In a world dictated by pharmaceutical industries, taking pills has been reduced to a reflex. Although an over-reliance on pills is a global phenomenon, in India, it’s somewhat of a mindset issue. A yardstick to measure the capability of a doctor. In other words, if you haven’t prescribed medication, you haven’t done your job as a serious physician. To the patient, the journey back home is all the more gratifying when loaded with bottles of medications.
I remember my early days of patient care in India, when every alternate person entering my chamber was a medical representative promoting drugs from their companies, some with information, some with added incentives. In this process, what gets forgotten (often conveniently) is that no drug is an angel. Most drugs will have a tolerance level, exhibit resistance and will, invariably, produce some long-term side effects. While the subject of drugs and how they can help and harm is a topic for a different day, my focus today is on antibiotics and their relentless intake. Doctors love to prescribe antibiotics and patients love to swallow them. But a brief history detour before we delve deeper.
If there was any word uttered more than Jesus, Coca-Cola and Elvis, it was penicillin
Cut to 1928, and Alexander Fleming, an otherwise fastidious and brilliant Scottish scientist, was rather slapdash in placing his petri dishes while hustling out of his lab to go on vacation. This oversight allowed a bunch of opportunistic moulds to invade the cultured colonies. A euphoric Fleming returned to find half of the colonies cleaned up by these green invaders. He grabbed them for dear life, extracted the chemical and went on to make one of the greatest discoveries of the modern world — penicillin.
For the next few decades, if there was any word uttered more than Jesus, Coca-Cola and Elvis, it was penicillin. Sweeping through the World Wars, the Cold War and all their collateral damage, penicillin and its allies fought endless battles. From syphilis to sore throat, penicillin was one charmer that swayed the snake at will.
However, what followed was sad, inexplicable… yet intricately inherent in our human culture. Physicians, in their zeal to be noble, dished out penicillin and its progenies like condoms. Antibiotics were prescribed even for the viral common cold, with the tacit assumption of superadded bacterial infections. Ditto for fungal infections. To make it worse, antibiotics became prescribed as ‘initial coverage’ without completing the full designated quota. Penicillin, like a squandered talent, was let loose. The ritual continues even now.
Please be less cavalier with antibiotics
In many cases, antibiotics are neither necessary nor sufficient TT archives
In India, the situation is even more perilous. One does not need a prescription to get a course of antibiotics! You walk into any pharmacy store and you can get an antibiotic. The inevitable result? Another set of fashionably named but insensitive bacteria… now thoroughly resistant and fiercely aggressive. Frightening facts are emerging — antibiotic use in animals raised as a human food source is associated with the emergence of antibiotic resistant strains of bacteria.
Where do we go from here? Despite pledges and dinners from pharmaceutical reps, the pipeline smells of dirt. A few options have emerged as potential antidotes against the craze for antibiotics. A growing body of advice suggests listening to grandmothers — prevention is the mother of all cure. Hand washing, thoroughly washing or processing of raw foods such as fruits, vegetables, raw eggs and undercooked meat are some of the ancient thoughts being brought back to the table. Armed with genetic engineering, we are pursuing important alternatives to antibiotics in our current era of multidrug resistant pathogens. Phytochemicals, occurring naturally in vegetables and fruits, are an equally sought-after alternative. All this coupled with a fervent plea to pharmacists and pie-eyed physicians: “Please be less cavalier with antibiotics.”
In the meantime, the enduring insight is this: Antibiotics, like all drugs, must be utilised judiciously. In some cases, they will be all we need. But in many others, they are neither necessary nor sufficient.
Dr Shuvendu Sen, born and brought up in Kolkata, is a US-based physician currently serving as the vice-chair, Research, at the Jersey Shore University Medical Center, New Jersey. An award-winning physician and author, his works include The Fight Against Alzheimer’s (Rupa Publications, 2024), Why Buddha Never Had Alzheimer’s (HCI/ Simon & Schuster, 2017) and A Doctor's Diary (Times Group Books, 2014), among others. Dr Sen can be reached at shuvendusen57@gmail.com
