The Antibiotic Era by Scott H. Podolsky

Author:Scott H. Podolsky
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2015-09-02T04:00:00+00:00

Stuart Levy, as he appeared in Time magazine in mid-1981, “speaking at a Boston press conference about the dangers of antibiotic overuse” and in the context of the release of the “Statement Regarding Worldwide Antibiotic Misuse.” “Those Overworked Miracle Drugs,” Time (August 17, 1981): 63. Reproduced with the permission of photographer Steven Liss.

That same year, the University of California–Berkeley’s Mark Lappé published the well-researched and highly readable Germs That Won’t Die: Medical Consequences of the Misuse of Antibiotics. Lappé, while serving in the California Department of Health, had previously warned against the environmental spraying of Malathion to curb fruit fries, and in Germs That Won’t Die, he argued not only for more restrictive use of existing antibiotics but, à la René Dubos, for more emphasis on strengthening the body’s “natural defenses,” whether through vaccination or through what would come to be increasingly described as “probiotics.”120 Lappé’s book would serve, as Robert Bud has noted, as forerunner to over three decades of public-oriented print and media—some items more sensationalized than others—on the hazards of antibiotic misuse and overuse.121

Lappé directly cited the medical community’s “violent opposition” to Calvin Kunin’s support for antibiotic audits and hospital oversight committees (as described in chapter 4), and in 1982, the same year Lappé’s book was published, the IDSA’s governing council rejected Kunin’s proposal that the IDSA establish and propagate society-sponsored national guidelines on antibiotic usage.122 The IDSA’s membership, however, indicated a desire for the society to take a larger role in public affairs (this largely took the form, at the time, of advocating for increasing funding in infectious disease research and training).123 In 1984, Kunin spoke to the IDSA membership at their annual meeting on “The Responsibility of the Infectious Disease Community for the Optimal Use of Antimicrobial Agents.”124 In preparation for the talk, he and Stephen Chambers polled members concerning their views on antibiotic usage. They found that 87 percent claimed a “strong” interest concerning antibiotic usage; that the majority felt that antibiotic resistance in the United States stemmed from usage in the hospital (chiefly) and the office (less so), rather than via the developing world or animal feeds; and that an overwhelming majority advocated for educational and regulatory counter-measures.125

By 1985, the IDSA’s governing council approved the formation of an Antimicrobial Agents committee, with Kunin as its head.126 And Kunin (who would become IDSA president in 1987) used the committee to publish selected IDSA-sponsored guidelines on antibiotic usage over the next several years.127 Yet resistance to Kunin’s efforts surfaced ongoing deliberation regarding the ability to make definitive recommendations in the setting of insufficient data, a persistent Achilles heel for would-be reformers. Reflecting such caution, Kunin’s internally distributed IDSA white paper “Report of the Antibiotic Use Committee” (the committee name change in the title appears to have been an oversight) generated calls “for a softening of language indicating a desire to ‘regulate’ or ‘control’ the use of antibiotics or the testing of antimicrobial agents.”128 When push came to shove, advocating for confronting antibiotic resistance was not yet to be a chief mandate of the society.

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