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The Antibiotic Era

The Antibiotic Era
, 328 pages

18 halftones, 7 line drawings

December 2014



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The Antibiotic Era

Reform, Resistance, and the Pursuit of a Rational Therapeutics

Choice 2015 Outstanding Academic Title

In The Antibiotic Era, physician-historian Scott H. Podolsky narrates the far-reaching history of antibiotics, focusing particularly on reform efforts that attempted to fundamentally change how antibiotics are developed and prescribed. This sweeping chronicle reveals the struggles faced by crusading reformers from the 1940s onward as they advocated for a rational therapeutics at the crowded intersection of bugs and drugs, patients and doctors, industry and medical academia, and government and the media.

During the post–World War II "wonder drug" revolution, antibiotics were viewed as a panacea for mastering infectious disease. But from the beginning, critics raised concerns about irrational usage and overprescription. The first generation of antibiotic reformers focused on regulating the drug industry. The reforms they set in motion included the adoption of controlled clinical trials as the ultimate arbiters of therapeutic efficacy, the passage of the Kefauver-Harris amendments mandating proof of drug efficacy via well-controlled studies, and the empowering of the Food and Drug Administration to remove inefficacious drugs from the market. Despite such victories, no entity was empowered to rein in physicians who inappropriately prescribed, or overly prescribed, approved drugs.

Now, in an era of emerging bugs and receding drugs, discussions of antibiotic resistance focus on the need to develop novel antibiotics and the need for more appropriate prescription practices in the face of pharmaceutical marketing, pressure from patients, and the structural constraints that impede rational delivery of antibiotics worldwide. Concerns about the enduring utility of antibiotics—indeed, about a post-antibiotic era—are widespread, as evidenced by reports from the Centers for Disease Control and Prevention, academia, and popular media alike. Only by understanding the historical forces that have shaped our current situation, Podolsky argues, can we properly understand and frame our choices moving forward.

Scott H. Podolsky is an internist at Massachusetts General Hospital, professor of global health and social medicine at Harvard Medical School, and the director of the Center for the History of Medicine at the Francis A. Countway Library of Medicine. He is the author of Pneumonia Before Antibiotics: Therapeutic Evolution and Evaluation in Twentieth-Century America.

"Carefully researched and persuasively argued, The Antibiotic Era illustrates the power of historical analysis to enhance our understanding of the present. Podolsky traces debates over rational antibiotic therapy and examines actors and outcomes from the 1950s to our current concerns about antibiotic-resistant bacteria in the complex context of global health."

"Anyone who knows antibiotics will want to read this book, a brilliant, entertaining exposition of 'antibiotic reformers' as described by a gifted historian which focuses on the controversies and consequences stemming from the acceptance of antibiotics into clinical practice."

"A well-written and exhaustively researched book that compellingly details the history of the successes, failures, and limits of antibiotic reform. Scott Podolsky marshals an impressive array of archival sources to critically engage a subject that holds significant policy and public health relevance. The Antibiotic Era is an original and valuable contribution to the literature on the history of pharmaceuticals, late twentieth-century medicine, and the burgeoning field of global health studies."

"Podolsky's fascinating book should serve as a reminder to physicians, researchers, and policy makers of how our predecessors dealt with the study and treatment of serious and life-threatening diseases, and how regulatory and policy responses based on adequate and well-controlled studies were designed to protect patients and save lives."

"A masterly account of the efforts of reformers to counter the seductive marketing and irrational use of antibiotics in the hope of attenuating the inevitable emergence of resistant microorganisms.  We are now in the catch-up phase of the current 'antibiotic resistance crisis.'  This important book tells us how we got here."

"The author deftly handles the debates that festered around the appropriate roles of industry, clinicians and government in the production and use of antibiotics... The work is scholarly, exceptionally well researched, and worthy of serious examination for those interested in past, current and future efforts to frame and inform the public about antibiotic-resistant bacteria."

"This remarkable book ultimately shows that antibiotic resistance is an issue of huge cultural import that spans many disciplinary areas and which cannot be completely understood in all its significance without understanding its history: it is surely necessary to know the molecular details of the biological processes through which microbes acquire resistance; but it is also necessary to understand the conflict between the various social forces that shaped the debate concerning the misuse, abuse and overuse of antibiotics. The book accomplishes this latter result formidably well."

"... this book is a fascinating reminder that the benefits of antibiotics were squandered right from the beginning of the antibiotic era."

"The Antibiotic Era is about more than just antibiotics per se: it is also a rich and deeply thoughtful exploration of the contested process by which notions of therapeutic rationality have been developed, enacted, and resisted. As such, it should be read by both historians and other scholars of recent American medicine and by those interested in the use and misuse of antibiotics more broadly."

"With access to a wide range of archives from government agencies and academia, Podolsky takes us through a host of conferences, councils, courts, congressional hearings, symposia and task forces to reveal the tensions that grew since the 1940s between the pharmaceutical industry and medical academia, patients and doctors, and government and the media concerning over-marketed and irrationally prescribed antibiotics."

"Podolsky's historical accounts challenge readers to be mindful of what continue to be serious concerns within the global public health system."

"The need for an assessment such as The Antibiotic Era has never been greater... This book's value will only increase over time, and is recommended beyond health collections alone."

" The Antibiotic Era should be mandatory reading for those in the medical profession and is well worth the steep learning curve for those with an interest in the field but from a different background."

"... an in-depth and well researched book."

"This book is carefully researched and persuasively argued... it is a fascinating historical analysis..."

"We can thank the author for the effort and hope the lessons are duly noted and learned. This is an essential addition to every academic library in the health care professions."

"Readers unfamiliar with the new pharma history will find The Antibiotic Era an excellent introduction to the field, while those well read in the subject will find plenty to hold their interest."

"[Podolsky] brilliantly reconstructs the history of how the debate on antibiotics regulation was crucial in the making of drug regulation legislation in the USA...The Antibiotics Era is an excellent book and it will clearly become a reference for all scholars interested in the history of twentieth-century medicine and drug relation."

"... this is a fabulous book. This title contributes to a fundamental shift in the writing of the history of medicine. It tackles issues of therapeutics, and it also narrates the contemporary history of medicine, for which actors, debates, and interests are similar to those today. Scott Podolsky deserves praise as one of the drivers of this fundamental shift in the way the history of medicine is written. This publication deserves to gain the widest possible readership."

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