GERMS THAT WON'T DIE

Antibiotics are hazardous to your health, cautions pathologist and public-health activist LappÉ (Genetic Politics) in this densely written diatribe against medical and hospital practice here and abroad. The paradox results from the principle of natural selection at work. A drug may destroy most pathogenic bugs but leave a few resistant strains around to survive and multiply. In turn, the resistant strains can render other bugs resistant to antibiotics or turn harmless types into virulent strains by exchanging genes in nature's own style of recombinant genetic engineering. LappÉ cites innumerable studies to show that these biological events--known for many years--have had little effect on US public health policy. He blames the laissez faire philosophy in which doctors' prescriptions are sacrosanct, drug companies are profit-motivated, and patients demand medical relief. What with increased travel, a lessening of sexual restraints, and the prophylactic use of antibiotics in cattle feed (which leads to the spread of antibiotic resistance across species lines), the problems mount. LappÉ's answers are multiple: designate some antibiotics for emergency in-hospital use only; educate medical students and physicians about the long-range dangers of upsetting the bacterial ecological balance; establish peer review committees to survey prescribing practices; restrict the use of antibiotics in cattle feed; and increase research on alternate methods of combating infection. LappÉ advocates vaccine development and other immunological approaches as well as such obvious preventive measures as isolating high-risk patients and implementing better standards of hygiene in hospitals. The sustained tone of alarm, the use of a fairly technical vocabulary, and the occasional nod given to unconventional prophylactics (such as yogurt douches) are off-putting. On the whole, however, LappÉ's points are well taken. And since he can cite areas and entire countries where restrictive measures are beginning to pay off, he can also demonstrate that what should be done can be done.