In the last few weeks antimicrobial resistance has been in the headlines with a frequency that has rarely been seen. The likely explanation is the unprecedented high level meeting convened by the United Nations that focused the world's attention on this public health crisis. To many, antimicrobial resistance seems to be a strictly modern problem with solutions only recently proffered. However, that is far from the truth and Harvard's Dr. Scott Podolsky's latest book The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics provides a comprehensive historical overview of a medical community grappling with a nascent technology that transformed medicine, the pharmaceutical industry, and the FDA.
This book, which should be required reading for anyone in the field, is the result of meticulous research that not only shows how antibiotics rippled through medicine but also how the entire medical subspecialty of infectious disease developed. The book is full of legendary figures in infectious disease such as Max Finland, Harry Dowling, Ed Kass and many others.
One of the most valuable aspects of the book, to me, is that I know have a better understanding of how my field developed. I often wonder how physicians, who were once deluged with infections, lost their expertise and the need for a sub-specialty occurred. As Podolosky illustrates, in the post WWII era, civilization caused infectious diseases to recede in the US at the same time scores of new treatments (i.e. antibiotics) were coming to the market and experts who knew the (now rare) bug and the drugs used to treat them were valuable. This scenario culminated in the founding of the Infectious Diseases Society of America in 1963 and subspecialty certification in 1972.
These early infectious disease physicians were on the vanguard in warning against antibiotic excess, the evolution of resistance, bacterial vs. viral diagnostic dilemmas, and the lure of shotgun empirical treatment approaches to cover all possibilities. Also detailed was the chasm between academic and community medicine ("town vs. gown", which still exists today) in which academic medical centers are ably equipped to use antibiotics judiciously but community hospitals are woefully behind.
The book has many pearls of historical insight that are too numerous to list. A few of my favorite quotes I think will be sufficient to close with:
The “end” of antibiotics was envisioned almost from the beginning.
Patients are not born into this world with the view that antibiotics are required for common colds. It is learned from their friends who learned it from their doctors when they went, and so forth.