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The Antibiotic Era: Reform, Resistance and the Pursuit of a Rational Therapeutics

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’Each chapter is broken down into shorter essays, comprehensive notes and references at the end complete an in-depth and well researched book’

Title: The Antibiotic Era: Reform, Resistance and the Pursuit of a Rational Therapeutics

Author: Scott H Podolsky

Publisher: John Hopkins University Press

Reviewer: Jane Brocksom, Urology & Continence Nurse Specialist, Leeds Teaching Hospitals NHS Trust

What was it like?

This is only a 188 page read – aside from notes, abbreviations and index (total pages 309), yet at times it’s a complex read but from a historical perspective, it’s interesting. The focus of the book is the history of antibiotic development, usage and the ”antibiotic reformers” who spent six decades evolving the notion of ”rational (or prudent or appropriate) therapeutics”. 1940’s Post World War 2 saw the “wonder drugs” to treat infectious diseases born, out of this development came the reformers who saw the marketing and development of such drugs being without regulation – no monitoring of efficacy just on the safety. Pharmaceutical industry marketing was based only on testimonials at this stage. The ”therapeutic reformers” saw the need to establish rigorous studies hence clinical controlled trials provided the regulation needed – ”irrational medicine” replaced with mandatory clinical trials proving a drug’s efficacy.

But they didn’t stop here the next step for the reformers was to focus upon inappropriate prescribing – the battle in 2015 continues? Supply V. Demand complicates the narrative in the last chapter. Or as Podolsky writes towards the end of his introduction “the tensions between aspirations and resistance – and between data and action, town and gown, autonomy and accountability, education and regulation and private practice and public health – have played out through the antibiotic era. As we contemplate a post-antibiotic era, we could do well to consider their historical foundations”.

What were the highlights?

Chapters include – The origins of antibiotic reform; Antibiotics and invocation of the controlled clinical trial; From Sigmamycin to Panalba: Antibiotics and the FDA; ‘Rational’ Therapeutics and the limits to delimitation; Responding to Antibiotic resistance.

Each chapter is broken down into shorter essays, comprehensive notes and references at the end complete an in-depth and well researched book. A 188 page history of Pharmaceutical regulation and inappropriate prescribing of the ”wonder drug” in a six decade time span, we witness the birth of drugs and death of the combination antibiotic, the empowering of the Food and Drug Administration (FDA) and the Kefauver-Harris drug amendments.

Strengths & weaknesses:

Possibly the main weakness is that this book is written from an American perspective, with an American author and detailing American research but the subject is a global problem and affects a global audience. The occasional reference to UK industry is made. Don’t let it put you off reading – the sections on Pharmacological Company’s developments are fascinating - the unscrupulous to the regulated, testimonials of safety to clinical controlled trials to prove efficacy.

Who should read it?

Podolsky is a Physician – Historian who has authored another book previously on the subject of antibiotics. This book is carefully researched and persuasively argued. On many levels it is a fascinating historical analysis but also a complex and difficult read albeit more suitable for HCP’s undergoing higher level academic studies.

the antibiotic era

the antibiotic era

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