bioethics, physiology

Penicillin and Other Wonder Drugs

October 20, 1940, the New York Times dedicated 230 words in a synthesis of scientific news to “A New ‘Sulfanilamide.’” This ‘new’ sulfanilamide was originally discovered on the morning of Friday, September 28, 1928, by Alexander Fleming in his laboratory at St. Mary’s Hospital in London. It is better known as penicillin, and it is actually the cornerstone of a group of antibiotics known as beta lactams.

Penicillin is naturally a part of the fungi family, and its derivatives became the first antibiotic. Previously, patients with bacterial infections could only hope their body could fight off the infection. Medical professionals could only support the body and hope the fluids, rest, and other interventions helped. Penicillin changed the game. It could actually kill the bacteria.

Penicillin was quickly hailed to be a wonder drug. By May 6, 1941, the New York Times gave penicillin a full-column article, even reporting in a subheadline “New Non-Toxic Drug Said to Be the Most Powerful Germ Killer Ever Discovered” just as it was starting to be tested in humans. By 1942, penicillin cured an American patient of bacterial septicemia, a deadly disease state (even today). By the end of World War II, penicillin was in widespread use, production, and significantly reduced the likelihood of death.

It seemed like penicillin could fix anything and everything. It seemed like penicillin could cause no harm. It seemed like it was a miracle

Penicillin is a great drug, but it is not a wonder drug.

Macy (2014) estimates that about 8% of the US population has an allergy to penicillin, making it the most common drug allergy. By 1967, penicillin-resistant pneumococci were noted in Australia, and now articles are named “The State of the World’s Antibiotics” describing growing resistance patterns. The US’s Centers for Disease Control and Prevention has an ongoing report about microorganism threats that becoming resistant to antibiotics, gonorrhea being one of growing concern and even being labeled a public health threat by Suay-García and Pérez-Gracia (2018).

Multidrug-resistant organisms (MDROs) are quickly becoming a public health threat. The New York Times recently published an article about Stephanie Spoor, a Chicago woman treated at Northwestern Medical Center for pan resistant Candida auris, a fungal infection that would not respond to any established therapies. The very resistant carbapenem-resistant enterobacteriaceae has been growing at a rapid pace. As I read through Antibiotics Simplified, a synthesis of microorganism classification and antibiotic therapy, I am amazed at how many pathogens are resistant to penicillin, the supposed wonder drug.

But don’t we all go looking for cure-all therapies? Don’t we all wish there was a magic wand that could just take everything away and make it better? Isn’t this something we wish would just come in and fix everything?

I know at this point in my graduate program that I wish at least weekly it would just all be done. If there was a cure-all for graduate school, I’d take it.

It’s natural to want something difficult to end. It’s natural to try to fix things. It’s natural to want to feel better.

But wonder drugs are not real and pretending that they are is dangerous.

We wish for the perfect diet pill instead of addressing our poor eating. We drink and smoke despite knowing the harms, wishing for a pill to cure us when our livers and lungs are failing. We spend money on lottery tickets instead of budgeting.

Pretending that something exists that is perfect and fix us is a lie. It is a physiological lie. The body often heals itself. Yes, it needs antibiotics to fix bacteria that it cannot one its own, but unless the body integrates what it is receiving, the antibiotic is useless. Even wonder drugs like penicillin in its prime needed a body that was willing to work.

We forget that. Or maybe we never learned it. The point is even the most wonderful of wonder drugs needs something from us.

Life is the same way.

Lately, I have been dwelling on the idea of idols. I have been reading Les Miserables by Victor Hugo, and I have been particularly struck by how Marius idolizes people so recklessly. Hugo wrote him this way, even titling a chapter where Marius is falling in love with Cosette (whom he has never spoken a WORD to) “Beginning of a Grave Illness.” The guy is a pathological idolizer.

But I think so many of us do the same thing.

In dating, we imagine a perfect spouse, this is the wonderful person that is going to make us happy, forgetting that marriage can be hard.

In our future families, we imagine the sweetest child, this adorable baby that will coo and have the best fat rolls, forgetting that babies are difficult.

In our jobs, we imagine the perfect job, this fantastic opportunity where we are challenged but passionate and excited to go into work everyday, forgetting that all work becomes monotonous at times, even the ones we love.

In our friendships, we imagine the best friend, this amazing person that supports us when we need it, calls us when we’re lonely, and is always fun, forgetting that our friends need us too.

Notice how I used that with all of those, including the people? The little grammatical point which makes a huge difference? When we describe a person, we describe them using “who” such as “Oh, my friend Janice who refuses to wear pink on Wednesdays.” When we describe an object, we use “that” such as “Oh, my book that I really love.”

When we make people, relationships, even objective things like jobs or medications an idol, we put this ideal on them that is unattainable.

I had a patient just recently who used everything. Cigarettes, e-cigarettes, marijuana, alcohol, crack. She even admitted to some transient heroin use. What saddened me is the healing burn mark on her wrist from where she purposely burnt herself, which was by a cluster of scars that looked like burn marks. Here was a young woman about my age that sought every wonder drug, every cure-all, every idol she could to find happiness and still found herself lacking.

If there is anything I am learning as a future nurse practitioner, it is that I never want to promise my patients a wonder drug. Some antibiotics make you feel worse before you feel better. Some have nasty side effects. Some people are allergic to it. Some things do not even need them and go away with time, patience, rest, and supportive care.

Wonder drugs do not exist. But that is a very, very good thing.

References:

Allen, K. D. (1991). Penicillin-resistant pneumococci. Journal of Hospital Infection17(1), 3-13.

Gelband, H., Molly Miller, P., Pant, S., Gandra, S., Levinson, J., Barter, D., … & Laxminarayan, R. (2015). The state of the world’s antibiotics 2015. Wound Healing Southern Africa8(2), 30-34.

Logan, L. K., & Weinstein, R. A. (2017). The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace. The Journal of Infectious Diseases215(suppl_1), S28–S36. doi:10.1093/infdis/jiw282

Macy, E. (2014). Penicillin and beta-lactam allergy: epidemiology and diagnosis. Current Allergy and Asthma reports14(11), 476.

Navalkele, B. D., Revankar, S., & Chandrasekar, P. (2017). Candida auris: A worrisome, globally emerging pathogen. Expert Review of Anti-Infective Therapy15(9), 819-827.

Suay-García, B., & Pérez-Gracia, M. T. (2018). Future prospects for Neisseria gonorrhoeae treatment. Antibiotics7(2), 49. doi:10.3390/antibiotics7020049

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s