The Dump That Killed Twenty Thousand

Chloramphenicol is one of the "wonder" drugs, an antibiotic effective against a broad range of infections. However, it has equally powerful side effects. One of them is aplastic anemia, a frequently fatal blood disease. Extrapolating from fatality-rate figures given by the California State Department of Health, we can estimate that between 888 and 1,487 Americans have died from aplastic anemia induced by chloramphenicol. The drug is marketed in this country by Parke, Davis & Company, most commonly under the name Chloromycetin.

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Despite this risk, chloramphenicol still is uniquely effective against certain esoteric diseases, one of them being typhoid fever. The problem (for the drug companies) is that there are only a few hundred cases of typhoid fever a year in the U.S. Hence, Parke, Davis for many years aggressively pushed its Chloromycetin as a cure for a wide variety of other maladies. Experts testifying some vears ago before Senator Gaylord Nelson's Small Business Subcommittee on Monopoly said that between 90 and 99 percent of Chloromycetin prescriptions were being given out for common colds, acne or other conditions for which no drugs are effective, or other drugs are safer.

Eventually, under the pressure of congressional hearings, lawsuits and other publicity, chloramphenicol sales in the U.S. declined sharply. Parke, Davis began printing warnings on Chloromycetin packages sold in the U.S. stressing that the drug should only be used for a few life-threatening illnesses. Are these warnings "justifiable?" Senator Nelson asked Parke, Davis executive Leslie Lueck at a 1967 hearing. "Yes," he replied. To Lueck's consternation, Nelson then produced an ad for Chloromycetin from the British medical journal The Lancet that carried no warnings at all. Lueck made some excuses; Nelson said: "I don't see how you people can sleep at night."

If Parke, Davis people lost any sleep over Britain, they ought to have become insomniacs over Latin America. There, University of California pharmacologist Dr. Milton Silverman reported in a 1976 study, chloramphenicol was recommended to physicians for treatment of all sorts of conditions -- including tonsillitis and bronchitis -- that were scarcely life-threatening. Parke, Davis gave no warnings at all about the drug to doctors in Guatemala, Costa Rica and other Central American countries. McKesson Laboratories, a rival supplier of chloramphenicol, recommended its brand for whooping cough; and while it disclosed a few hazards to doctors in Central America, it listed none at all in Colombia and Ecuador.

Besides causing an unknown number of deaths from aplastic anemia, promiscuous use of chloramphenicol -- like that of many antibiotics -- has had a more serious consequence: bacteria have built up resistance to it.

No one knew how serious a problem this would be until a 1972-73 epidemic of typhoid fever in Mexico. Believed to be the most catastrophic outbreak of typhoid in history, it afflicted about 100,000 people. Up until that point, most doctors had assumed that chloramphenicol would prove as effective against typhoid as it had in the past. To their dismay, they were wrong. The particular typhoid bacteria they were dealing with had, through long exposure, built up resistance to chloramphenicol. Doctors were largely helpless.

20,000 of the typhoid victims died.