Medicine and war: recognizing common vulnerability of friend and foe

Article Abstract:

A review is presented concerning the history of and ethical issues involved in the role of the physician in wartime. The recognition that enemies are brought closer together by suffering is an ancient one, and the first military hospital was established during the 11th century in a war in the Middle East. After a series of international conventions between 1864 and 1949, physicians have been accorded neutral status and allowed special protection during battle. These protections should extend to civilians and prisoners of war, particularly when they are wounded. Medical personnel are not to be attacked and are to be repatriated immediately if captured; in return, they are not to engage in acts of war and must care for all wounded or sick people. They are also to speak out against atrocities committed by either side, a mandate that has been ignored all too often. Physicians have been convicted and hung for war crimes, beginning with Captain Henry Wirz of the Confederate prison in Andersonville, Georgia, in 1865; his defense that he followed ''superior orders'' was also used by German physicians tried after World War II. The medical societies of Germany should have protested the grotesque experiments their colleagues carried out, as did the physicians of the Netherlands. These physicians willingly surrendered their licenses when threatened to do so if they did not cooperate, then continued to practice medicine. Many were sent to the extermination camps. A similar fate apparently awaits those who protest in Iraq: the International Commission of Health Professionals for Health and Human Rights has told the United Nations that physicians who speak out against acts of brutality risk their lives. Many have been murdered, jailed, exiled, or become untraceable. A large proportion (as many as 85 percent) of the health care personnel in Kuwait left the country after the Iraqis invaded it; many, however, were not Kuwaiti citizens. While it could be said that these physicians who left lack strength of character, the necessity to choose between one's patients and one's life surely presents a terrible dilemma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Crimes against, Ethical aspects, Iraq, Prisoners of war, Atrocities, Medicine, Military, Military medicine

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New insights into how bacteria develop antibiotic resistance

Article Abstract:

The number of bacterial strains resistant to penicillin-type antibiotics has increased worldwide. In 1989, 50 percent of bacterial samples (isolates) obtained from patients with pneumococcal disease and 70 percent of isolates from infected children were resistant to penicillin. The beta-lactam antibiotics, including penicillin, introduced almost 50 years ago, are the most commonly used antibiotics. Although tens of thousands of derivatives of penicillin have been developed, only 17 are currently marketed in the US. Penicillins act against bacteria by interfering with the construction of the bacterial cell wall. Resistance to these antibiotics results from changes in bacterial genes caused by single mutations; complex, multigene mutations; or incorporation of plasmids (genetic elements not contained in the nucleus) into bacterial genes. These plasmids may contain the genetic information for the production of enzymes, such as beta-lactamase, that degrade antibiotics. A new genetic change detected in beta-lactam-resistant pneumococcal bacteria involves the remodelling of an enzyme called the penicillin binding protein (PBP), needed for the production of the bacterial cell wall. Bacteria may counteract the action of antibiotics by producing more PBP for building the cell wall; preventing the access of antibiotics to its binding site; and using plasmids which code for enzymes that destroy antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) strains have an extra PBP called PBP2 that does not bind as strongly to beta-lactam antibiotics and can maintain cell wall production. Altered PBPs have been detected in other bacterial types. Vancomycin, previously considered a last-resort drug to treat infections with antibiotic-resistant strains, is now increasingly used. Bacterial strains resistant to vancomycin and the newest beta-lactam drugs, carbapenems, have already been identified. With increased understanding of the mechanisms of bacterial resistance, new drugs can be developed to counteract resistance mechanisms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Genetic aspects, Drug resistance in microorganisms, Microbial drug resistance, Beta lactam antibiotics

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