Environmental Regulations

In 1928, Dr. Alexander Fleming was working at St. Mary's Hospital in London as a bacteriologist. One day, he returned to a plate culture of staphylo-coccus to find that it had been contaminated by a blue-green mold. What was most interesting about the contamination was that bacteria colonies next to the mold (Penicillium) were being dissolved. A subsequent effort by Fleming to grow the mold in pure culture resulted in the discovery of penicillin, a substance produced by the mold that had antibiotic properties.21 Penicillin itself was not actually chemically isolated until World War II, earning Howard Florey and Ernst Chain the Nobel Prize in medicine because of its critical impact to the field.

The discovery of penicillin has rightly been hailed as a medical revolution. It was the first of a series of antibiotic drugs that transformed much of the way that medicine was practiced in the twentieth century. The very nature of the battle against infectious disease was radically altered, with the public quickly learning to rely on the availability of a pill to cure much disease. But the promise of these drugs was in some respects short-lived. The story is well known. The mechanisms of natural selection operated on the genetic structure of bacteria when they were exposed to antibiotics, causing them to mutate into strains that were resistant. Already in the 1950s—little more than ten years after the isolation of penicillin—it was apparent that tuberculosis bacteria had undergone mutations that provided it with resistance to streptomycin.

The situation has only gotten worse. Widespread use of antibiotics—many would more bluntly characterize it as negligent overuse—has resulted in the development of so many resistant bacterial strains that many antibiotics are now all but useless. And the condition is much worse in certain parts of the world where practices associated with the use of antibiotics are much less structured than others. A memoir published in 1996 by two senior epidemiologists of the Centers for Disease Control (CDC) noted how quickly local environments can be affected by antibiotic-driven bacterial mutation. At the time, the Pakistani city of Karachi had a population approaching 10 million and had many sectors without sewer lines and where waste would run in open ditches. The city tap water was unfit to drink and the general lack of sanitation was manifested by fecal material appearing in the food and water supplies, resulting in widespread infection by typhoid, salmonella, shigella, cholera, and other bacterial diseases. Blanket treatment with wide-spectrum antibiotics acted as a strong selection mechanism as bacteria were repeatedly cycled through human bodies, causing the development of resistant strains. It took only ten years for Salmonella typhi—the cause of typhoid fever—to develop from an organism that was highly sensitive to cheap and available antibiotics to being completely resistant to multiple, more costly antibiotics.22

In the United States, the CDC has become aggressive in promoting campaigns to educate both medical personnel and the public of the dangers of inappropriate antibiotic use. As a public-health organization, it describes antibiotic resistance as among its "top concerns." There is evidence that these campaigns are having some success in shaping public attitudes and providing an understanding that while antibiotics are indeed "wonder drugs," there are limits to how they can be used, and that inappropriate use has the risk of depriving future generations of their wonders.

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