THE PLAGUE MAKERS

A clear warning that the growth of antibiotic-resistant bacterial strains means big trouble ahead, and a multifaceted plan of action for dealing with the problem. Fisher, a medical writer whose last book (RX 2000, 1992) contained mostly cheery predictions about medicine's future, takes a closer look at a dark cloud on the horizon: overuse and misuse of antibiotics and the subsequent increase in bacterial resistance to them. He asserts that the problem has multiple causes: Hospitals routinely overuse antibiotics for prophylactic purposes; pharmaceutical manufacturers overpromote them; inadequately educated physicians overprescribe them; misinformed patients demand them, Third World countries often fail to control them, and the livestock, poultry, and fish industries abuse them. Fisher includes chilling stories and frightening statistics (e.g., each year some 2 million Americans acquire infections in the hospital, and more than 80,000 of them die) to dramatize his message that infectious diseases once thought under control are making a comeback in stronger, more virulent forms. He also says serious attention must be given to evidence, though not conclusive, that the immune-suppressing effects of antibiotics are a factor in the development of AIDS and may even cause it in the absence of HIV. The take-home message is not one of despair, however; Fisher says much can be done and outlines 15 actions citizens can take. These mostly involve persuading physicians, hospitals, medical societies, and governments to take various remedial steps, and he includes names and addresses of individuals and organizations to contact. Finally, he provides a brief guide to infections, with their common causes and their recommended treatments, and a list of commonly used antibiotics by class, explaining the therapeutic advantages and disadvantages of each class. Cogent arguments crisply presented.