Doctor treats the patient, not society
Dear Dr. Roach: I was shocked recently when I read an article from a reputable source implying that sooner rather than later (and maybe already), doctors who have a patient who could be treated successfully only with massive doses of antibiotics would be required to allow the patient to die rather than run the risk of creating a generation of bacteria that are resistant to antibiotics. In other words, one person must die for the sake of many.
While I understand the logic of this, I also find it profoundly disturbing on many levels, and wonder what your comments might be.
J.F. As doctors, we are obliged to act primarily in the best interests of our patients — not ourselves, and not society. Therefore, in the case of a patient who would die without the only effective antibiotic, our primary duty would be to use the antibiotic in hopes of saving our patient, recognizing that this may reduce the effectiveness of the antibiotic in the future.
Of course, we should take great pains to isolate the patient so that this hypothetical resistant superbug does not get out and spread to other people. This happens in hospitals every day.
Hospitals have systems in place to restrict certain antibiotics to life-threatening situations when only those antibiotics are effective. This is done to minimize the risk of developing bacteria that are resistant to all our antibiotics.
Unfortunately, despite this, there are times in the hospital when there are no effective antibiotics, and people die because of highly resistant bacteria despite our best attempts.
We would never let someone die because of the possibility of resistance. We would never withhold a potentially useful antibiotic if it was expected to help. This is part of the doctor’s ethics.
Dear Dr. Roach: Please address a baby-boomer health concern, hepatitis C. A television advertisement stated that a blood test can reveal its presence and that there is effective medication to cure it. How does hepatitis C affect a person?
E.B. Hepatitis C is far more common than most people realize. In the United States, about one per cent of adults have chronic infection, about three million people. The number is slightly lower in Canada.
About half of people with hepatitis C do not know that they are infected, as it frequently has no symptoms for many years.
Because hepatitis C can lead to severe complications — including cirrhosis, liver cancer, liver failure and need for transplantation — identifying people early so that they can be treated has become a priority, especially since new treatments have become available that are very effective and have few side-effects.
You mentioned baby boomers, and they indeed are a high-risk group who should be screened for hepatitis C. (Definitions of baby boomer vary, but people born between 1945 and 1965 are recommended for screening.) If that’s you, ask your doctor if you have already been screened, and if not, request it.
Apart from people born during this time, other people who should be screened for hepatitis C include anyone with HIV infection, anyone on hemodialysis, anyone incarcerated and people from high-risk countries, especially Central and East Asia, the Middle East and North Africa.
Screening is easy and safe — a simple blood test. Finding out that you are negative is a relief. Finding out that you are positive is potentially lifesaving.