‘I don’t know’ doesn’t seem to be an option

In the debate over how long to take antibiotics for, certainty is called for – even if it is wrong

So how can we trust officialdom now? On Wednesday the Government announced the date of execution for that health-disasteron-wheels known as the diesel car – even as hundreds of thousands of us still pootle around in the trusty diesels we bought precisely because the government encouraged us to believe they were green machines. Then, yesterday, researchers suggested the advice that we must always complete a course of antibiotics is bunkum.

Worse than bunkum, in fact. In the new British Medical Journal article, scientists say that taking all those little pills may be contributing to the emergence of superbugs that are resistant to antibiotics in the first place. Hmmm. Doesn’t the relevant NHS guideline read: “It’s essential to finish taking a prescribed course of antibiotics, even if you feel better”?

So who should you believe? The Government that tells you to buy a diesel car, or the one that insists you must scrap it? The medical experts who say that failing to complete a course of antibiotics puts humanity itself at risk, or those who say that the reverse is true? Is it any wonder that public trust in our institutions is crumbling?

It need not be this way. Keynes may or may not have said “When the facts change, I change my mind”, but no one can blame authorities for reversing their advice when new evidence comes to light (though they can be blamed for not being sufficiently sceptical of the data). On this basis, there is some excuse for reversing course on diesels now, scant compensation though that may provide to their owners.

But the extraordinary thing about the shock antibiotics proposal is that it is not the result of a huge wave of new evidence. On the contrary. It turns out that the way we take antibiotics has its basis in a Fifties therapy for tuberculosis, not modern treatment for mild ear infections.

The reality is that we simply don’t have the evidence to know precisely how to dose patients in all their immense variety fighting infections in all of theirs. Studies are expensive; not enough research has been done. A lot of this hard-and-fast advice today is actually based on extrapolations and assumptions. Informed guesswork, in other words, and rules of thumb. When someone comes along and challenges those assumptions, the result may be that there is no real rhyme or reason for the established way of doing things.

The honest answer to the “How long should I take my antibiotics” conundrum is: “We just can’t say for sure”. That’s why official advice will not change: stopping your antibiotics too soon risks your infection returning. Stopping them after an unnecessarily long course risks making future infections harder to treat – and we tend to privilege now over the future.

Indeed, it’s likely that we’ll never know for sure the answer to the “how long” question. Rather, resolution will come from a different direction, such as diagnostic tests that instantly identify bugs so they can be targeted with the most appropriate drugs, rather than the general pharmaceutical barrage we too often fire off at the moment.

In the meantime, perhaps officialdom should put greater faith in us, the people, to deal with nuance and risk. After all, the world is becoming an infinitely more complex place, so surely it is not so wrong for governments to say “We’re not sure” or “The balance of probabilities is…”

Except I’m afraid that, according to study after study, that’s a very bad idea. Generally, we humans hate uncertainty. Given the choice between definitely being subjected to an electric shock now and perhaps getting one later, most people opt for the former. Equally, personal happiness is often related to one’s sense that the world is fair. We crave order.

Everyone from governments to airlines knows that if they can’t or don’t know how to mitigate uncertainty, then skilful communication of that fact is essential. That’s why Whitehall has produced at least half a dozen reports on the very subject since the turn of the century alone. But has this slew of advice about how to issue advice improved the cack-handed way that advice is issued? Sadly, that is one answer of which we can be sure.