Doctors seem to think public can’t handle medical truths.
Those who practise medicine sometimes disagree about whether what they do is an art or an empirical science; it’s probably both. But either way, one would hope that when health agencies dole out categorical advice about how to handle a medical problem, the advice would be based on empirical evidence. Instead, we’ve learned from a new BMJ study, the words of wisdom may be based on merely a feeling.
According to Dr. Tim Peto, he and his fellow U. K. researchers started from the premise that, “( a) lot of people have very clear views that they have to complete the course of their antibiotics so as to avoid developing resistance to antibiotics.”
In my own experience, this is something doctors and pharmacists emphasize almost every time they talk about the amoxicillin I’m about to take to clear my sinus infection. “You’re going to start feeling better in a day or two,” they say sternly, “but it’s extremely important that you take the medicine for a full 10 days.” I’ve even passed the dire message along to my kids any time they have resisted the dregs of their banana- flavoured penicillin: “You have to finish it or you’ll create a SUPERBUG. SUPERBUGS are SCARY.”
Anyway, Peto and his coll eagues wondered where this ubiquitous idea came from. And if there was any evidence to back it up. What they found was not especially encouraging.
The idea seems to have first taken hold, the BMJ article says, after Alexander Fleming’s 1945 Nobel Prize acceptance speech. This was the speech during which the Scottish scientist and discoverer of penicillin “painted a vivid clinical vignette in which an imagined patient with a streptococcal throat infection who takes insufficient penicillin, transmits the infection — now in resistant form — to his wife, and is thus responsible for her subsequent death from antibiotic resistant disease.”
If that notion — a man killing his wife by not taking his strep throat meds for long enough — sounds overwrought, it might be because it is. Fleming may have been a genius, and we are no doubt living far better and longer lives because of him, but on this one point, he seems to have been talking a lot of nonsense.
Indeed, can you guess how much strong scientific evidence Peto et al found that finishing a long course of antibiotics really does reduce antibiotic resistance? If you’re thinking “around zero,” you’re the one who should get a prize.
The medical community’s repetition for over 70 years of this groundless “truth” about antibiotics doesn’t exactly inspire confidence. In fact, the old doc’s tale may even have been harmful: using antibiotics for longer durations gives bacteria more opportunity to develop the kind of resistance everyone is trying to prevent. Superbugs will be stopped by reducing unnecessary prescriptions for antibiotics, not by keeping necessary prescriptions going for extra time.
This i s something the medical and public health communities need to come clean about to patients. Instead, they seem to think the general population isn’t to be trusted with the information. ( You want the truth about finishing your Zithromax? You can’t handle the truth about finishing your Zithromax!)
The comments to Scientific American from Lance Price, a microbiologist and director of the Antibiotic Resistance Action Center at The George Washington University, seem representative. The BMJ commentary “is a really good thought piece,” Price said, “but I think they go too far in saying we need to stop this (’finish the pills’) messaging…. ( To) say, ‘ Let’s pull the plug on this messaging without providing a reasonable, actionable countermessage’ is totally irresponsible.”
The desire to avoid antibiotic anarchy is understandable. ( Who knows how quickly people would ditch their pills without specific advice? After two days? Two hours? Two seconds?) One wants the medication to have a chance to work.
But the practice of medicine itself works better when people trust their doctors — and public health organizations have more pull when they’re viewed as honest — which means that admitting the antibiotic messaging mistake openly and clearly is probably the healthiest thing to do.