According to physician and historian Scott H Podolsky in his book ‘The antibiotic era’, only by properly understanding the historical forces that shaped our current position on antibiotic resistance can we frame our choices for moving forward.
The book’s subtitle, ‘Reform, resistance and the pursuit of a rational therapeutics’, sets the scene. With access to a wide range of archives from government agencies and academia, Podolsky takes us through a host of conferences, councils, courts, congressional hearings, symposia and task forces to reveal the tensions that grew since the 1940s between the pharmaceutical industry and medical academia, patients and doctors, and government and the media concerning over-marketed and irrationally prescribed antibiotics.
Using examples such as chloramphenicol, which was heavily promoted despite known risks of aplastic anaemia, Podolsky gives a sobering account of how reformers struggled to change how antibiotics were developed, promoted and prescribed. He traces the long battle to empower the US Food and Drug Administration (FDA) with a regulatory framework that eventually included rigorous criteria, such as controlled drug trials, rather than relying on ‘testimonials’. The FDA’s attempt to withdraw existing drugs with unproven efficacy, such as fixed-dose combination antibiotics, is particularly enlightening. In the case of Panalba (a widely prescribed and profitable combination of tetracycline and novobiocin), its manufacturer went all the way to the US Supreme Court on the grounds of encroachment on physician prescribing autonomy. They failed, but still no one regulated physicians who inappropriately prescribed, or over-prescribed, approved drugs.
The book contains some illustrations of people mentioned in the text and some examples of advertisements from the period, but barely mentions antibiotic use in food production. However, Podolsky makes his point about historical analysis and this book is a fascinating reminder that the benefits of antibiotics were squandered right from the beginning of the antibiotic era.
‘The antibiotic era’ by Scott H Podolsky. Pp xii+309. Price £22.50. Baltimore: Johns Hopkins University Press; 2015. ISBN 978 1 4214 1593 2.