November 9, 2001 (Ira Pilgrim)
At Carthage nothing that results in profit is regarded as disgraceful.
Polybius,c.200BC
The relatively new antibiotic ciprofloxacin has been getting more publicity than penicillin got when it was first discovered. But, as Shakespeare said in Hamlet, "Something is rotten....." Why am I suspicious?
For one thing, it is made and marketed by Bayer under the trade name of Cipro. Bayer is a company that continues to make a fortune on the drug aspirin. Aspirin is a drug that can be made in any college freshman chemistry laboratory. It is a great drug and is as effective a pain killer as any non-addicting drug. It is not effective for severe pain, but neither are any other over-the-counter drugs. It is an undisputed fact that the only difference between Bayer aspirin and any other brand of aspirin is the box and bottle that it comes in. Bayer aspirin costs at least twice as much as other brands in the same quantities. That is because 1. Bayer spends a lot of money on advertising and 2. Bayer makes a hellofalot of money. Now Bayer doesn't have to advertise Cipro. That has been taken care of by the media for free. People with lots of Bayer stock are probably celebrating.
Fortunately for Bayer, and unfortunately for the rest of us, you can only buy ciprofloxacin from Bayer because they hold the patent on it and, so far as I know, they have not allowed any other company to make it. There are, however, eight other brands of similar drugs (fluoroquinolones), but we haven't heard anything about them. Why not?
Three years ago I went to Ukiah Valley Hospital for prostate surgery. My urologist prescribed Cipro. The hospital charged my insurance company $100 per tablet. When I left the hospital I was able to get the same thing at a drug store for $10 per tablet. It is now priced at about $5 per pill. That is still a very hefty price for an antibiotic.
Every book that I have says that the drug to use first for anthrax is penicillin. The second choice is one of the tetracyclines. So far, the anthrax that has been detected is sensitive to both penicillin and tetracycline; both of which are older, time tested, safer than Cipro and a lot cheaper. The last drug to use is ciprofloxacin, if the others don't work; which is highly unlikely. I believe that using Cipro as a prophylactic for anthrax borders on medical malpractice.
The first choice for urinary infections is a sulfonamide and the second choice is ciprofloxacin or a similar drug. If cultures have been taken and sensitivity tests performed, it is not necessary to guess. There are good reasons for doing it this way. Every antibiotic that is used heavily leads to the development of resistant strains of the bacteria to that drug. Many drugs that were once 100% effective for certain organisms are no longer effective. It is a good bet that, before too long, ciprofloxacin will lose its effectiveness for many bacteria since it is now being used indiscriminately. One indication of how heavily it will be used is the fact that it is being hawked heavily on the internet. For a hefty price, anyone can buy it. I received an e-mail that said, among other things, "Order direct from your computer...no inconvenience or embarrassment to you. No hassles, no waiting rooms, everything is done on-line."
The use of the potentially most effective new antibiotic immediately is a good idea in a potentially lethal disease such as meningitis or respiratory anthrax. It is not a good idea with most other diseases, nor is it a good idea to use it as a prophylaxis. The skin form of anthrax is not considered to be a lethal disease and most people who get it recover without any treatment. I would guess that Cipro, when used indiscriminately as it is being used now, has the potential for killing more people than it saves. Drug companies are not concerned about this. It is sales and the bottom line that counts.
When this anthrax scare is over, we will wonder what the big fuss was all about. There is no epidemic. There have been 8 deaths, almost all of which could have been prevented if the people involved had seen an physician who could recognize the symptoms of anthrax when the first symptoms appeared; not an easy thing to do. More important, as a consequence of a government and media sponsored advertising campaign, Bayer has sold more Cipro than would, or should, ever be used.
I recently read a newspaper article that stated that Cipro was not the only effective antibiotic for anthrax. They mentioned Amoxicillin(a type of penicillin). Amoxicillin is another antibiotic where there is no generic equivalent available.* No mention yet of the safe and effective tetracyclines. Am I implying that there might be pecuniary considerations involving the guardians of our nation's health? Perish the thought.
*12/13/01 My daughter Jan, who is the drug buyer for a large hospital, tells me that amoxacillin is available as a generic and that it is relatively cheap. The source that I used for this information was out of date.