This issue of The Journal carries a provocative paper by Henry L. Simmons and Paul D. Stolley sounding alarms over what they feel is an immediate crisis—a major disruption of the microbiological environment related to several decades of injudicious use of antibiotics. Commentaries by several distinguished clinicians—each from a different aspect—discuss the ominous presentiment. We share their concern.
How did all of this get started? Have we physicians precipitated this crisis in "microfloral pollution" through ignorance or slothfulness or failure to heed warnings posted along the way?
Perhaps, but I believe the problem has another aspect that penetrates beyond these considerations. It has to do with the changing interface between physician and patient. It has to do with patient pressure—the "operant conditioning" of the general public—the emergence of the "pill culture."
The problem of overprescribing antibiotics (or any other drug) occurs for the most part in the office of the