Attached below is my recent submission an Oxford essay competition (in which I wrote about the discovery of penicillin) entitled:
The field of medicine has progressed immensely in the last 100 years. What do you believe is one of the biggest changes or discoveries that has shaped modern medicine today?
Since the beginning of humanity, Homo sapiens have been practising medicine; whether that be through so-called ‘sorcery’ or ‘folk medicine’, or more modern-day rational science, man seems to have had a drive to diagnose, treat and prevent disease of his fellow human. There is evidence that populations as far back as the ancient Hyksos (~1785 - 1555BC) undertook medical treatment, with the earliest known text on medicine appearing as long ago as the 17th century BC. Literature such as the Kahun and Ramesseum papyri detailed symptoms of conditions relating to gynaecology, myology and ophthalmology and was largely devoid of a ‘magician’s’ approach to treatment - marking the start of true medicinal practice. Thereafter, medicine has been improved upon hugely, perhaps with some of the most momentous changes and discoveries taking place within only the last 100 years. Innovations such as the vaccine (1796), anaesthesia (1846), and immunotherapy in the 1970s have all clearly had a profound effect on our medical system and saved numerous lives over the years.
However, the discovery that I believe has shaped modern medicine most dramatically was the discovery of penicillin in 1928 by Dr Alexander Fleming. Fleming, upon returning to his laboratory from a holiday, discovered that a sample of staphylococci (a type of gram-positive bacteria) had been contaminated with a fungus, killing the colonies nearby, whilst those further away remained unaffected. This group of antibiotics, with molecular formula R-C9H11N2O4S, is an effective treatment for many virulent strains of bacteria. Even Fleming himself said of the discovery: “I certainly didn’t plan to revolutionise all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did.”
It can be argued that penicillin has shaped modern medicine due to its time of discovery. With the final years of WWII, penicillin became a miracle drug; saving the lives of an estimated 100,000 soldiers during the fighting. Unfortunately, Fleming was a poor communicator and, as a result, his discovery failed to gain much traction amongst his fellow scientists. This was until 1940 when a team led by chemist Howard Florey made some significant progress in showing the in vivo action of penicillin as a bactericide. Mass research and development followed and by June 1945, over 646 billion units per year were being mass-produced. This was a truly unprecedented discovery for military surgeons. Gangrene dropped from a rate of 20-30 cases per thousand to only 1.5 and the lives of 12 - 15% Allied soldiers with an infected wound were saved. Battlefield diseases such as pneumococcal pneumonia and bacterial meningitis, both previously acute and often fatal conditions, could now be treated with a sprinkling of penicillin and some stitches, allowing surgeons to operate on huge swathes of patients when previously they would have to pick out those whom they believed to have a chance of survival. However, perhaps what is most significant about the time at which penicillin was discovered was the War acting as a ‘springboard’ for the drug, as well as a catalyst for research into other antibiotics. Pharmaceuticals like Pfizer and Merck invested heavily in the screening of a variety of other natural products for antibacterial properties leading to the discovery of a host of new antibiotics, including streptomycin (1943) and tetracycline (1945). As Dr Theodore C. Eickhoff, Professor of Infectious disease at the University of Colorado, states: “It is really impossible for me to imagine what the world would be like without penicillin. I question whether there would be a discipline of infectious diseases as we know it today.” Clearly, penicillin has had an enormous effect on both the way emergency medicine is viewed as well as leading to a change in the treatability of infections.
Furthermore, penicillin has shaped modern medicine due to the number of lives that it has saved. Whilst it is incredibly difficult to estimate the total number of lives the discovery of penicillin (and the subsequent rise of antibiotics) has saved, the UK Review on Antimicrobial Resistance notes that if all antimicrobials were to be lost, 10 million deaths would result annually and there would be a USD 100 trillion cumulative loss in global GDP by 2050.
As it is such a broad statistic, these numbers are hard to verify; however it is undeniable that antibiotics have had a considerable effect on the quality of medicine. This is further supported by the fact that global life expectancy spiked during the early 1900s. In the UK alone, life expectancy for a male was around 56yrs and about 60yrs for a female in 1921. By 1951, however, men now lived to 66yrs and women to 72yrs - a massive rise over only a 30 year period. Arguably, these increases are largely due to a drop in infant mortality as well as improvements in general hygiene and the medical system (with the advent of the NHS in 1948, for example). However, it is irrefutable that antibiotics had a part to play. Prophylactic antibiotics could now be used for major surgery such as an appendectomy down to more routine illnesses such as skin or chest infections, allowing more likely and rapid recovery of patients as well as halting the potential spread of disease in hospital settings.
However, the discovery of penicillin did bring with it many issues and potential problems for the future. Antibiotic resistance is now viewed as one of the “biggest threats to global health” by the World Health Organisation, leading to “longer hospital stays, higher medical costs and increased mortality.” Overprescription of antibiotics has led to an increase in resistance through one of three mechanisms: genetic mutations, acquired resistance, or natural resistance (as a result of natural selection). This is a difficult cycle to break, as the microorganisms that develop resistance can reproduce and become more prevalent, whilst those that do not develop such resistance subside - meaning that the more antibiotics are used, the greater the problem of resistance becomes. An issue that Fleming himself predicted in his Nobel Prize speech is that antibiotic resistance now affects over 500,000 people every year in the European Union alone, resulting in 33,000 deaths. - although there are some solutions and prevention schemes currently taking place to abate the problem, at both a global and local level. There are now many international monitoring programmes for identifiable drug-resistant bacteria, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, allowing medical professionals to submit data from individual laboratories and hospitals to construct visual reports of disease outbreaks. Antimicrobial stewardship teams have now emerged in many hospitals and GP surgeries, focussing on the prescriber to ensure antibiotics are used only when appropriate. This is also the case for farming, where bacteria in the animal’s flesh can develop resistance due to the antibiotics administered to them. As a result, only antibiotics deemed to be ‘not clinically relevant’ are now used.
Over the last 100 years the field of medicine has progressed immensely - with numerous discoveries and developments contributing to this advancement, of which penicillin is the largest due to the number of lives it has saved, and the opportunities it gave to further research into antibiotics and the way we treat disease. Time will only tell, however, how useful this discovery will be into the future and there is a large burden on medical professionals on how we chose to utilise antibiotics that will determine their efficacy. Yet, if we continue to produce, research and use antimicrobials in the same way that we have done for the last 100 years, the future should be easy to predict.
Bibliography
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