The Creation of Antibiotics and the Birth of Modern Medicine
By William Rosen
358 pp. Viking. $28.
In the 1930s, the advent of sulfa drugs represented a turning point for the health care industry, previously limited in its ability to fight infectious disease. Doctors now had a potential cure for strep, meningitis and gonorrhea, while patients were for the first time requesting a specific treatment by name. In “Miracle Cure,” Rosen skillfully blends scientific, political and economic history to trace the development of antibiotics and how they underwrote the modern pharmaceutical trade.
He dedicates much of his narrative to penicillin, which catalyzed the greatest change in both industry and clinical practice, starting with the Scottish physician Alexander Fleming’s accidental discovery, in the 1920s, that a penicillin-producing fungus slowed the growth of staph bacteria in a petri dish. In 1940, British researchers led by the Australian pathologist Howard Florey established the drug’s efficacy in mice. Recognizing the mass-market potential, Florey enlisted the United States Department of Agriculture’s Northern Regional lab in Illinois, where a bacteriologist found “a mold so powerful that it would, by the end of the 1940s, be the ancestral source for virtually all of the world’s penicillin.”
For Rosen, part of what made penicillin’s path so revolutionary was the government’s reliance on private companies like Pfizer and Merck to produce large quantities of the compound as part of the war effort. The lucrative federal contracts these entities received muscled out competitors and established Big Pharma as we know it. “The only comparable events in American economic history were the deals that built the transcontinental railroad and allocated the radio broadcast spectrum.”
Other antibiotics followed, promising to cure diseases from typhus to tuberculosis. Enter the age of drug-resistant “superbugs,” the consequence of corporate marketing, prescription-happy physicians and the use of growth-inducing antibiotics in livestock. Rosen’s take on this crisis is understandably cursory, given that he died of cancer shortly after finishing the book. He does make clear, though, that the current pipeline is meager, and the future of antibiotics insecure.
The Making and Unmaking of Tuberculosis
By Kathryn Lougheed
272 pp. Bloomsbury Sigma. $27.
In the 1940s, scientists developed the first cure for tuberculosis, the drug streptomycin. The disease almost immediately showed signs of resistance, so researchers devised a combination therapy to hold tuberculosis at bay temporarily. Yet, as Lougheed, a science journalist and former disease researcher, explains, tuberculosis continues to evolve in new and menacing ways — spurred on in part by our very efforts to contain it.
Lougheed’s history of tuberculosis dates it back to ancient mummies and medieval bones. She touches on New England folklore that links the disease to vampirism, as well as TB’s 19th-century associations with creativity (think: Frédéric Chopin, Keats and the Brontës). Still, she is generally flippant about the cultural significance of disease; she calls Thomas Mann’s “The Magic Mountain” “a looong German book set in a TB sanatorium.”
Fortunately she becomes more engaged as she delves into contemporary research on the pathogen itself. Tuberculosis establishes a complex presence in the people it infects: Upon entering the body usually through the lungs, it is engulfed by immune cells called macrophages. In most cases, instead of succumbing to them, the bacteria spur the creation of organized structures, called granulomas, fortified by walls that are several cells thick, making them hard for drugs to penetrate. This means that as patients undergo treatment, the bacteria may be exposed to “sub-lethal concentrations” of drugs, which can hasten the evolution of resistance. In addition, granulomas often enter a quiescent state, during which they may be even less susceptible to therapy.
Lougheed offers an impressive survey of current attempts to diagnose and treat the disease, from the experimental use of cancer drugs that modify the immune system to statins, which are typically prescribed to lower cholesterol. (As it happens, M. tuberculosis can feed on cholesterol within the body.) Without underplaying the challenges, especially of TB’s multidrug-resistant and extensively drug-resistant strains, she presents a league of smart scientists whose ingenuity and commitment offer at least some sense of hope.