OK, ADMIT IT: You want Cipro. With a two-month supply of Cipro in the medicine chest, you could sleep at night. Make that two months' worth for everybody in your household. You want what's best for your family, and Cipro is the best. And when any of us gets the sniffles this winter we'll be ready. So what if it turns out not to be anthrax? Better safe than sorry, right?
Well, no—but try to tell that to the hundreds of thousands calling their doctors and demanding a prescription for Bayer's powerful and expensive brand-name antibiotic. "I try to tell my patients that Cipro's not a good idea for them," one harassed Seattle physician says. "One out of 10 says, 'Oh, all right, what do you recommend?' The other nine say, 'I don't care, I want it anyway,' or, 'If you won't give it to me, I'll find someone who will.'"
The Cipro rampage has nothing to do with medicine and everything to do with TV. Cipro happened to be the bottle Tom Brokaw held up on the NBC Nightly News. It could just as easily have been Johnson & Johnson's Levaquin or Bristol-Myres Squibb's Tequin or half a dozen other antibiotics made by GlaxoSmithKline and Lilly and Pfizer. And you know what's really scary? None of them's the right one for the job at hand, even assuming there's a job to do.
Antibiotics like Cipro et al. are known as broad-spectrum agents, meaning that they attack many different species of bacteria. Trouble is, a lot of the species in question aren't harmful to human beings. Some are even highly beneficial, like the so-called intestinal flora inhabiting your gut and helping you digest the food you eat. Broad-spectrum antibiotics take 'em all out; which is why, after you've been put through a course of one, you find yourself eating pap for a week or two while your duodenal garden gets to growing again.
Even worse is what happens when large numbers of people take such antibiotics over extended periods of time. Bacteria look similar under the microscope. But if you check out the large number of individual bacteria, you'll find there's a lot of genetic variation among species and within species. When they come up against a killer like Cipro, most individual bugs can't cope and die. But there are billions of bugs, and if only one happens not to be affected by the drug, well, it only takes one bug and a few hundred half-hour generations to produce billions of bugs again: this time, all resistant to the drug in question.
We're not talking theory here. Just last year, New Jersey-based Pharmacia Corporation got FDA accreditation for a drug called Zyvox. Zyvox promised to address one of America's biggest public-health problems: strains of intestinal, skin, and lung bacteria found in hospitals and grown utterly drug-resistant from constant exposure to antibiotics. It took less than six months for Zyvox to go from miracle cure to part of the problem. After just three weeks on Zyvox, resistant strains of the same old baddies began appearing in patients.
Epidemiologists have recognized for a generation that our current approach to infectious disease treatment is doomed. Every time a new drug capable of destroying a virus or bacterium comes along, it also has the effect of putting pressure on its target to evolve a response or die. Bacteria and viruses aren't smarter or more flexible than we are. But there are an awful lot of them, and they breed very quickly. In the long run, the deck is stacked in their favor.
Deep medical thinkers are only beginning to think about ways to get out of the arms race entirely. There are other ways, short of nuking them, to deal with disease organisms. The body has numerous mechanisms for eliminating microscopic bioterrorists before they can do harm. Some don't kill the enemies; they just flush them harmlessly away. Peaceful co-existence with bacteria may seem a weird way to go about improving public health, but it worked in world politics; we should start dismantling the medical arsenal along with the ICBMs.