I learned the hard way about antibiotic resistance, after losing my legs in a fire, aged twenty. I have managed to do very well on my new prosthetic legs, but I am walking around on skin that has been grafted from other parts of my body, and it is not as strong as normal skin. Every now and then I will get a cut or a blister and I usually manage my way around that with plasters and antiseptic creams. However, if I’m unlucky, or doing too much walking, the wound will become infected, and that’s a different level of problem. The solution was always to take a course of antibiotics, and within forty-eight hours or so, I would see a significant improvement. I could usually even keep walking while the wound healed.
Thus, I frequently took antibiotics throughout the 1980s and 1990s, with great results. However, everything changed in the early years of this century. I developed a routine-looking skin infection and took a course of antibiotics. The infection got worse. I took an extended course of antibiotics. The infection got worse. I was prescribed different types of antibiotics. They had no effect. My familiar skin infection had learned how to resist the antibiotics. I had to spend long periods in a wheelchair. It took extended treatment with different antibiotics, and a new skin graft, to eventually solve the problem. Thankfully, it’s almost ten years now since I had any infection and I’ve learned to avoid them by taking greater care with my prostheses and adapting my lifestyle.
I would like to thank Dr F.X. Keane, consultant (retired), at the National Rehabilitation Hospital, Dr Nicola Ryall and Dr Jackie Stowe, also of the National Rehabilitation Hospital, for their great help and advice over the years.
Dr Colm Power in Wicklow, and my microbiologist friend who prefers to remain anonymous, have given me invaluable assistance with medical detail. Early drafts of the book read more like a medical textbook than an entertaining thriller, and microbiologists will spot where I have used artistic licence to help keep some of the medical issues understandable. Any mistakes are down to me. But the premise remains true: the more antibiotics we take, the more antibiotic resistant bacteria will develop.
A number of other medical professionals helped me in writing this book. They share a deep unease about the entire system by which medicines are prescribed to patients, but preferred not to be mentioned.
Dr Paul Carson and Glenn Meade, authors of many worldwide bestsellers, have been of enormous help to me, both in practical terms, and as an inspiration. I am very grateful for your time and encouragement.
Tim Palmer, P.J. Cunningham, Cliodhna O’Donoghue, Kate Egan, Tom Mooney and Michael McNulty were my ‘test readers’ and provided great encouragement and skilled critiques. Thank you all very much, for helping me to bring this story to life.
Security and defence analyst Declan Power helped with a question on the Middle East and any mistakes in that area are mine.
Thanks to Bolton’s finest, Chris Bogle, for some north of England dialogue for Anna, such as, ‘Best look at those maps then.’ (Did you spot the clue?) Thanks also to marketing expert Ronan O’Driscoll, Art O’Leary and Paul Dunne for coming up with lots of suggestions for brand names. Mary Stoner in Dallas double-checked a few American terms for me.
Thanks to Vanessa Fox O’Loughlin and the Inkwell Group for good advice, and particularly to Afric McGlinchey, for a great first edit, which made all the difference in getting published.
My huge thanks to all the team at Black & White Publishing, for believing in my book and helping to make it as good as it can possibly be. Particular thanks to Graham Lironi, who was great to work with as a sharp-eyed editor, and who added lots of ideas too.
If you’re interested in looking deeper into the drug approval process and marketing phenomenon, the FDA website is a rich seam of information. Just like Tsan Yohoto, you can register and they will email you copies of their reports and warning notices to the pharmaceutical companies, as they’re published. The reference to the fake drug site, Havidol.com, is factual.
Finally, I would like to thank the police officers of the First and Sixth Precincts, Manhattan, and especially the Fifth Precinct, for their courtesy and helpfulness in answering endless questions and for letting me hang around and observe. New York’s finest!