Nevermind Zombies and Aliens – Overuse of Antibiotics is Creating Superbugs Part II

The following are the musings of a doctor friend who is chief of medicine of a northeastern hospital. I had reached out to ask for their thoughts on the overuse of antibiotics. What I got back was this medical professional’s musings on their frustrations in dealing with this important issue.

I can write a book for you on this.

I am certainly not in favor of indiscriminate use of unnecessary antibiotics in farm animals, but do not feel I am expert enough in this area to weigh the risks and benefits of their use and not certain of how much we know of the impact on humans who eat these animals (I don’t really eat meat often). There hasn’t been definitive data showing that those who eat “organic” food do better than those who don’t. (editor’s note: true enough, but eating meats from animals that had not been administered antibiotics can only help with this issue, and err on the side of caution, no?)
HOWEVER, when it comes to using antibiotics in humans – the overuse is ridiculous and here are the primary reasons that it happens:
1. The culture of Americans is demanding, selfish, and unrealistic – one of the most frustrating parts of my life when I was seeing patients every day was when they would come to me with respiratory symptoms – nasal congestion, cough, sore throat. They came wondering what could be wrong with them (a cold – were they born yesterday to not know this?) and expecting when I told them it was a cold that I could somehow cure them. I would get exhausted during a busy winter season spending the majority of my day explaining to patients that antibiotics are not effective against viruses and there is no way to cure a cold or a viral sore throat or bronchitis.
They would say things like, “I have the beginning of a sore throat and stuffy nose and I am going on vacation tomorrow and I can’t be sick, so please give me an antibiotic.” The vast majority of the time I would not give them an antibiotic. Most accepted this because we had a trusting relationship and I took the time to clearly explain why antibiotics would not be the right thing for them. Others felt cheated. They took the time to come see me, paid their $8 copayment, and got NOTHING from me to help them. Occasionally I even wrote a prescription for a stronger version of advil or nyquil as a decongestant and cough suppressant just so they felt like the visit and the copayment had some value.
Then there were the doctor shoppers who got symptoms of a cold, and doctors #1 and #2 wouldn’t give them antibiotics and doctor #3 on day #8 gave them an antibiotic, and miraculously on day #9, that one pill “knocked the cold right out of them.” Doctor #3 is the great hero who they will then always go to, neglecting to understand that the average duration of a cold is exactly 9 days and that it is not scientifically possible for a single dose of an antibiotic to knock anything out of anyone.
2. Not all doctors are good at translating what we read in the medical literature to practice – much gets lost in translation. Some doctors that have practiced a long time fail to read the literature and keep up as they should. Others read it but are resisting to changing their practice. For example, there is good evidence now that treating children with ear infections with antibiotics is unnecessary and not helpful. It is a practice that has been the standard for so long – it is a habit of doctors and an expectation of patients. What doctor will be brave enough to actually stop prescribing these. In addition, the diagnosis of sinusitis or bronchitis leads doctors to prescribe antibiotics, even though the majority of these are actually viral. To be cautious, antibiotics are given because of the feared consequences of watching and waiting . . . which gets to #3  , , ,
3. The lawyers – they are out there as a constant threat. The commonest malpractice lawsuit is of the type “Failure to diagnose . . . . . . “ The argument litigators use in their case is comparing a physician’s actions with the “standard of care in the community” – not measuring against recommendations in the medical literature. So if the evidence in the medical literature is clear that we should not be giving antibiotics for ear infections and a physician follows this evidence and a child with an ear infection ends up with persistent fluid in their ear, the need to place drainage tubes, and even mild hearing loss, this physician who followed the recommendations in the medical literature will be sued and will lose. Even though this would have happened to the child with antibiotics as well, the lawyer will find an expert witness to tell the jury that it is the standard of care to prescribe antibiotics for ear infections because that is what all doctors in this community do, and this physician deviated from that standard of care, and that deviation more likely than not caused the fluid and the hearing loss. And then the mother and the poor child will be there for the sympathy. Any testimony from the defense stating that the physician was acting correctly by following the recommendations in the medical literature will be ignored because the average juror does not have the capacity to understand the medical literature and the complexities of microbiology and antibiotics.
So there you have it. Demanding Americans who expect doctors to be perfect and cure everything and doctors who are humans and will never be perfect, and lawyers who are there to gain financial benefit every time the doctors are not perfect.
It is so much easier to just prescribe the antibiotic and not worry about the C. difficile and other multi-drug resistant bacteria we are allowing to proliferate.
Sorry for the lengthy response.

No need to apologize. Wow! Could you hear the frustration there? That’s the voice of a doctor that would like to do right, and does so when their patients allow them to, but can’t always because either the patient is not educated or trusting enough to listen to the medical professional’s advice, or the prudent CYA way of administering medicine forces their hand to err on the side of writing the prescription in order to stay out of court. I’d be frustrated too. Fuck!

My conclusions: The medical establishment, especially hospital administrators, are painfully aware of this problem. Doctors in general are aware of the problem, but there needs to be more education on this in the medical community to give them the information, and will, to do battle with and educate their demanding patients.  No more “doctor #3s”, would help.  Also, the medical community, in coordination with the CDC needs to revise the “standard of care in the community” in regards to ailments for which antibiotics have been found to be questionable.  This is where government in the form of the CDC and NIH, can take a greater role to arm the doctors and patients with information and immunize doctors against lawsuits.

Perhaps we’ll need a public service program on this asking people to not take antibiotics (and not request them from their doctors) for illnesses that would not benefit from them, listen to your doctor!  

The people in this equation that are most grievously unaware of this problem are the patients, us! We need to get educated and advocate on this issue. Talk about this in public, talk to other people about it. We don’t need to be alarmist about it, but this is a serious health care issue that will effect more and more people going forward. There’s no need for people to only be aware of this when they’re personally effected. Get the information out there.

My father was one of just 2,000,000 people estimate in 2011 to catch one of these bugs. His life is not the same now. There were 2,000,000 more in 2012 and there will be at least 2,000,000 more this year. 

It’s got to stop.

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