Disease and drugs

 As an infectious diseases physician, I have read widely about the history of development of antibiotics in the 20th century. One of my favorite books is The Mold in Dr. Florey’s Coat: The Story of the Penicillin Miracle by Eric Lax. The stories in the history of medicine are fascinating and this one is no exception, as good as any novel you might pick up. Penicillin has been in clinical use since World War II; the emergence and prevalence of resistance to it has diminished its utility but it remains the premier drug to treat a long-standing human scourge – syphilis.

The long story of syphilis itself is another engrossing tale. Treponema pallidum met its match with penicillin. Cures now number in the uncounted millions worldwide. Although there are reports of gene mutations in T. pallidum related to penicillin resistance no documented penicillin resistance has been reported. 

After my Navy career I was the medical director for the sexually transmitted diseases clinics for the Chicago Department of Health from 2002 to 2004. There was an upsurge in syphilis cases at that time, primarily in men having sex with men, in Chicago. We made a large effort to reach out with information, testing, and treatment and used a lot of Bicillin (the form of penicillin given for most syphilis cases). 

Now the U.S. is seeing another large upsurge in syphilis. CDC reported that syphilis is now at its highest peak since the 1950s and increased by more than 80% to 207,000 between 2018 and 2022. There were 3755 cases in newborns, a 937% increase over a decade.

I read this article in ProPublica with gross alarm. For years the cost of Bicillin was pennies per dose and it was widely available. Then Pfizer bought out the 2 competing companies that make Bicillin and troubles began. As the article notes, there are several possible solutions but there is also a lot of extraneous finger-pointing. For example, another well recognized use for Bicillin is in military basic training camps, where it has a long track record of reducing streptococcal respiratory infections. 

In my opinion, what we have here is yet another example of the deterioration of our healthcare and public health enterprise in the United States in fealty to bottomline corporatism. Here is yet another example of an elegant solution that worked well for many years jeopardized by Pfizer’s desire to monopolize the production and sale of Bicillin (and get hundreds of dollars vs pennies for its manufacture). The article also mentions the intermediary companies for drugs because they have a role in upping the cost of medications with no discernible reason to exist, except to generate profits for owners. Meanwhile, children are born as though it was the 18th century with a disease that will weaken them in body and mind as well as shorten their lives. That’s enough to make any rational person see red.

As Albert Einstein said, “Three great forces rule the world: stupidity, fear, and greed.”