Antibiotics - a warning from 50 years ago

Doctors are at last beginning to show serious concern about the rise in the number of organisms which are resistant to antibiotics. Numerous members of the medical establishment appear to think that they’ve just discovered the problem of antibiotic resistance. They haven’t, of course. They are 50 years late (and probably 50 years too late). Here below is what I had to say about antibiotics in my book `The Medicine Men’ which I wrote in 1974 and which was published in 1975. The medical establishment surely cannot be as collectively stupid as it now appears to be. Was all this just another part of the depopulation plan devised in earnest back in the 1960s and 1970s? Doctors within the establishment have a choice: they are either stupid or wicked. They could, of course, be both.


From The Medicine Men (1975)

A survey done in 1966 in Canada, in which the records of 4,894 patients given antibiotics were examined, showed that in 48.5 per cent of cases an infection was present but that in 62.5 per cent of cases the wrong drug had been prescribed. Hardly surprising, perhaps, that a doctor in America, writing in the New England Journal of Medicine has claimed to have set up an organisation (similar in style to Alcoholics Anonymous) for doctors suffering from Compulsive Antibiotic Prescribing. It is not only antibiotics, however, which are prescribed unnecessarily. In one large American nursing home which had previously averaged 175 prescriptions per week, the average number of prescriptions was reduced by careful doctors to ten a week.

One of the problems is undoubtedly that doctors, though they are not taught how or what to prescribe, are very jealous of their freedom to prescribe whatever drugs they want to give their patients. So any registered practitioner can legally hand out large amounts of potentially lethal drugs to his patients, even though he may not have the foggiest idea how the drug works, what its dangers are or what it is supposed to do.

D. R. Laurence in Clinical Pharmacology has written that before prescribing any drug a doctor should decide whether or not he should interfere with a patient at all, what alteration in the patient’s condition he hopes to achieve, whether the drug he is using will do this, what other effects the drug may have and whether the likelihood of benefit outweighs the likelihood of damage. He implies that if in doubt the doctor should put his pen away. But this is an ideal situation and unfortunately doctors are usually too ignorant and too busy to do this. Doctors pick up the details of how to prescribe from colleagues, from patients who have been given drugs by other doctors and from the companies manufacturing the drugs they use. Hardly an ideal situation.

One of the ways in which over-prescribing occurs is the fondness of patient and doctors for ‘repeat prescriptions’. In one survey of the handwriting on prescriptions handed in to chemists in the United Kingdom, it was found that one-third of all prescriptions had been written and signed by different people. One experienced doctor has estimated that up to a half of all prescriptions are written by receptionists and signed by doctors.

It is now known that many prescriptions are written out by receptionists on pre-signed forms. In other words, the doctor signs a few forms and then when the patient comes to the surgery to ask for more tablets, the receptionist merely fills out the prescription. This is not at all an uncommon occurrence and can lead to dreadful mistakes. For example, one epileptic was fired after he had a number of fits while at work. He had by mistake been given an anti-inflammatory drug when he had asked for a repeat of his anti-epileptic drug. The receptionist had made a mistake and written the name of the wrong type of drug. Repeat prescriptions are of course popular with both patient and doctor. The doctor is so busy that he is eager to cut down his workload. The patient wants another batch of his tablets and is happy to have them without having to wait in the queue or make an appointment. Some patients even demand antibiotics or analgesics when they have an infection or an attack of pain. They expect their doctor to be able to treat them at a distance. It is not at all rare for patients to ring the surgery and leave a message that they want such and such a drug, without even giving any details of the symptoms which are troubling them. One chemist recently reported that he had dealt with a patient who had not been seen for six years by his doctor but who had nevertheless regularly been obtaining large quantities of sleeping tablets. I am surprised that the chemist should be shocked. He must have been very inexperienced. I have seen instances of patients who have been taking potentially dangerous tablets for up to twelve years without a full consultation.


Antibiotics in farming
Drugs lose their potency as antibiotics as the bacteria they are intended to kill adapt themselves to their use. Resistance can spread quickly through a colony of bacteria.

Between 1963 and 1970 there was an extensive outbreak of multiple drug-resistant Salmonella in Great Britain in both cattle and human beings. In Guatemala there were recently 12,000 deaths due to dysentery; these were blamed on the growing antibiotic resistance to enteric bacteria. Since the problem of antibiotic resistance first became apparent in 1959 when Shigella in Japan became resistant to drugs, there have been many other examples. Because putting antibiotics in animal feeds protects the animals from infection, many farmers have been doing this for some time. It was reckoned in 1968 that antibiotics in feed supplements were saving British pig and poultry farmers about £40 million a year. Unfortunately, however, due to organisms becoming more resistant, fourteen babies died at a Teesside hospital. A good result of this tragedy was the formation of the Swann Committee to look into the use of antibiotics in animal husbandry. The Committee was formed in May 1968 and during the following couple of years the drug industry ( busily selling antibiotics to both doctors and farmers) battled against its recommendations, which were that the Minister of Agriculture should restrict the use of antibiotics in animal husbandry.

The Office of Health Economics published a booklet on the subject in 1969 which was rather one-sided and which put forward the benefits of using antibiotics in rearing animals. The Office of Health Economics was founded and is largely financed by the Association of the British Pharmaceutical Industry. Other abortive attempts were made by the drug industry to oppose the recommendations of the Swann Committee. The editor of a weekly scientific journal who mildly criticised an involved drug company reported that the managing director of the company wrote to the chairman of his publishing company, ‘clearly expecting the chairman to take internal action.’

NOTE
The Medicine Men by Vernon Coleman is now available again. You can purchase a copy from the bookshop on www.vernoncoleman.com