Health: Taking on the superbugs

A RECENT report from the House of Lords' science and technology committee warned of a "major threat to public health" in which antibiotic- resistant "superbugs" rage unchecked and killer diseases such as TB, gonorrhea and pneumonia cannot be cured by modern drugs. But overuse of antibiotics in medicine and farming is not confined to Britain. This is a global problem and one that has hit hard the developing world where powerful antibiotics, rarely used here, are sold over the counter to millions of people.

In developing countries such as Bangladesh, the situation is especially bad. Most people cannot afford to consult a trained doctor, so they take their symptoms to a "quack" (the accepted term there for an untrained doctor). They often work from medicine shacks, side by side with "pharmacists", who are also often untrained.

"The quack will ask you how much money you have got and, depending on your answer, he will sell you your treatment," explains Dr Khairut Islam, national advisor for health in Bangladesh with the charity PLAN International. "It may be one day's worth of antibiotics and paracetamol, or two day's worth of antibiotics - so that you feel better for a few days."

But one or two day's dosage of antibiotics is only enough to kill off the most sensitive bacteria, while stronger strains of bacteria survive to cause further infection - which is now antibiotic-resistant and harder to treat. TB is a case in point, because it calls for a very long period of treatment with drugs. We are now experiencing a global epidemic, which is killing three million people a year around the world.

Meanwhile, the poor in the developing world suffer increasingly from ill health, paying ever higher prices for new drugs without getting good quality treatment. "In the past 15 years we have exhausted four generations of antibiotics which no longer work for us because of overuse and not completing the course," says Dr Islam. "Our medicine shops are now selling ciprofloxacin - which you only use with caution in the West - and its efficacy will be exhausted in another two years. We are sitting on a time bomb."

One way to try to end these abuses is to regulate the medicine shops. "At the moment, anybody can set up a medicine shop," says Dr Islam, "and you can buy any damn thing you want. The law is in place to stop that happening, but it is not enforced."

So, are the drug companies at fault? Dr Islam does not blame them directly, but he says this situation "definitely helps the business. They send their reps around our medicine shops and they justify it by saying they are `updating our knowledge'." The picture is further complicated by the many small, backstreet drugs manufacturers who operate across Asia. "You may get 80 different brands of one drug," says David Livermore, head of the antibiotic reference unit at the UK's Public Health Laboratory Service. He points out that many cheaper, "pirate" brands are also cut with starch and not as strong as they claim to be.

Another alternative is to encourage the use of homeopathy, which is cheap, virtually free of side-effects and long established in Bangladesh. On a recent visit, I watched as Horish Chandra Roy, homeopath in the northern rural area of Dinajpur, tended to around 100 people in just three hours.

The clinic, a one-room bamboo shack, offered no privacy for Monjiron, a skeletally thin woman of 40, as Roy took her pulses and looked at her tongue (Ayurvedic techniques of diagnosis). "I have fever, weakness, burning stomach pains and blackouts," she said. This could have been an infection meriting antibiotics, but Roy prescribed Bryonia and Nux Vomica. Monjiron paid seven taka (10p) to register for the year, plus a two taka charge for each subsequent visit, including remedies. Contrast that with the cost of antibiotics at 10 to 20 taka per tablet depending on strength.

Can we learn from Bangladesh? Homeopaths in Britain have long been advocating low-potency remedies as an alternative treatment of infections, while our bodies can heal without medication. Dr Islam says: "We cannot fully assess the efficacy of this treatment, but people who come here get comfort and attention. Medicine of whatever kind sometimes alleviates symptoms, sometimes cures disease - but it always consoles."