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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Of Eisenhower, Alexander Fleming, and the art of the enduring warning

As warnings we ignore at our peril go, I hear two continually repeated because the very different men who made them had unassailable credibility on the enduring subjects of which they spoke.

In a final address as he left the White House in 1961, President Dwight Eisenhower -- the military commander who oversaw D-Day – warned of an emerging “military-industrial complex” and the potential for the “disastrous rise of misplaced power.” It remains a phrase that is repeated every time the saber is rattled.

The other oft cited warning was made by a Scotsmen named Alexander Fleming, the discoverer of penicillin. In a 1945 speech accepting the Nobel Prize, Fleming warned about the rise of antibiotic pathogens and became the first to call for a kind of “drug stewardship” approach to preserve penicillin efficacy.

“But I would like to sound one note of warning,” he said. “Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in under-dosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

To illustrate his point, Fleming told a rather charmingly chilly anecdote as a hypothetical illustration of the problem to the assembled dignitaries:

“Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X, whose negligent use of penicillin changed the nature of the microbe.”