Should You Take Antibiotics?

It often seems, to doctors at least, as if trust in medicine is inversely proportional to its ability to save lives. When doctors could do little more than hold their patients’ hands as they died, often hastening their deaths with their absurd prescriptions, they enjoyed absolute trust. As soon as they could actually save lives, however, mistrust set in and writs began to fly. It is really most aggravating (for doctors).

An editorial in a recent edition of the New England Journal of Medicine draws attention to the current widespread mistrust of antibiotics. The authors are right to do so: I have quite often heard it urged against the benefits of modern medicine that it has produced bacterial resistance to antibiotics, as if this would be of any consequence if there were no antibiotics in the first place. No one would refuse an anaesthetic for an abdominal operation because there had been thousands of anaesthetic accidents since ether was first introduced.

That antibiotics had side-effects was recognized early in their career: and where side-effects come, can lawsuits be far behind? The first thoughts of those whose lives have been saved by them, albeit at the cost of damage either temporary or permanent, turn to compensation.

In my pharmacology textbook as a student there was a "natural history" of attitudes to a new drug. First it was a miracle-worker; then it was deadly poison; finally, it was useful in some cases. Attitudes to antibiotics seem to be following this pattern.

Only those who can relive, either in their memory or imagination (which is much rarer), what it was like to be ill in the pre-antibiotic era can appreciate the rapture with which the development of antibiotics was greeted. The authors of the NEJM editorial exaggerate slightly when they write that, before antibiotics, pneumonia ended in death; only a significant percentage of cases did so. But all the same, antibiotics represented one of the greatest advances in the history of medicine. They initially raised hopes of a permanent victory over infectious diseases.