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The mythology of modern medicine--III. Microbes and man--Part 2. MV Kothari, L MehtaDept of Anatomy, Seth GS Medical College, Parel, Bombay, Maharashtra.
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 0007996505 Keywords: Antibiotics, therapeutic use,Attitude to Health, Clinical Medicine, methods,trends,Drug Utilization, Forecasting, Human, Infection, drug therapy,epidemiology,Microbiology, trends,Mythology, Treatment Failure,
Principle Six: ANTIBIOTICS ARE AT BEST MICROFLORA FLUCTUATORS Correlates and Corollaries 1. 'INFECTIOUS DISEASES are among the most common problems that present themselves to the physician. Many of them can be treated only symptomatically... It is the contention of those of us who deal principally with infectious diseases that in treating all of these groups there is a tendency to bring about immediate symptomatic relief to the patient rather to delve into the nature of the infectious process."[1] 2. "There are numerous reasons why a patient may not respond to therapy with antibiotics. One of the major factors is that the wrong antibiotic may have been prescribed, since these drugs are extensively misued by physicians... Antibiotics are commonly administered to hospitalised patients who show no evidence of infection; in fact, in some hospitals much of the antibiotic use may fall into this category. It is also clear that there is a considerable misuse of antibiotics by the patients themselves." 3. “Numerous antibiotics with overlapping spectra are now available, dosages for different infections vary widely, the drugs themselves are potentially dangerous, and their administration entails considerable expense. They should never be prescribed as placebos, antipyretics, or substitute for diagnosis. In the vast majority of instances in which this is done, patients recover just as they would if no 'therapy' had been given, and the drugs are wasted... Furthermore, antibiotics may select out resistant variants or facilitate the transfer of R factors between both pathogenic and commensal enterobacteria. Resistant variants can then replace sensitive strains and pose the additional hazard of spread to others. Finally, to expose a patient to the risk of drug reaction without proper indication is inexcusable, whether the drug is an antibiotic, a sedative, a laxative, or a narcotic” [3]. 4. "The manifestations and outcome of untreated tertiary syphilis were elucidated by study of a group of patients in Norway early in the 20th century. Of these patients, 30% became seronegative; another 30% remained seropositive, the patient dying of unrelated disorders; and remaining 40% manifested the features of tertiary syphilis” [4]. The foregoing stands endorsed on a wider canvas, by King and Nicol[5], who mused that "it is one of the surprises of recent medical history that the number of cases of late syphilis.. has declined progressively despite the fact that very large numbers of early cases must have escaped diagnosis and treatment during the second world war and in the immediate post- war years." 5. “The most obvious determinant of bacterial response to an antibiotic is the presence or absence of the target for the drug action. If an organism lacks the receptor for the drug, it will not respond…. Bacteria often contain the drug receptor but they do not respond because the concentration of antibiotic at the target site is inadequate.. Sometimes bacteria are sensitive to an antibiotic and sufficient concentrations are achieved at the site of action, but the organism is able to escape the consequences of the drug effect.. Microorganisms become less sensitive to antibiotics through a variant of biochemical mechanisms” [2]. 6. The future generations will view antibiotics as Nature's most malicious trick on mankind[6]. In fact if a universal antibiotic were to be discovered, it should be treated the way we ought to have treated the atomic bomb - destroy the idea and the thing at the very start [7]. 7. “It is all part of 'the wonderful mystery the all wise God hath made in the creation,' and man, even though he be a microbiologist, must have a care how he tampers with it. The use of a vaccine, perhaps especially a live one, may seem a fairly delicate manipulation of the environment, but it can lead to quite substantial alterations in the microbial balance. Wild poliovirus may be denied its place when attenuated vaccine virus is widely used, but other, enteroviruses may seize the chance to occupy it” [8]. If the foregoing is read between the lines, we can safely dethrone all antibiotics, all antimicrobial from their exalted angelic position to spell out what they really are: a. From streptococcal to syphilitic infections, more cases recover, on their own, without the antibiotic therapy than with. Many a patient recovers despite the antibiotic/s. b. There are too many ifs and buts that govern the therapeutic action of any antibiotic. As a situational antimicrobial, it has limited scope and unlimited limitations. c. If and when an antibiotic works, it can and does serve only as a microllorafluctuator pushing out a group of microbes to allow others to step in - the so-called opportunistic infections. Pray, who provides the opportunity, the invitation, the carte blanche? in man's war against microbes, the deployment of antibiotic umbrella is fraught with the umbrella - like in all wars - bringing with it its own occupation army, or it subverting the local innocents into mischief-makers. d. Antibiotics of any kind - chemotherapeutic or immunological as by a vaccine - must contend with the cardinal truth: Nature abhors microbial / viral vacuum. Granting that you take microbes as your enemy, antibiosis often only allows you to choose your enemy. e. In the whole admirable saga of antibiosis through penicillin and after, sight is lost of the fact that the ravages of microbes against man were precipitated in this century, by man himself in the form of world wars. The relentless progress in weaponary meant tearing apart of man's skin, muscles, bones and innards and rubbing the wounds with the mud of trenches. The microbes had no other go but to become trenchant. The harmless microbial residents of the microbioderm were pushed into areas ordinarily bathed by the always microbe - free millieu interieur. The human tissues had no other option but to eliminate the non- self elements, a battle that inevitably meant immune-system- initiated tissue destruction, abscesses, septicemias. In this warfare between microbes and man, man fired the first shot. Antibiotics came as exigencies of war wounds. What role can they have in humans whose skin and mucosae are unbreached? f. Amount all forms of drug-manufacture, borth dependent antibiotic making is the worst polluter of the water-systems of the world. The pollution has turned pervasive to affect animal bodies and soil as well. It's only the profiteering man that thought of making more beef by adding tetracyclines to cattlefeed. You can now appreciate how the European and American soils were botched up. Principle Seven: MODERN MEDICINE (MM) IS LARGELY IMMUNOSUPPRESSIVE Correlates and Corollaries 1. A perusal of the tail-ends-indices-of medical or pharmacological texts reveals MM's anti-ismant(i)acid, antiallergic, antidiabetic, anti hypertensive, anti-immunity, anti- inflammatory, antipyretic, antitussive, and so on. 2. In not a single anti-ism, does MM know what really is the problem, so like in a police-state, it choses to suppress whatever reactivity that the body's innate and infinite wisdom exhibits in the form of some symptoms, some signs. Nowhere in the annals of antihypertensive research/therapy is there any allusion to the 1912 lamentation of Sir James Machenzie[9], the pioneer British cardiologist, that a raised blood pressure may be body's wisdom at work for a purpose MM knows not. 3. The global outcome of MM's pervasive and relentless anti-ism has been, for the human body, counterproductive. Antacids also mean rebound secretion and alkalosis. Antiallergens are veiled CNS depressants. Antiarthritics suppress signals from diseased joints to allow more damage. Antidiarrheals, now largely abjured, interfere with colon's cleansing action. Antihypertensives are antipotency. Anti- immunity agents beget endless syndromes. Antipyretics and antibiotics abort the dialogue between the patient and the microbes. Antitussives inhibit the friendliest of coughs. MM's anti-ism has alienated man from so many things within the human body and around. 4. Suffice it to generalize that any patient under any anti-regimen gets physiocompromised in one way or more, in measures minimal to maximal. 5. In the context of the Principle Seven, the leading immunocompromising agents are corticoids, NSAIDs, antipyretics, antibiotics, all anticancer drugs, all immunosuppressants. Raeburn[6] righty bemoaned that the immunodeficiencies in children is a direct result of MM's antibiosis. 6. MM's anti-ism deplorable on three counts: It allows MM to look knowledgeable when it is rank ignorant; it licentiates it to throw spanners in body's wheels; it weakens the human race globally. It's high time MM opens an anti-anti discipline. Principle Eight: AIDS IS THE GIFT OF GLOBAL IATROGENIC IMMUNOSUPPRESSION Correlates and Corollaries 1. A modern Dictionary of Biology[10] defines natural selection: “Organisms that are better adapted to the environment in which they live produce more viable young, increasing their proportion in the population and, therefore, being selected.” Another dictionary of Modern Medicine adds. “…. the evolution of species results from mutation and selection of organisms that are best adapted phenotypically to survive in their environment, i.e., ‘survival of the fittest’”[11]. 2. The trillion-dollar question has always been: Who selects and what is selected and why? Koestler[12] has been critical of the circular tautology in the theory of the survival of the fittest: who survives? whichever is fittest; who is fit? whichever that survives. 3. In the microbiocracy ruling the human organism, the proliferative propensity of any single virus or bacterium called X is held in check by the milieu comprising the rest of the microbial galaxy, as also the innate resistance of the human organism. In this dynamic, ever-changing game, the organism X forever seeks an opportunity to assert itself. It is the shift in the milieu that offers the opportunity. So, the milieu leads, the microbe follows. Once the microbe X has an upper hand, it proliferates, increases its corporate genotype, and is now able to dictate the milieu itself. It gets naturally selected. 4. Like the herpes viruses, HIVs are inherent to and probably coevolved with primates including man. MM's outstanding iatrogenic contribution has been immunosuppression in one way or another, alteration of microbial flora especially through antibiosis, creating thereby a human herd that is immunodeficient. 5. The global immunodeficiency in the human species has allowed the HIVs to get selected, proliferate, and then to accentuate their success by dictating terms with the milieu by making it more immunodeficient. The 60 years or so of MM's antiobiosis and immunosuppression have allowed HIVs, to reach a critical mass and Potency so as to precipitate the first batch of AIDS cases by 1981. Prinicpal Nine: REVERENCE FOR MICROBES IS REVERENCE FOR MACROBES. Correlates and Corollaries 1. The microbial-macrobial mutuality is from the dawn of creation whereas MM's declared war against microbes is measurable in terms of decades. 2. MM owes to the life-old man-microbe symbiosis a measure of understanding, a modicum of respect, a manner of reverence. This done, MM will learn to appreciate the inherent benignity of the microbes and the unfathomable wisdom of the human body. 3. A perspectival approach, as attempted in the forgoing, will induce MM to practice more the Hippocratic ethos of Primum, non nocere - Firstly, no harm, and the Parean humility of Je le pensay, et Dieu le guarit - I dressed him and God healed him. 4. The disrespect for microbes on man has been reflected by mankind's disrespect for microbes in the soil, in waters, to the utter detriment of life in general and mankind in particular. The time for a sea-change is now. 5. Mankind with all its MM arsenal is in a hopeless minority against the massive, microbial world. If MM does not see the writings on the wall, the Illichean Medical Nemesis isn't far. Principle Ten: THE DIVIDING LINE BETWEEN THERAPIST AND THE RAPIST IS VERY THIN Correlates and Corollaries 1. “It is necessary only to recall the dangerous or fatal reactions that occasionally follow the use of antibiotics for trivial respiratory infections, the gastric haemorrhage or perforation caused by cortisone administered for a mild arthritis, the fatal homologous serum hepatitis that may follow needless transfusions of blood or plasma, or the arterial thrombosis or arrythmia that may complicate coronary angiography”[13],[14]. 2. In the commercialised setting of MM, the guiding principle is Fee for service that gets automatically translated into affirmative action - for every ill, a pill/potion/procedure. For every fever or alleged infection, antipyresis, antibiosis. Both the physician and the patient -the polar-opposites in the therapeutic game need to cure themselves of knee-jerk- therapeutics. 3. Aseptic surgery/procedure followed by prophylactic antibiosis imply distrust of the former and overtrust of the latter. Surely, there is no room for prophylactic antibiosis. 4. The cult of anti-inflammatory drugs -oxyphenbutazone being the most commonly prescribed betrays MM's double ignorance: No one knows how they work if at all, and the fact that the inflammatory response is mankind's only licence to survive. 5. All surface infections - commonly of the mucosae - are in the realm of milieu exterieur (ME) are a problem that the microbes really have to solve among themselves, and they are in situation wherein the production of infection and inflammation have a ready outlet to the exterior. Here, antibiosis is best avoided. 6. For infections deeper to the skin and mucosae, Le in the arena of the milieu inteieur (M1), there are a number of points that can help towards rational avoidance or use of antibiosis. a. A microbe in MI is treated as not-self - recognised, restrained, removed. b. Whereas the ME areas are swamped by multitudinal microbial species, deeper - W infections tend to be singular whether localised, or systemic. What factors determine this singularity? Man, microbe, or both? c. Cordoning off an infective focus, localizing it, liquefying the focus and then attempting a vent to the exterior is an underestimated propensity of human body. And except for the rather lightly-packed craniovertebral canal, most areas in the body allow enough room for the inflammatory tumour to process itself to spontaneous or assisted resolution. Assist the CNS early. d. Most broad spectrum antibiotics are bacteriostatic which means the major brunt of 'fighting' the infection is borne by the body itself. Knowing that in the natural course of any infection, more cases recover without rather than with antibiosis, a therapist must give the maximal opportunity to their patients to recover sans antibiosis. e. The gravest-looking infections have not necessarily killed their owners, nor have the antiobiotics always prevented/cured the infections. In many a 5 star hospital in Mumbai, burst sternal wounds after bypass are quire common and often heal despite antibiotics. f. In areas where the pus under pressure causes unbearable pain - finger-tips, teeth, bones - relief comes not by exhibition of antibiotics but by assisting drainage. g. In unplanned injury - accidental trauma - quite often the good general health and civilian nature of injury allows one to allow the patient to recover without antibiosis. h. The gastritis and altered bowel flora following oral antibiosis is a leading cause of post-operative unease, loss of appetite, loss of weight, and immunodeficiency. A patient who can eat well should be fed well - With food and not fads. i. Therapists should bear in mind that while seemingly treating a single patient very well and successfully, he may be mistreating the whole herd of humanity. "At the bedside of his patient, the physician sees a very small part of a very large scene. He is often able to destroy the infectious agent by treating its victim with an antimicrobial drug, but, although this may represent one of the wonders of modern medicine, it is really quite a feeble contributor to the solution of the problems of competition between man and microbes, and the latter has already found one answer in infectious drug resistance" [8]. j. A good therapist is one who knows when not to treat.
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