Types of resistance

doi:10.1136/bmj.323.7320.0

BMJ 2001;323 ( 3 November )

Editor's choice

Types of resistance

The anthrax infections in the United States have highlighted the uncomfortable topic of antibiotic resistance. As North Americabuys up large stocks of ciprofloxacin for treating anthrax $---$ andother manufacturers offer alternative antibiotics (p 1023) $---$ TonyHart and Nicholas Beeching warn (p 1017) that prolonged administrationof ciprofloxacin to many individuals may lead to the emergenceof resistance. That, they conclude, "would be an even greatertriumph for theterrorists."

The pessimists' view on resistance $---$ that "bacteria are bound to win the war against medicine" $---$ is quoted by Richard Wise inhis commentary on a paper that seems to show that general practiceswith very different rates of antibiotic prescribing show onlysmall differences in rates of antibacterial resistance. PatriciaPriest and her colleagues conclude from their data that tryingto reduce the overall level of antibiotic prescribing may notbe the best way of reducing resistance (p 1037). But Wise arguesthat the dynamics of the relation between prescribing and resistanceare complicated (p 1041).

This week's theme is another complicated relationship $---$ that of men and their health. As Siegfried Meryn and Alejandro Jadadsay in their editorial, "despite having had most of the socialdeterminants of health in their favour, men have . . . a lifeexpectancy about seven years shorter than women's" (p 1013). Thisdifference is even greater in eastern Europe. Martin McKee andVladimir Shkolnikov paint a bleak picture of the vulnerabilityof poorly educated single men (p 1051) $---$ "to be drunk anywhere canbe dangerous but especially so in a society where there are fewpeople on whom one can depend and where many elements of the environmentpresent lethalhazards."

One thing this issue does is to explain the all-important difference between sex and gender (p 1055, 1061). Alexander Kissand Siegfried Meryn do this by contrasting the gender differencesin two sex-related cancers $---$ breast and prostate (p 1055). For example,there is little research into the effect of prostate cancer onmen's ideas of masculinity, but much on the effect of breast canceronfemininity.

Abi Berger was heartened when her general practice became an all-female practice and none of her male patients said that itmattered (p 1077). But that might have been because $---$ as Ian Bankspoints out (p 1058) and Gordon Graham illustrates (p 1076) $---$ menresist consulting doctors of any sex. Meanwhile, Marcus Müllnerfinds from that great barometer of 21st century life, the web,that men seem to be "mainly concerned with hair growth, penisenlargement, smart eating, and betterweightlifting."

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The future of men and their health: Siegfried Meryn and Alejandro R Jadad
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