THE development of newknowledge is a fascinating exercise. Since humans evolved, theyhave been driven by curiosity to learnmore and more about nature. Overtime the knowledge accumulated cameto be systematised and this is what wecall science. The hunger for knowledgedeepened and expanded our collectiveunderstanding of nature. Thisknowledge is utilised to create toolsand other artifacts that humans use toimprove conditions of living. Sciencehas always been a collective activity,though under capitalism today thereare attempts by corporations to claimownerships over knowledge throughthe exercise of intellectual propertyrights – in the form of patents,copyrights, etc.The story of how antibioticswere developed and how they foundapplications in medicine is a story thatillustrates how knowledge develops.Not as a magnificent discovery by onescientist, as we are often told, but as aprocess that involves a number of stepsand contributed to by a number ofpeople. Further the story of antibioticsdoes not stop with its discovery. Thecurrent story of antibiotics is also astory about corporate greed and abouthow the benefits of science to societyare under attack under capitalism.
THE STORY OF ANTIBIOTICS -ALEXANDER FLEMING'S 'MISTAKE'
Let us first recount the events whichled to the discovery of antibiotics.School textbooks tell us that theantibiotic era was ushered in throughan accident. A British bacteriologist,Dr Alexander Fleming, was carelessin leaving his dish of bacterial culture(i.e., a dish with nutrient material forbacteria to grow) out in the open whenhe left on a holiday. When he returnedafter several days he found that amould (a kind of common fungus, like what grows on stale bread or cheese)had accidentally grown on a part of thedish of bacterial culture. He also foundthat in the area covered by the mouldthere was no bacterial growth! And that is how the world’s first antibiotic– penicillin – was discovered. Flemingnamed the mould penicillum notatum,from which the name penicillin wasdiscovered.Actually there is much more to thestory. Fleming was not the first personto think of using moulds (or otherliving organisms) to treat infections.
We have evidence that fungus was firstused thousands of years ago to treatinfections. The ancient Egyptians,for example, applied mouldy breadto infected wounds. Similar practiceshave been recorded among the ancientGreeks, in Serbia and even in India.In Russia, warm soil – probablycontaining moulds – was used bypeasants to cure infected wounds.We don’t know how effective thetreatments were, nowhere near howeffective modern antibiotics are forsure, but the basic notion of usingfungus to treat infections has existedfor long. At that time the knowledgethat infections are caused by bacteriadid not exist, but the empiricalknowledge that moulds can treatinfections existed.
In the modern era, in 1874,physician Sir William Roberts notedthat cultures of the mould Penicilliumglaucum that is used in the makingof some types of blue cheese did notdisplay bacterial contamination. LouisPasteur postulated in 1877 that bacteriacould kill other bacteria. So in 1928when Alexander Fleming came upwith the notion of using moulds totreat bacterial infections, he was notthe first to do so. This is not to belittleFleming’s contributions but to say thatoften many people have similar ideaswhen new knowledge is being created.
FINDING A WAY TO PRODUCEPENICILLIN
The story of Penicillin does not endwith Fleming’s ‘mistake’ in 1928.Fleming didn’t have the equipmentor resources, nor a background inchemistry, and couldn’t isolate theactive ingredient in the penicilliummould that killed the bacteria. Sonot much progress took place intranslating Fleming’s discovery intothe actual use of penicillin. In 1938,Dr Howard Florey, a pathologist,came across Fleming’s paper onthe penicillium mould. Florey andhis team undertook to unravel thescience beneath what Fleming calledpenicillium’s “antibacterial action.”
A key colleague of Florey was DrErnst Chain, a Jewish German émigré.After the Nazis came to power, Chainmoved to England in 1933. Chainwas to later learn towards the endof World War II that his mother andsister had been killed by the Nazis.In 1940 Florey, Chain and othersin the team demonstrated that thepenicillum extract cured mice withdeadly infections – the first actualdemonstration that penicillin couldcure infections. They, however,grappled with the problem ofproducing enough pure penicillin thatcould treat a human patient as it took2,000 litres of mould culture fluid toobtain enough pure penicillin to treat asingle case of sepsis in a person.
Dr Norman Heatley, who alsoworked with Florey is said to have usedevery available container, bottle andbedpan to grow vats of the penicillinmould so that he could produce enoughPenicillin. Now aware that the fungusPenicillium notatum would never yieldenough penicillin, Florey and Heatleystarted searching for a more productivespecies of fungus. With some luckthey found that the fungus Penicilliumchrysogeum, yielded 200 times theamount of penicillin as compared topenicillum notatum. With the use ofvarious techniques Heatley and Floreygot this fungus to increase its yield fivefold. Penicillin had finally arrived as amedicine and was poised to change theway infections were treated.
THE GOLDEN AGE OF ANTIBIOTICS
Penicillin was used during World WarII in soldiers with infected woundsand the results were dramatic. Whilein World War I, the death rate frombacterial pneumonia was 18 percent;in World War II, it fell, to less than1 percent. By the end of the war,
American pharmaceutical companieswere producing 650 billion unitsa month. Ironically, Fleming didlittle work on penicillin after hisinitial observations in 1928. In 1945,Fleming, Florey, and Chain – but notHeatley – were awarded the NobelPrize in Medicine. Does the storyhave a happy ending? For decades itseemed so. Soon new antibiotics likechloramphenicol and tetracycline werediscovered. Soon others followed andnow it became possible to develop newantibiotics entirely through a syntheticroute, without requiring extractionfrom living organisms like moulds.
These meant new antibiotics could bedeveloped much faster and could bemanufactured at much lower cost. Sooninfectious diseases caused by bacteriabecame a rarity in developed countriesand death rates fell in developingcountries as well. Science, it seemed,had delivered the ultimate tool toconquer some of the deadliest diseaseshumankind had been plagued with forthousands of years.
A TWIST IN THE TALE
But then the story started changing.Infectious diseases were still killingmillions in poor developing countrieslike India. These were the countrieswhere infections flourished becausebacteria attack the vulnerable – theundernourished, those forced to livein harsh unhygienic conditions, thosealready weakened by other diseases.
With improvement in living conditionsin rich countries and the readyavailability of antibiotics, infectiousdiseases all but disappeared in Europeand North America. But the conditionsthat breed infections persisted inthe developing world and thoughantibiotics were available, they wereoften too expensive. For example,in the 1950s, Indian prices for newantibiotic such as tetracycline andchloraphenicol were one of the highestin the world. Multinational companiessuch as Pfizer and Parke Davis hadan almost complete monopoly andcorporate greed won over societalneeds. The situation changed in Indiaonly in the early 1960s when twopublic sector companies – IndianDrugs and Pharmaceuticals Limitedand Hindustan Antibiotics Limited –commenced antibiotic production inIndia. By the 1970s pharmaceuticalmultinational companies started losinginterest in antibiotics. Infectionssoon came to be seen as diseasesof poor people in poor countries.
Millions continued to die but thesepeople (or their governments) didnot have the money to buy expensivenew antibiotics. So, as a result,pharmaceutical companies stoppedresearching and developing newantibiotics. They started targetingdiseases in the rich countries,especially heart diseases. For example,world over, over 10 million peoplefall ill with TB, and about 2 milliondie every year (of them almost halfa million in India). Yet till recently,the last drug developed specificallyfor TB was in the 1970s – almost 50years back! Clearly the pipeline for newantibiotics has dried up.
CORPORATE GREED
When Alexander Fleming wasconferred the Nobel Prize in 1945, inhis acceptance speech, he had warnedthat the overuse of penicillin mightlead to bacterial resistance. Fleminghad been uncannily prescient. Overtime bacteria have developed resistanceto the older antibiotics. This is partiallya natural process and part of how everyspecies tries to survive by adapting toadverse circumstances. We are nowinvolved in a race with bacteria, as wedevelop new antibiotics, the bacteriaafter some years start developingresistance and the old antibioticsare not effective any more. We have,however, accelerated this processin several ways. Most importantly,antibiotics are being tremendouslyoverused. Most common infectionsare caused by viruses, on whichantibiotics do not work. Yet, routinely,physicians prescribe antibiotics forviral infections, including influenza,for example. Global data suggests that40-70 percent of antibiotics are used inviral infections, where they are useless.Both pharmaceutical corporations andignorant or unscrupulous doctors andhospitals stand to gain by pushingmore use of medicines, even if they areuseless.
Antibiotics are also being misusedin veterinary practice. They areroutinely used as ‘growth promoters’in animals. In India this is routinelyseen in the poultry sector and in factyou have to pay more to buy ‘antibioticfree’ chicken.
The sum total of these follies is thatthe spectre of ‘antibiotic resistance’now haunts the world. In her addressto the United Nations, Margaret Chan,the then director general of the WorldHealth Organization (WHO), describedantimicrobial resistance as a ‘globalcrisis’. The WHO and, in fact, the entireUN system is now engaged in findingways to minimise the countries. Evenrich countries are seeing resurgenceof infections that they thought haddisappeared. We are seeing bacterialstrains that are resistant to all oralmost all antibiotics.
Our story has a mix of the goodand the bad. It shows us that science,as a collective human endeavour, hasimmense potential. It also shows usthat as a society, under capitalism, weoften do our best to undermine thefruits of human knowledge.
