiotics must be developed is touched on; what incentives are there for drug companies to make such a thing if they cannot market their new product to patients?
Thanks for your comment. A follow-up article will be published later this month, which may address some of the issues you raise.
A tenuous link to make – perhaps the author could elaborate further on how he drastically draws this conclusion? I fully agree with the content of the article but don’t understand why the last paragraph about banning marketing is necessary to achieve this. He makes a very good point of the need to develop new antibiotics but what incentives would they have to do this if they can’t then promote their product?
One of the proposals to encourage drug companies to develop new antibiotics is for countries to put up prize money for the development of new antibiotics. And you would pay the company not to use the antibiotic.
For me, the lack of development of new antibiotics is an unintended consequences of a free market capitalise political and economic system. If governments were more powerful and able to properly tax large corporations , they could invest more money in R and D in universities and the universities could develop new antibiotics.
Advertising and marketing creates demand. It has been drilled into the public that when you get ill you need to take medicine. This is good for business but bad for antibiotic resistance. The whole point of creating drugs was to reduced fatalities from infectious diseases. If we have unwittingly created a system of production and distribution of drugs that is contributing to an increase in fatalities of infectious disease maybe we should consider altering the system.
Thanks for clarifying that! Just a further thought: there are more left-wing governments in the world; if your point about taxation stands, why have these nations not already have developed stronger antibiotics? Or is the dominance of multinationals too great and global bodies such as WHO too weak? Following on from this – would sufficient funding be able to be achieved if multinationals were not as dominant as they are?
ok let me try and explain my position here.
At this moment in time, I believe our economic policies in the Western world are very right wing. We have austerity economics which means reduced funding for public institutions such as Universities. At the same time there is widespread practice, acceptance and tolerance of tax avoidance schemes. According to research for the TUC by campaigning chartered accountant Richard Murphy, British businesses and wealthy individuals avoid paying £25 billion worth of tax each year.
Why is this bad for the development of new antibiotics?
If we look at the history of antibiotic discoveries, we will see that while drug companies have played a role, Universities, public institutes and other non profit institues have played arguably a more important role.
Penicillin (Public Institutions)
In 1928 Alexander Fleming discovered the antibacterial properties of Penicillin working at St. Mary’s Hospital in London.
Australian pathologist Howard Florey and German refugee biochemist Ernst Chain used Flemings findings to turn Penicillin into a usable drug whilst working at Oxford University.
Prontosil (Drug Company)
In 1935 Gerhard Domagk, director of experimental pathology at IG Farben in Germany discovered the antibacterial properties of Prontosil. It must be mentioned here that he initially withheld publishing his results for patent-protection reasons. Drug companies for obvious reason don’t like sharing their acquired knowledge and findings with others.
Sulfanilamide (non- profit private institute)
in 1935 French medicinal chemist Ernest Fourneau showed that in living organisms the inactive Prontosil is converted to Sulfanilamide, an active antibacterial drug.
Unlike Prontosil, Sulfanilamide was cheaper, had fewer side effects, did not impart a red colour to skin and was not subject to patent restrictions.
Sulfanilamide had a simple chemical structure that was highly amenable to being modified into other sulfa drugs that were less toxic and could treat a wider range of infectious diseases. Before the availability of penicillin in the 1940s, sulfas were the best antibacterials available.
Streptomycin (public institute)
Selman Waksman was born in a peasant village near Kiev in present day Ukraine. He moved to America where he became a faculty member in biochemistry and microbiology at Rutgers University. He coined the word Antibiotic and discovered over twenty of them including Neomycin and Streptomycin.
Isoniazid (public institute)
Isoniazid was first synthesized in 1912 at the German University of Prague by Hans Meyer and Josef Malley, and then it languished on chemistry shelves for four decades. In 1951, its effectiveness against tuberculosis (TB) was recognized and the results were so promising, that people predicted that TB would soon become a disease only found in medical history books.
Tetracyclines (drug company)
In 1948 Benjamin Minge Duggar working at Lederle Laboratories discovered that Chlortetracycline was active in combating a wide range of bacteria.
In 1950 scientists at Pfizer found Oxytetracycline.
In 1952 Lloyd Conover working for Pfizer synthesized tetracycline. Within three years tetracycline was the most commonly used broad-spectrum antibiotic in the USA.
During the time tetracycline was very popular, the Federal Trade Commission raised illegal price-fixing charges against five companies, alleging that they had colluded to keep the price of tetracycline artificially high.
Erythromycin (drug company)
In 1949, Abelardo Aguilar, a Filipino scentist sent soil samples to his employer Eli Lilly for testing. Erythromycin was isolated from the Streptomyces mold by a research team lead by J.M. McGuire and marketed as Ilonsone in 1952.
Ampicillin (drug company)
Scientists at Beecham laboratories in the UK produced Ampicillin by modifying penicillin.
Rifampin (drug company)
In 1957 Piero Sensi isolated a series of chemicals with antibacterial activity from a pine forest in Nice, France. He was working for Dow-Lepetit Research laboratories of Milan.
Antibiotics were first discovered in Public institutions, kick starting decades of discoveries. We now need to re-ignite the hunt for new antibiotics. The Governments proposal to try do that, is to offer prize money to drug companies if they discover new antibiotics.(which is actually an idea that contradicts right wing free market economics as it is effectively government intervention in the market) I don’t think this is a bad idea however if I was in charge I would also look at giving Universities and other public institutes serious money solely for the task of finding new antibiotics. I would get that money by tackling tax avoidance and moving away from austerity economics.
Right wing free market economics believes private companies good, public institutions bad. It believes market forces are the best way to solve our problems, shape our world. The history of antibiotic discoveries shows that this is not always the case. Well funded public institutions can be very good at solving problems. I think it is foolish to put all our faith in drug companies to discover new antibiotics and ignore the possibility that investing in public institutions could yield positive results. Private companies will alwasy pursue profit over the greater good, public institutions can focus on doing things for the greater good even if their endeavours are not commercially lucrative. Investing in new antibiotics is good for humanity but it is not considered to be good business sense from an investment point of view. Therefore it is going to require government investment, which will require a change in political idealogue.
What a difference a week makes.
This news story from Germany may back up and confirm my hunch that investing in University reseach made be the solution to antibiotic resistance:
A new class of antibiotics has been discovered by analysing the bacterial warfare taking place up people’s noses, scientists report.
Tests reported in the journal Nature found the resulting drug, lugdunin, could treat superbug infections.
The researchers, at the University of Tubingen in Germany, say the human body is an untapped source of new drugs.
You can read the full BBC article here:
http://www.bbc.co.uk/news/health-36910766?utm_source=Royal%20Pharmaceutical%20Society&utm_medium=email&utm_campaign=7373361_Thursday%2028%20July&dm_i=EQ,4E1BL,M7H2ZD,G4TEB,1