Act Now or Pay Later

The science community is begging us to understand that the standard risk assessments coming out of Washington about what really threatens to harm us are not just wrong, but that if we don’t heed what really matters, the DC consensus will also prove to be tragically wrong. The latest evidence in support of this view comes to us in a recently-released book and in an upcoming documentary film.

Deadliest Enemy 2In “Deadliest Enemy: Our War Against Killer Germs,” Dr. Michael Osterholm, founding director of the Infectious Disease Center for Research & Policy at the University of Minnesota, says that “infectious disease is the deadliest enemy faced by all of human kind,” because it has “the potential to alter the day to day functioning of society, halt travel, trade, and industry, or foster political instability.

In Osterholm’s view “there are only two microbial threats that … fit this description” for pandemic potential. One is “antimicrobial resistance and the very real threat of moving ever closer to a ‘post-antibiotic era’ … a world more like that of our great-grandparents where deaths due to infectious diseases we now consider treatable are once again commonplace.”

The other is influenza, “the one respiratory-transmitted infection that can spread around the world in short order and strike with lethal force.” Some variant of the bird flu, for example.

The pandemic potential of infectious disease is also the subject of the documentary “Unseen Enemy” whose global broadcast on CNN is April 7 in the US & Canada. The film is endorsed by the prestigious National Academy of Medicine who are holding an advance screening in Washington on April 3, which will include a panel discussion of experts moderated by Dr. Sanjay Gupta. Presumably it will be available on CNN at a later date.

It’s important to understand that what’s driving this pandemic potential is us. The filmmakers sum it up nicely: “Population growth, mass urbanization, deforestation, climate change and increased travel have dramatically increased the risk that familiar diseases will spread and mutate, and new ones will emerge. As people enter new spheres of biodiversity, they come into closer contact with other species, allowing viruses to jump from animals to humans and then spread more widely.”

One more thing. Pandemics are about more than just numbers or the disease itself. They’re also about how they scar our psyche with fear, suspicion, and even panic; for example, the Ebola scare of 2014. Take a look at this CBS report that came out at the time, “Ebola Panic Spreading Much Faster than Disease in U.S.,” which reads, in part, “The threat of Ebola is generating a considerable amount of fear and misinformation across the country, not to mention a growing number of false alarms. Fears about Ebola have reached a fever pitch in recent days.”

Here’s the thing: all that countrywide fear – yet there was only one case of Ebola that ever arose within the borders of the United States.

The films must-see trailer says we either get on board with this issue now or we’re gonna pay for it later.

(Dr. Osterholm’s book deserves fuller treatment & will be the subject of a future column.)

Medical Self-Defense: Your GP probably shouldn’t be allowed to prescribe antibiotics as they’re not the drug we thought they were. This means you have to learn about them.

Interesting perspective, as always (e.g. here & here), from Brad Spellberg, MD, Chief Medical Officer of the Los Angeles County-USC Medical Center, on how to fix the overprescription problem of handing out antibiotics like candy “just-in-case“: only allow the infectious disease specialist to prescribe them.

In an interview with Open Forum Infectious Diseases, the impeccably qualified Dr. Spellberg put it this way:

 

Oncologists don’t let non-oncologists prescribe chemotherapy. The single biggest mistake that our specialty made over decades and decades is that we’ve allowed anyone to prescribe these drugs, and the perception has been that they’re so safe and so effective you don’t need to be an expert in them. The result of that is a complete lack of control of use.

And you know as well as I Paul when you’re rounding on ID and you get consults and you go, “I can’t believe the drugs these folks are using.” Well, if we had the ability to say, “No you don’t get to use those drugs, only we can authorize the use of those drugs,” we would have a much better ability to protect these drugs.

 

Here’s the problem Spellberg’s addressing: Around a third of all antibiotic prescriptions handed out in the U.S. are done so in error. It’s either the wrong drug, the wrong duration, the wrong dosage, or the antibiotic shouldn’t have been given out in the first place, typically because the illness is viral, not bacterial. As a consequence, we’re losing our antibiotics. And since they’re wedded to the everyday practice of medicine – e.g. to prevent infections in surgeries, burn patients, & cancer patients undergoing chemo – the loss of them would mean a serious decline in health care, and perhaps something worse than that.

Spellberg concedes that “the cat is out of the bag,” that we’re not going to be able to take away the antibiotic prescription privilege from the family doctor. Therefore, Spellberg implies, we need to practice medical self-defense. In the same way that we learn good health habits, basic first aid & CPR, we simply have to learn when and when not to use antibiotics. It’s actually not very hard, and it’s interesting stuff. Here’s the short version, from the CDC. But the best messaging out there – this is interesting – remains this eye-opening public forum put on by the Harvard School of Public Health. Don’t be intimidated because it’s Harvard. The discussion is for everyone. And it’s got it all. Our take on it is here.

 

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