Questions & Answers
Q & A- Donald Poretz
Q&A with Dr. Donald M. Poretz
‘Quick Fix’ Strategy a Prescription for Drug Resistance
By: LUCY SCHULTZE
As president of the Infectious Diseases Society of America (IDSA) for 2007-08, Dr. Donald M. Poretz is spreading the word about the dangers of not only infectious diseases themselves but also the way doctors have been treating them.
The mounting problem of antimicrobial resistance is at the center of current efforts by the IDSA, which is supporting the Strategies to Address Antimicrobial Resistance (STAAR) Act introduced in Congress this past fall. In addition to this pressing issue, the IDSA is focused on other issues of public health and bioemergencies, as well as ongoing research in the area of HIV/AIDS.
Poretz is in private practice with Infectious Diseases Physicians in Annandale, Va., and is a clinical professor of internal medicine at Georgetown University School of Medicine in Washington, DC. He was IDSA’s Clinician of the Year in 2004, and is consistently voted by his peers as one of the outstanding infectious-diseases physicians, as published in The Washingtonian Magazine and The Best Doctors of America.
What is the focus of your society’s work regarding antimicrobial resistance?
First, we’re supporting the STAAR Act (Strategies to Address Antimicrobial Resistance), which would allow Congress to create a position in the Department of Health and Human Services that would oversee various other intergovernmental departments and would be a multidisciplinary group watching what is happening throughout the whole country as far as trends in antibiotic resistance. We’re concerned that several presently used antibiotics are losing their ability to treat these resistant bacteria.
What other strategies are you pursuing?
We think that it would be reasonable for Congress to give various tax breaks to pharmaceutical companies for developing novel and unique antibiotics. Unlike drugs which are useful in treating problems like hypertension and hyperlipidemia which are taken essentially for the rest of a person’s life, antibiotics are only given for a finite period of time. The cost of developing a new antibiotic is somewhere between $600 million and $800 million. Paradoxically, when we ask pharmaceutical companies to develop these new drugs, at the same time we don’t want to use them unless absolutely necessary. For these reasons, financial incentives should be given for the development of new and novel drugs.
What should physicians know about this movement?
It’s very important that a doctor believe that an antibiotic is absolutely necessary before it is prescribed. To use an antibiotic when someone has a self-limiting viral infection such as the common cold, is unnecessary, expensive, and can lead to more resistance. Yet, the public often demands a “quick fix,” which can place a lot of pressure on physicians who today have less and less time to spend with a patient and often find it easier to write a drug prescription than explain why the drug is not necessary. We want people to know when and when not antibiotics are indicated. The public needs to be educated about these facts.
How well do you feel the message is understood today?
It is gradually sinking in. What really makes a difference is when you have a spokesperson who gets up in front of a group of individuals and says, “Look what happened to me when I took this drug” or “I was in the hospital and I experienced the effect of drug resistance.” Those kinds of personal statements are helpful in trying to decrease unnecessary usage. So far, pediatricians have taken the lead in reducing antibiotic overusage, especially for self-limiting ear infections. On the other hand, doctors are often fearful that their patients will go somewhere else if an antibiotic is not prescribed. Physicians will also occasionally practice defensive medicine by giving these drugs unnecessarily.
In the area of HIV, what kind of research is going on today?
People are looking at ways to attack the HIV virus in its various stages of replication. What we’ve learned in the past several years is that if you use only one drug, the virus tends to mutate and become more resistant not only to that drug but to other drugs in the same class. We now know that multiple drugs given together will decrease the chances that the virus will mutate so this has become the standard of care. On the other hand, HIV is becoming a very controllable, chronic illness similar to hypertension, diabetes, and cardiac disease. Nevertheless, one of the problems will be continuing to re-educate the public about not becoming blasé about how HIV is transmitted.
What are the prospects for an HIV vaccine?
If we could prevent HIV with a vaccine that would be the Holy Grail, but after 20 years of research it has proven extraordinarily elusive to develop such a vaccine. This is where people in governments all over the world and other groups such as the Gates Foundation need to spend a lot of time, money, and effort. Prevention is obviously much more cost-effective than treating after someone has acquired the disease. Unfortunately, at the present time, we have a long way to go in developing a preventive vaccine.
February 2008
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