Bioterror, Bacteria, and Drugs

In first half of the 20th century, the world was a more dangerous place than the world we know. Everyone knew someone who died of infectious disease. My mother was terrified of bacteria, with reason. My grandmother had died of tuberculosis when my mother was just 12.

In 1929, the year my grandmother died, a scientist set out on the path to make the world a safer place. That was the year Alexander Fleming was surprised to discover a mold killing a bacterial culture he was growing. By the 1940's, the potential uses of penicillin against bacterial diseases were recognized. The first antibiotic came into use when my mother was in her 20's.

Although scientists would never find drugs to arrest viruses as effectively as antibiotics stop bacteria, between the 1950's and the 1970's, vaccines against all common serious viral childhood illnesses also became available to us.

As a child, I never saw anyone whose life was threatened by an infectious disease. I never knew anyone to die from one. I grew up in a drastically changed world.

My mother was still terrified of germs, though, and was determined that she and her family would avoid the invisible predators. Her mother had been careless, but she would be different. She would be as vigilant as possible.

We ate well, dressed warmly, and washed our hands often. We were suspicious of publicly circulated objects. My mother knew the invaders might ride in on dollar bills and public library books. If I ever lifted my hand to my face after contact with such an item, she'd immediately jump to attention and order me to wash my hands first. A library book would never touch a surface in any room where food might be prepared or eaten.

No one else's parents seemed to be as fanatic about germs as my mother, so I considered this overreacting. My friends apparently did, too. Once, when I was a small child, my mother's admonition frightened me after I'd touched something and put my hand to my face unaware, and a friend whispered in comfort, "My mother always says you gotta eat a pound of dirt before you die." It seemed a wonderful point of view to adopt. Since I was absolutely certain I could never consume a cumulative pound of dirt in my lifetime, this new idea helped give me peace of mind.

Even so, I never really forgot what my mother taught me. I would always be surprised by how little fear of microorganisms most people seemed to have. If I saw a worker lift a bucket from the floor to a surface where food might be prepared, I felt sick. In the end, though, I'd shrug and figure that if so many of these people were still alive and kicking it spoke very well for my friend's pound-of-dirt theory.

As I went on in life, the world seemed to contain different demons from the natural ones my mother knew. Once my father was driving his car home from a doctor's office, and his vision suddenly went dim. He felt dizzy and pulled his car over to the side of the road. After a few minutes, he felt better, drove home, and called the doctor. In astonishment, the doctor exclaimed to my dad how lucky he was, saying, "You don't know how close you came." My dad could easily have died from an anaphylactic reaction to penicillin.

One day in 1970's, as a nursing student on a hospital ward, I saw a group of my fellow students gathered together in the hall. They appeared to be earnestly discussing something very serious, so I stopped to find out what was wrong. A woman was dying. She was not dying from an infectious disease; she was dying from damage caused by a drug prescribed by her doctor to prevent tuberculosis. She never even had the disease herself; a family member had had it. The drug was given to protect her from possible infection. I heard my classmates all swear they would never take a tuberculosis drug unless they had the disease.

In the 50 years since my grandmother died, amazingly the world appeared to have come full circle. The cure seemed to have become the cause. During the years I worked and studied in hospitals, most of the deaths I saw in nonelderly patients without terminal cancer were attributed to prescribed drugs. I was not a bit surprised when I later read that adverse reactions to medications were a leading cause of death in the United States between the 1960's and the 1990's (Lazarou, Pomeranz, and Corey, 1998).

My mother knew that germs were dangerous; I know that sometimes drugs can be dangerous. If I were advised by a physician to take Cipro following an anthrax contamination in my environment, I would certainly take it. I would not take Cipro or any other drug, though, unless I knew I was at serious risk without it.

 

No one wants any of the adverse interactions mentioned above, nor would one want to develop a dependency to prescription drugs like antibiotics and painkillers.

 

Reference:

Lazarou J; Pomeranz BH; Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279(15):1200-5.