About all those resistant infections … We’re not doing anything wrong, are we?

Please think carefully about the brief and exceptional talk by Debbie Goff, an infectious disease clinical pharmacist of 30 years standing, and ask yourself a question: Because of how we misuse antibiotics, are we essentially engaging in a form of collective self-harm?

Before you write off the question as hyperbole, consider, first, the vast amount of harm caused by “superbugs,” i.e. bacteria that antibiotics have little or no effect on. To really come to grips with how much damage is being done, a thought experiment helps: Visualize the packed crowd in a large American football stadium, say from the Super Bowl. Now think of seven such stadiums, all jam-packed – say, the Patriots home field, the Packers, the Giants, and so on – and finally, imagine all those people dying … every football season, from an infection.

guiltThat’s the death toll every year, worldwide. Add to that the people who become seriously infected but recover, and the total harm is orders of magnitude greater.

There are no safe harbors. For example, in a U.S. hospital (you’re safe there, right?), you have a 1 in 7 chance of catching a superbug; in a nursing home, the risk goes up to 1 in 4. All-told in the U.S., over 2 million serious resistant infections happen annually – i.e. multiple hospitalizations, stays in the ICU, surgeries, amputations (and years of anxiety by patient & family over possible re-occurrence) – plus over 23,000 deaths, around half due to MRSA alone.

And consider, second, and most importantly, how much all this carnage is driven by what we do (vs. what the bug does), and by how we think. This is the thrust of Debbie Goff’s talk: It’s not just about the bug, it’s about us too, and probably more so. The threshold issue is how we (mis)understand antibiotics: unlike every other therapeutic, they’re a “societal drug,” which means the more we use them the less effective they become – for everyone – because bugs adapt to drugs by evolving resistant strains, as quick as overnight. The logical import is therefore crystal clear: conserve antibiotics as best we can by using them properly & only when we must.

But logic is not our strong suite. Instead, we humans drive resistance to antibiotics (in a sense, we manufacture it) through a worldwide network of misuse. For example, by health care providers handing out scripts like Halloween candy – “just-in-case” as Goff correctly puts it – and by us, as patients, demanding them just like, well, kids at Halloween. Hint: “Hey Doc, I need a Z-pak,” is not the way to go about it. With the upshot that we’ve developed a dangerous one-third rule of abuse: 33% of antibiotics prescribed in hospitals have errors – wrong drug, duration, or dose; and 30% of antibiotics prescribed at the doctor’s office are unnecessary, typically because your illness is viral – a cold or the flu – not bacterial.

The practice of medicine is, ultimately, very personal. Debbie Goff begins by introducing us to a 35-year old mother of two, fresh from a successful surgery, who is prescribed – unnecessarily – a 10-day course of antibiotics, “just-in-case” she develops an infection. Keep in mind that what unfolds next didn’t have to. And that’s the whole point: we’re doing this to ourselves. Another name for that is self-harm.

 

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