The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics by Scott H. Podolsky

Abstract

Reviewed by: The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics by Scott H. Podolsky Flurin Condrau Scott H. Podolsky. The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics. Baltimore: Johns Hopkins University Press, 2015. xii + 309 pp. Ill. $34.95 (978-1-4214-1593-2). Scott Podolsky’s excellent book on the history of antibiotics traces debates about the usability of antibiotics, their limitations, and imagined futures with or without these powerful drugs since 1945. It takes as its starting point contemporary observations that the usefulness of antibiotics might soon evaporate, while acknowledging the enormous shift in medical thought and clinical practice brought about by antibiotics. When these new drugs hit a largely unregulated medical marketplace, an unprecedented range of clinical applications emerged, and with that seemingly unlimited opportunities for the drug-developing industries. The key insight of the book is as simple as it is persuasive: antibiotics have a long and complicated history. Debates around the “rational” use of antibiotics or their “irrational” over-prescription reveal changing networks of actors, organizations, and interests that shaped their history. The book is ordered in five, largely chronological chapters on antibiotic reform, controlled clinical trials, the FDA, “rational” therapeutics, and antibiotic resistance. The author acknowledges limitations to the book’s purview, which includes medical thought and debate rather than clinical practice. That explains the absence of patients, diseases, and sites of medical practice. Also missing from the account are veterinary debates around antibiotics. However, the material base for this book is enormous. There is a wide array of institutional collections, [End Page 142] with papers from the FDA, AMA, and FTC, and government hearings. There is an equally diverse set of individuals, including pharmacologist Louis Lasagna, epidemiologist Edward Kass, and infectious diseases specialist Maxwell Finland. The author investigates notions of the rational use of antibiotics, which dominated medical debate until the 1970s. The author argues that “rational” was what individuals, groups, and interests labeled as such. Claims of objective truth, or rationality, turn into quasi-political statements in the framework of regulation, interest politics and clinical conflicts. For example, the initial debate around antibiotics from 1945 highlighted antibiotic specificity, prescription practices, and telephone sales of drugs for patient self-help. When infectious diseases specialists ran a symposium on “Crusade for the Rational Use of Antibiotics” in 1954, the main thrust of this campaign shifted to discussions around regulation. The book traces this shift with particular interest in Maxwell Finland, who in 1962 became the first president of the Infectious Diseases Society of America. For Finland, antibiotic combination therapy threatened to descend into chaos. He acknowledged that the individual physician no longer understood all the combinations of antibiotics at his or her disposal. In contrast to Henry Welch, then antibiotic division chief of the FDA, Finland argued for caution when using antibiotics. The book explores the regulatory challenges posed by antibiotics. It maps the hearings led by Senator Estes Kefauver, which resulted in the Kefauver-Harris amendments in 1962, to include debates around false advertising claims. It is worth noting how direct-consumer marketing makes this aspect of the story, and perhaps the book, one largely dealing with the North American story of antibiotics. The stronger European link is provided through references to the thalidomide disaster, which occurred during the Kefauver hearings and certainly influenced the amendments. The author describes this development as a convergence of interests, actors, and industries rather than as the conventional narrative that thalidomide singlehandedly changed drug regulation. One of the book’s themes is the long tension between the rationality of medicine and the irrationality of medical practitioners. The impetus of scientific medicine, since the nineteenth century, has been to substantiate claims of rationality. While in the early days of scientific medicine the juxtaposition involved magic or religion, the postwar era saw this move to the subconscious and advertisement, and from the mid-1960s, to economic concerns. The question of what constituted rational therapeutics became the key battleground for industries, regulators, and medical experts. On balance, this is a fabulous book. This title contributes to a fundamental shift in the writing of the history of medicine. It tackles issues of therapeutics...