Types of resistance

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:0

The anthrax infections in the United States have highlighted the uncomfortable topic of antibiotic resistance. As North America buys up large stocks of ciprofloxacin for treating anthrax—and other manufacturers offer alternative antibiotics (p 1023)—Tony Hart and Nicholas Beeching warn (p 1017) that prolonged administration of ciprofloxacin to many individuals may lead to the emergence of resistance. That, they conclude, “would be an even greater triumph for the terrorists.”

The pessimists' view on resistance—that “bacteria are bound to win the war against medicine”—is quoted by Richard Wise in his commentary on a paper that seems to show that general practices with very different rates of antibiotic prescribing show only small differences in rates of antibacterial resistance. Patricia Priest and her colleagues conclude from their data that trying to reduce the overall level of antibiotic prescribing may not be the best way of reducing resistance (p 1037). But Wise argues that the dynamics of the relation between prescribing and resistance are complicated (p 1041).

This week's theme is another complicated relationship—that of men and their health. As Siegfried Meryn and Alejandro Jadad say in their editorial, “despite having had most of the social determinants of health in their favour, men have … a life expectancy about seven years shorter than women's” (p 1013). This difference is even greater in eastern Europe. Martin McKee and Vladimir Shkolnikov paint a bleak picture of the vulnerability of poorly educated single men (p 1051)—“to be drunk anywhere can be dangerous but especially so in a society where there are few people on whom one can depend and where many elements of the environment present lethal hazards.”

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

Abi Berger was heartened when her general practice became an all-female practice and none of her male patients said that it mattered (p 1077). But that might have been because—as Ian Banks points out (p 1058) and Gordon Graham illustrates (p 1076)—men resist consulting doctors of any sex. Meanwhile, Marcus Müllner finds from that great barometer of 21st century life, the web, that men seem to be “mainly concerned with hair growth, penis enlargement, smart eating, and better weightlifting.”


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