Perspectives in Health Magazine
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Are We Killing the Cures?
by Alexandre Spatuzza
Mr. Marin Carmelo owns the largest pharmacy in the Vila Nhocuné neighborhood in São Paulo's populous zona leste, or "east side." His store is modern and well stocked, and it towers over the smaller drugstores on the other side of the street. In his 28 years of business in the neighborhood, Carmelo has made a name for himself: "the doctor," as customers call him. People from all over the area come to him for medical advice, increasingly so, he says, in the last few years. "I know what kind of medicine a customer wants just by looking at him," boasts Carmelo. "I just try to do my best."
Doing his "best" means liberally giving out paramedical advice as well as medication, selling most kinds of drugs over the counter, even those labeled with a red band indicating they require a doctor's prescription. "People don't trust doctors," Carmelo explains matter of factly, "or else they don't have the patience to wait for hours or days to get treatment."
The lack of effective monitoring and enforcement of controls on the sale and use of antibiotics is cited by the World Health Organization (WHO) as one of the main causes of growing resistance of the world's microbes to antimicrobial drugs. The indiscriminate and improper use of antibiotics results in a survival-of-the-fittest selection process for microbes, which can both inherit and acquire resistance to drugs, through mutation or by sharing DNA. Just as in normal Darwinian evolution but accelerated umpteen times by the division of millions of microbes, an infection treated with the wrong drug or for too short a time results in most bacteria being killed while the resistant ones survive to multiply. Using antibiotics for viral infections, against which they are impotent, promotes the growth and spread of resistant microbes in patients, their families, and the community.
Countries in Europe and North America have been tackling this issue (with mixed results) since the 1980s. In Latin America and the Caribbean, however, attention has been focused on the issue only during the last 10 years. Experts have only begun to map out the details of the problem, and information remains incomplete on which microbes are resistant and just how widely antibiotics are used. What researchers have found, however, are certain commonalities across the Region. Besides free-dealing pharmacists, these include weak or poorly enforced regulation, inequitable availability of health services, and working conditions that foster inappropriate prescribing practices by health professionals.