Resistance is worse than useless

February 11th, 2006 by Ben Goldacre in adverts, africa, alternative medicine, bad science, dangers, herbal remedies, times | 63 Comments »

Ben Goldacre
Saturday February 11, 2006
The Guardian

Let me take you back to 2005, and one of several Bad Science stories about Susan Clark and her What’s The Alternative column in the Sunday Times. She’s no longer in that post – if you’re lucky we’ll have room to talk about her successor soon – but she stood out on account of her penchant for giving advice on the bigger diseases: MRSA, malaria, that kind of thing.

Anyway, she also liked to recommend that plants whose constituents had recently been discovered to have antibiotic properties should be taken prophylactically, that is, to stop you getting a disease. She suggested, for example, that pau d’arco should be taken by patients to prevent themselves from getting MRSA in hospital, and artemisinin to prevent malaria.

Now my objection to this at the time was, in some ways, a subtle point. Think about how “superbugs”, bacteria resistant to antibiotics, come into existence: they are exposed to antibiotics in lower doses, but killed off incompletely, some survive, and so, by a process of mutation and natural selection, the bacteria evolve to be resistant to the drugs. The bacteria that survive the battle are the ones that are most resistant.

Now I realise evolution may be a problem area for some of you, but this really is an incredibly clever process: for example, once new resistance genes have evolved, bacteria can then share these genes with completely different bacteria nearby. They literally swap genes between each other. This is happening right now, in your body. They are clever, clever little buggers. To prevent resistance to antibiotics, you want to keep your best antibiotics out of farming, and away from pushy patients with viral coughs, to give a couple of examples.

But this kind of thing doesn’t occur to alternative therapists. And the problem is that malaria, for which Clark was recommending artemisinin, prophylactically, without any evidence, to travellers, isn’t a decadent westerners’ playground. Malaria kills more than a million people a year, mostly children. As recently as 2004, in the Lancet, there was hope that artemisinin could be used to eradicate malaria for good, if used carefully to treat people with the disease.

And now, here is the punchline. Just this month the new chief of the World Health Organisation’s malaria programme warned that the growing misuse of artemisinin – which you can still buy from the usual “health food” outlets – could create an incurable strain. The same thing happened with resistance to chloroquine, our magic bullet for malaria in the 1940s, of course: it’s now virtually useless. Dr Arata Kochi from WHO says any drug companies even selling the drug artemisinin alone, instead of with other drugs in the same tablet – which ensures a cleaner kill of the malaria in your blood – will face boycotts of their other products. This kind of threat is almost unheard of.

Now let’s be clear. I’m not saying Clark is a mass murderer, although if anyone followed her advice, clearly they would be contributing to resistance to the drug, as the artemisinin-exposed malaria bugs are sucked out of her travelling readers’ blood by mosquitoes and then deposited into the arms of the picturesque natives. No. Susan Clark is merely a tiny cog of a huge system: and this whole system, of perpetuating and disseminating the beliefs of alternative therapy fantasists, of flattering them that they have a valid perspective and contribution to make, simply because it is commercially and politically expedient to do so, in our decadent, healthy western countries, is dangerous, stupid, shortsighted, and flawed.

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63 Responses

  1. Ben Goldacre said,

    February 15, 2006 at 3:57 pm

    yeah thats true, the anopheles mosquito doesnt live in the uk. having said that, does anyone know why you dont see anopheles mosquitoes and malaria in the USA? did they just DDT everything in sight?

  2. Chris L said,

    February 15, 2006 at 5:39 pm

    From the Wikipedia entry on DDT (

    “DDT was responsible for eradicating malaria from Europe and North America. Though today malaria is thought of as a tropical disease, it was more widespread prior to an extensive malaria eradication program carried out in the 1950s. Though this program was highly successful worldwide (reducing mortality rates from 192 per 100,000 to a low of 7 per 100,000), it was less effective in tropical regions due to the continuous life-cycle of the parasite and poor infrastructure. It was not pursued aggressively in sub-Saharan Africa due to perceived difficulties, with the result that mortality rates there were never reduced to the same dramatic extent, and now constitute the bulk of malarial deaths worldwide, especially following the resurgence of the disease as a result of microbe resistance to drug treatments and the spread of the deadly malarial variant caused by Plasmodium falciparum.”

    It seems that allowing the use of DDT in Africa would be extremely beneficial, on balance. One suspects that the environmental problems it causes would not stop its use in the first world if it was our children that were dying in their thousands.

  3. Janet W said,

    February 15, 2006 at 5:54 pm

    “….For three centuries, malaria plagued the United States, from the deep south up to Michigan. When falciparum malaria entered the colony of South Carolina in the 1680s, the area developed an international reputation for “unwholesomeness.” “Those who want to die quickly, go to Carolina,” ran an English saying. “Carolina in the spring is a paradise, in the summer a hell, and in the autumn a hospital,” commented a German traveler. As late as 1914, 600,000 people in the United States suffered from locally transmitted malaria.

    Mosquito abatement measures, such as draining wetlands and using pesticides, effective drugs, and lifestyle changes ended malaria’s grip on the U.S. The disease still occasionally appears in the United States, though.”

  4. Janet W said,

    February 15, 2006 at 5:55 pm

    the problem with Google is it’s so distracting…

    “Sarah Emma Evelyn Edmonds(1841-1898) Union Soldier.Sarah Edmonds, a Canadian by birth, assumed the alias of Franklin Thompson and enlisted as a private in the Second Michigan Infantry in Detroit on May 25, 1861. Her regiment participated in the Peninsula campaign and the battles of First Manassas, Fredericksburg, and Antietam. In April 1863, Edmonds deserted because she acquired malaria, and she feared that hospitalization would reveal her gender”

  5. Nat said,

    February 15, 2006 at 5:57 pm

    Actually there used to be a lot of malaria in the UK.

    It’s mainly been modern public health measures (draining swamps, DDT etc) and improvements in housing that have practically eradicated malaria from developed countries.

    There are still outbreaks of malaria which occur every year, but they’re usually caught fast and prevented from spreading.

    Lots of useful info here too:

  6. Ben Goldacre said,

    February 15, 2006 at 6:36 pm

    “the problem with Google is it’s so distracting…”

    yup. and interestingly, as in the lady soldier example, it also demonstrates the very human frailty of ascribing more significance to anomalies than to the everyday… it’s… almost like… its a huge collective human mind…

  7. Terry Hamblin said,

    February 16, 2006 at 9:19 am

    Outbreaks of malaria occurred in Kent after the first world war. It was thought to have been brought back by returning soldiers.

    Don’t write off intelligent design too easily. The resistant TB may have evolved, but the new drugs were produced by intelligent design. A current car advert shows a new model with the tag, “Don’t you believe in evolution?”

    Once more the designer fails to get the credit

  8. Hatter said,

    February 16, 2006 at 11:25 am

    Regulation of some herbal remedies and medications is fine if their use can cause harm to others, particularly large-scale harm like misuse of antibiotics. Otherwise potential users should simply be warned of potential negative consequences. See the stupid kav-kava and ephedrine scares of recent years for typical examples of overreaction and unacceptable interference by our nannies in government.

  9. Adam said,

    February 19, 2006 at 9:20 pm

    I couldnt agree more!

  10. Playground Equipment said,

    February 24, 2006 at 5:24 pm

    Do you provide a blog feed subscription for this blog so I can get it via email?

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  13. Max01 said,

    December 26, 2009 at 6:35 pm

    What a lot of crap. Everyone gunning for Susan Clark when she has done nothing that the entire medical establishment has not been doing for the last 50 years. What about all the GPs who are still prescribing antibiotics for virus conditions? How can you pick her out for criticism and ignore the rest? A blatant case of bias