The London EveningStandard

April 23, 1998


The safe way forwardwith lifesaving drugs (Op-Ed)


Senior scientistshave warned the Government of the dangers of antibiotics being over-prescribedby doctors and abused by farmers, subsequently losing the drugs' effectiveness.EMILY GREEN says this is a case where it is vital to pay heed to thedoom-mongers.




THE sheer existence of antibiotics is a very Britishtriumph.


Yet, as the House ofLords' Science and Technology Committee yesterday made abundantly clear, whatwe possess in ingenuity, we lack in discretion.


We have, for fivedecades, used an invaluable medicine as a tool of convenience. As a result ofour abandon, we are spawning a new class of antibiotic-resistant bacteria. Now,on the verge of the 21st century, the challenge before us is to understand theaccomplishments of the 20th.


One cannot hear thestory of the discovery of penicillin without a sense of pride, and marvel howin the late 1920s, at the bacteriology department of St Mary's Hospital inPaddington, Alexander Fleming first noticed a mould growing in his experimentalplates containing staphylococci, how the fungus was penicillium notatum, andhow it was killing the live bacteria.


It is heroic stuff,how throughout the Thirties and Forties, the Florey group at the University ofOxford struggled, first to isolate penicillin, then to make enough of it tosave even a single life. For Howard Flo-rey, it was his contribution to the wareffort. "It is not the wounds that kill most soldiers," he would tellhis students, "but the infections that follow!"


Yet as the war ended,his group was still struggling to isolate enough to save even one life. Theycultured penicillin in bedpans to treat an Oxford policeman for streptococcalsepticemia meningitis, and he improved. They then ran out of the drug, andsought to retrieve what they could from his urine, but could not keep pace withthe disease and watched with desperation as he died. Penicillin was turned overto Canada and the US, where its production was achieved on a mass breweryscale.


FLOREY'S group was noticing antibiotic resistance even inthe late 1940s.


But, by the 1950s, itspublic guise was that of wonder drug in Europe the precious booty of the ThirdMan, in developing countries a promising tool against scourges such as typhoid.


However, out of thepublic eye, but very much as a result of public demand, antibiotic use really tookoff in agriculture. Here, Flo-rey's penicillin, and a growing range of new antibiotics,were increasingly being tipped into processed animal feeds, first for poultryand pigs, then for cattle.


Whereas before theWar, livestock health was a matter of good husbandry, after it, farming outputdepended on medication. By the 1970s, antibiotics were not regarded asmedicines, but "growth promoters".


Between 1973-83,EC-sponsored studies proudly reported that through genetic manipulation,enhanced feeds and antibiotic use, member states had managed to extract 23 percent more milk from a single cow. Twenty three per cent.


The economics of dairyfarming then became dependent on the drugs. The animals, dragging uddersinflamed with mastitis, to provide us with ever more, ever cheaper milk,required constant medication.


A nation that regardedbacon sarnies, a cheap pinta and roast chicken as less a luxury than a right,scarcely noticed as the antibiotic lines expanded willy-nilly.


In 1978, the fact thatlincomycin, an antibiotic introduced in pig feed, was highly toxic to dairycows, was regarded as an agricultural issue. Among this industry, the questionwas not whether to dose, but how?


"Which route isbetter?" asked publications such as The Feed Compounder. "In feed, orin water?"


Even, yesterday, inthe face of appalling criticisms of agricultural abuse of antibiotics, theNational Farmers' Union greeted the report from the Lords by saying: "Antibioticsare a very useful tool for farmers and we want to continue to use them, but arein favour of strict controls."


The word"tool" and "strict controls" are incompatible.


The organic movement,led in the UK by the Bristol-based Soil Association, regards antibiotics as amedicine, and will only permit their use on livestock under strict supervisionof a veterinarian. Yet organic production accounts for less than one per centof UK farming and the "tool" definition prevails.


LAST year, a Swiss group reported in Nature thatagricultural use now accounts for half of the world's antibiotic output.Certainly, farmers were not the only ones in the firing line yesterday.


Doctors, it was said,routinely over-prescribe them.


Now we must ask thequestion, is the problem them, or us? We have come to expect easy rude healthjust as blithely as we came to take cheap food for granted. And we equate itwith pills. Cystitis, a common urinary tract infection in women, is just aseffectively relieved by the drinking of cranberry juice as by the popping ofpills. Yet, a healthy diet somehow doesn't strike us as sufficiently medical.


On another level, wehave been spectacularly short-sighted. The sexual revolution of the Sixties isoften put down to the introduction of the Pill.


Just as important wasthe notion that sexually-transmitted diseases, traditionally fatal, could bebanished by a quick, if embarrassing, visit to an STD clinic. Though it waswell-publicised, we ignored the emergence in 1960s Vietnam of antibiotic-resistantsyphilis. A freak of war, of promiscuous GIs and prostitutes, we toldourselves.


Only the emergence ofviral STDs, untreatable by antibiotics, such as herpes and Aids, eventuallycurbed our promiscuity.


It has becomefashionable among promoters of alternative medicine to condemn any use of antibiotics,to treat them as some sort of poison. This is as foolhardy as overuse. Antibioticsare the only known treatment for a host of deadly diseases, includingpneumonia, meningitis and typhoid. It merits noting, too, that all the sameissues surrounding antibiotics apply to other chemical therapies forparasite-derived diseases in humans and animals, such as malaria and worms.


Britain is now at thecentre of redefining agriculture in the wake of the BSE crisis, and is at thecentre of a worldwide initiative to combat malaria.


This afflicts from twoto three million people worldwide, and controlling it would be a triumphindeed. The House of Lords has highlighted the way forward: conservative,humane and intelligent application of drugs that are very British lifesavers.


Copyright 1998Associated Newspapers Ltd.