Op-ed: The disturbing history of antibiotic therapy in medicine

It’s no secret that decades of insufficient medical research have allowed the human genetic material we use for medicines to spread into the soil. The fastest way to identify the bacteria that might be making us sick would be to find those naturally occurring strains. No longer! This past week, a U.S. Food and Drug Administration report revealed a remarkable antibiotic-resistant disease called carbapenem-resistant Enterobacteriaceae—an organism that I have no doubt belongs to my family tree.

With the advent of such novel superbugs, or K-superbugs, we all must take a careful look at what antibiotics are doing to our communities, particularly in Asia. In response to a rising tide of these pathogens, the U.S. government is making it easier for doctors and patients to seek alternative drugs. And new drugs to treat bacteria are being developed. But it’s not easy. The rights of genes are exclusive to their manufacturers. And even if the drug company could sell a cure for these bacteria for significantly less than the price they originally spent developing the drug, it wouldn’t get to market.

While these restrictions make sense on a small scale, it’s clear that science has to do better than they have. It’s time to separate the humane science of preventing antibiotic-resistant diseases from the corporate medicine of preventing patenting of essential human health interventions.

According to the latest data, K-superbugs are a major problem—and across the globe, the situation is actually getting worse. A recent report by the Associated Press, cited by Health Policy in its Sept. 21 report on antibiotic-resistant K-superbugs, estimated that 60,000 deaths were attributed to drug-resistant strains of K-superbugs in 2017. While we still don’t know exactly what triggered the surge in antibiotic-resistant K-superbugs, one hypothesis is that a series of recommendations in 2013 by the United Nations to curb antimicrobial resistance by cutting back on the use of antibiotics are eroding the balance of the antibiotics we should be using in our care.

Many countries are now implementing these guidelines; a person can now get an antibiotic prescription in the Netherlands, but the routine routine antibiotics we’ve known for years can’t be used. While that policy sounds reasonable, for parents, who’s to say that a too-easy antibiotic prescription will be taken for granted?

As a parent, I worried about my son using flu vaccine to stay healthy. I worried that antibiotics might make him sicker and I even worried that one of his shots would kill him. And while I know that a traditional flu shot can prevent infection, my attitude changed after seeing a viral vaccine put in use. That’s when I stopped feeling comfortable with my pediatrician telling me to give my son an antibiotic when he had a cold.

Unfortunately, if you want to know why some antibiotics don’t help, you should look no further than clinical trials on chronically ill children and adults. In Canada, health care providers still treat patients with tried-and-true antibiotics like Tysabri and Oseltamivir. Unfortunately, the drug never had a rigorous clinical trial that would show whether an individual who had a severe case of multiple sclerosis would benefit from taking it. The goal of these trials is not to give companies a sugarcoated version of an important medicine, but to establish the evidence to say whether it works and, if so, in what way. This is the right goal to pursue. But if people don’t know that they are taking a proper dose of a drug that’s been shown to work for one patient, they might as well take it and stop asking questions. As to the practice of keeping patients on antibiotics for months with no clear evidence they really need to be treated, that’s simply not the case with Tysabri. The drug had randomized clinical trials showing that it benefited patients who had relapsed with multiple sclerosis—and if you’re wondering why a patient or family wouldn’t want to take this treatment with few side effects, ask yourself why they wouldn’t take it.

This article first appeared in The Globe and Mail on Sept. 21.

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