It Will Take More Than An Apple a Day

PBS is running a very interesting series on global public health and the rise of “superbugs”, and I’ve caught a couple of segments. It’s both incredibly interesting and very frightening. We all know that you shouldn’t stop taking antibiotics before the end of the course. We also know that you shouldn’t take antibiotics for a viral infection. Yet we don’t worry about adding Triclosan to everything from toothpaste to hand soap to dish detergent. We don’t get fussed about demanding the latest and greatest powerhouse antibiotics when we get sick and doctors with closets full of samples from the pharmaceutical companies and too little time per patient to reason things out with them just hand the drugs over, even though it’s entirely possible that good ol’ penicillin or erythromycin would do the job just fine. And so we all contribute in some small way to the growing problem

The debate over pharmaceutical companies and the prescription drug market in the United States flares up around election time, is hotly debated for hours on CNN and MSNBC while FOX News runs segments on how the pharmaceutical industry is a driving force behind the “booming” American economy, aaaaand then it fizzles out and goes away. But the detrimental effects of the current paradigm for development and distribution of prescription drugs go beyond the astronomical prices for those drugs. Pharmaceutical companies are, as a general rule, no longer developing antibiotics. Not because there’s no need for new antibiotics, but because they are not profitable enough.

I can hear the voices now: “What are you, a communist? You can’t expect a company to do things that aren’t profitable! I mean, if they had to do that, they’d go out of business and you wouldn’t have ANY drugs, so how would you like that, Miss Socialist?” But I say that companies ought to have a certain level of social obligation. We often require companies to do things that aren’t profitable or that eat into profits for the greater good-- for example, restrictions on emissions for factories or requirements for certain types of safety equipment on cars. Why shouldn’t pharmaceutical companies be required to devote a certain percentage of their R & D budget to development of drugs for the public good? And to be perfectly frank, I also favor caps on the prices of drugs as well as corresponding caps on salaries for the top echelon at pharmaceutical companies. (Actually, I’m also in favor of similar measures for all industries. There is no reason on earth why any company should pay its executives millions, then complain that they can’t turn a profit and have to slash the salaries of their workers on the ground or declare bankruptcy. Lest you think I’m picking on the pharmaceutical industry, rest assured that my righteous anger/ Robin Hood complex extends far and wide.) I know, I know... I’m just a commie pinko. Still. I ask you: when the next big epidemic hits, be it caused by bioterrorism or just the normal natural cycle of disease outbreaks, and we discover that Cipro doesn’t cut it any more, don’t you think the public will be screaming in disbelieving rage that you can’t just pop a pill and get better?

Case in point: every one of us has had to go for a TB test at least once in our lives. I know that I’ve had many of them, given my globe trotting habits and my insistence on continuing to attend public school in between trips, and yet I never really thought it was any big deal. A quick jab in the arm and a week of comparing the little bumps to the pre-printed card, then a phone call to the nurse at the doctor’s office to confirm that the bumps didn’t match the ones in box 7 or box 8. And I remember reading about how people with tuberculosis used to be sent to a sanitarium to prevent the spread of the terrible disease, and how these sanitariums had become a relic of the past with the advent of antibiotic treatments. In fact, I had the vague idea that tuberculosis was kind of like polio: something horrible that happened to my grandparents or maybe my parents, but could never happen to me, thanks to the miracle of modern medicine.

So what would happen if I met with a client next year who came in with a racking cough... you know, the way half the public walks around in January and February... and we spend a few hours looking at documents for the immigration service, bent low over a shared table, breathing the same air... soon after, I wake up feeling under the weather and suffering from a raspy, hacking cough... that won’t go away, even after massive doses of Robutussin... so I go to the doctor’s office, where I sit in the waiting room, hacking away and feeling miserable... and it turns out that I’ve contracted multi drug resistant tuberculosis from that client. Contracting regular tuberculosis would have been bad enough—the standard treatment is a six to nine month course of antibiotics, which may or may not be covered by my health insurance and might cause major side effects, especially given the fact that I’ve already had allergic reactions to at least two antibiotics in the past. MDR tuberculosis is a whole different circle of hell. I am now facing a very uncertain future, including ever-increasing courses of antibiotics with higher and higher levels of toxicity, possibly even requiring treatment with experimental drugs. And there is always the possibility that this particular strain of tuberculosis will not respond to any of the drugs available, approved or experimental, and then I am facing a slow, wasting death.

And so are a lot of other people who I’ve come into contact with, from the other clients who’ve been in for a consultation, to my family and friends, to the woman in line in front of me at the supermarket when I stopped by to replenish my stock of Kleenex and Robutussin, to the neighbor I spoke to at length in the stairwell, to the child who sat next to me on the hour long bus ride to work, to the other patients waiting for the doctor to see them, to the nurse who took my blood pressure and temperature, to the people riding in the elevator with me... One of the reasons tuberculosis was so feared is the ease with which it is transmitted from one person to another. Think of all the people that you come into contact with in an ordinary day. Suddenly, drug resistant tuberculosis isn’t a Third World problem anymore.

One of the reasons The Stand is so frightening is that, at least in its first half, it’s not actually far-fetched at all. Captain Trips probably does, in fact, exist. And even if it wasn’t created by the military, it’s entirely possible that it could have entirely natural origins. We have been lulled into a false sense of security by the seeming ease with which modern medicine handles so many of the diseases that used to spell certain death for millions. Bacteria and viruses are far older and in many ways more ingenious than we humans could ever hope to be. Yesterday, it was smallpox; tomorrow, perhaps Bird Flu or something else terrible and unimaginable. Rather than cowering in fear and wallowing in sensationalized news reporting, we should be marshalling all of our resources to prepare the best possible arsenal for our defense. Instead, we’re fighting over flu shots and worrying about shareholder profits.