Do the Right Thing

Margaret Riley, Ph.D.: When we use an antibiotic it is like using an H-bomb because we are decimating the majority of our body’s microbial cells. Antibiotics are not “smart bombs,” they’re indiscriminate killers.

We expect a lot from our doctors. So when something comes along telling us they’re not doing what they should, it’s both surprising and disappointing.

Such was the case 2 weeks ago with the release of a survey that found that doctors prescribe antibiotics even when they shouldn’t, and do so for reasons that are highly questionable. For example, 28% of doctors will give an antibiotic simply because the patient asks for one, and 15% will prescribe them out of malpractice concerns – yikes!

But it’s another finding that’s even more worrisome: 11% of clinicians say their reason for prescribing an antibiotic when it’s not indicated is that, well, it won’t cause any harm and, besides, maybe it will do some good, perhaps in the way that a placebo will.

Oops. The problem with this “it will do no harm” school of thought is that it’s not only flat-out wrong, it’s also dangerous.

So says Margaret Riley, Ph.D., professor of biology at the University of Massachusetts, Amherst. She analogizes the taking of antibiotics to the ingestion of a hydrogen bomb on the basis that it kills everything, all of your body’s bacteria, the good and the bad. Antibiotics, she says, are not like a laser-guided missile that kill only the bad bacterial cells. Sound familiar? Think cancer.

Because in this sense, the effect on your body of a course of antibiotics is similar to the effect of a course of radiation to treat cancer: in both cases you’re using a shotgun to kill a fly and so you end up with “collateral damage,” examples of which are well-known in the case of radiation therapy – hair loss, fatigue, decreased appetite, radiation sickness, and so on.

The collateral damage caused by inappropriately prescribed antibiotics puts patients at risk for allergic reactions, super-resistant infections, and deadly diarrhea caused by Clostridium difficile, according to the US Centers for Disease Control and Prevention.

But remember, at least with radiation treatment there are cancer cells to be destroyed. But what this survey is saying is there are no disease-causing bacterial cells around to kill – but nevertheless 11% of clinicians write these collateral-damage-inducing scripts for antibiotics on the basis that, in their misguided view, it does no harm.

One more thing: it’s this over-prescription of antibiotics that drives the growing global crisis of antibiotic resistance. A problem so severe that even the Prime Minister of Great Britain, David Cameron, got on board this month publicly warning us that “We are in danger of going back to the dark ages of medicine to see infections that were treatable not be treatable and we would see many thousands of people potentially die from these infections.”

So back to our survey. The explanation for the physician-poor result, according to Russell Steele, MD, head of pediatric infectious diseases at the Ochsner Health Center for Children in New Orleans, Louisiana, is that “Education wears off in 5 years.” Residents and interns, he says, get it right when it comes to prescribing antibiotics, “but once they’re out in practice, they start sliding, and use antibiotics indiscriminately.”

Okay, that’s a start. And while we may appreciate this honest admission of indiscriminate use of antibiotics by physicians, on this critical issue at least, we expect more from our doctors – we expect them to do the right thing.

Here is Dr. Margaret Riley’s interesting (she has puppets!) lecture:

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