THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, July 10, 1994 TAG: 9407070446
SECTION: COMMENTARY PAGE: J2 EDITION: FINAL
TYPE: Book review
SOURCE: BY THAD ZAJDOWICZ
LENGTH: Medium: 73 lines
THE PLAGUE MAKERS
JEFFREY A. FISHER, M.D.
Simon & Schuster. 256 pp. $23.
ADVANCES IN TECHNOLOGY often bring unforeseen problems. The introduction of the internal combustion engine a century ago ushered in not only the age of modern transportation, but also global air pollution, depletion of natural resources and untold thousands of accidental deaths.
In The Plague Makers, physician Jeffrey Fisher discusses the unanticipated impact of a technology that underpins modern medicine: antibiotics. Because their widespread use over the past 50 years has bred microorganisms resistant to their effects, antibiotics themselves are the plague makers. The author predicts an ominous return to the world before wonder drugs.
Fisher traces the history of antibiotic development. Despite some errors (his outline of the story of the first use of penicillin in a patient in 1940 contains significant speculation on emergence of resistant bacteria then, for which no data exist), the story of antibiotics unfolds neatly. His contention that antibiotic-resistant microorganisms emerge because of overuse, misuse and abuse of antibiotics is chillingly on the mark. Fisher succeeds in raising awareness of the worldwide extent and magnitude of this situation; and also clarifies the multiple forces that contribute to the problem, including physicians' lack of information, patients' childlike faith in the power of antibiotics and the pharmaceutical industry's drive to have its medicines used widely, if not always wisely.
And yet the book's theme, the advent of doomsday, is overdrawn. Fisher fails to put antibiotic-resistant organisms into historical perspective. While we now take antibiotics for granted, we must remember that for almost all of mankind's existence, there were no antibiotics; pestilence raged through humanity in former days, and still does today. The author makes an error common to physicians in attributing better health solely to the miracles of modern medicine.
Historically, most advances against infectious diseases have involved improvements in social conditions, such as the provision of clean water, construction of sewage systems, better diets and control of vermin. The primary focus of the plague of antibiotic-resistant bacteria remains the hospital and the hospitalized patient.
Fisher includes a chapter on 15 things the public can do to ``prevent catastrophe.'' Most are reasonable recommendations; the most important are admonitions for physicians to use antibiotics responsibly and for patients to quit demanding antibiotics for ills for which an antibiotic is not indicated, as well as efforts to educate physicians about these drugs independent of the companies that sell them.
To improve hand-washing (the single most important element in preventing spread of infections in hospitals), he calls for a ``Star Trek''-type hand-washing device costing $6,000. Adequate sinks, soap and towels, and a change of behavior by health care providers, simply getting them to follow advice initially put forth in the mid-19th century, make more sense. Remind your doctor and nurse to wash their hands before they care for you!
Although this book is quite readable and has a real message, some parts are simply off-base. Fisher expends much time and effort trying to link antibiotic use with the AIDS epidemic; while the reading is interesting, the science is fringy. He also includes an appendix titled ``A Specific Guide to Proper Antibiotic Use.'' It contains multiple errors; my advice is to skip it.
The Plague Makers alerts the public to the increasing problem of antibiotic resistance, which is real, global and current. Despite some flaws, it is an interesting and quick read. Like every technology ever devised, antibiotics are a double-edged sword. MEMO: Thad Zajdowicz is an infectious-disease physician who lives in Norfolk. by CNB