Epidemics

Two news stories came out in the past week to reinforce an earlier idea I presented under the title of “Don’t Ask Your Doctor.”  At that time I explained how drug companies want patients to put pressure on doctors to increase sales (not necessarily to apply the proper cure to whatever ails you).  The two recent issues are the overuse of antibiotics and the so-called opioid epidemic.

In the case of antibiotics, it’s fairly simple.  Antibiotics kill bacteria.  If bacteria cause an ailment, antibiotics may help.  Otherwise it’s worse than a waste; it’s a danger.  Over time bacteria can mutate into forms that are resistant to the latest antibiotics.  Then anyone who is sick due to the new, modified bacteria will not be helped.  Hence, the outbreak of the super-bugs like MERSA becomes a major and growing concern in the US. 

This is an aspect of what I call “virgin in the volcano” thinking.  According to lore, primitive island people would hold an annual ceremony to toss a virgin into the volcano to appease the gods.  If there was no eruption, they assumed it worked.  If there was an eruption they formulated some excuse to justify the discrepancy and the practice continued.  Viruses, not bacteria, cause the common cold.  It goes away in a couple of weeks.  Many people believe they need antibiotics and hound the doctor for them.  Either the doctor gives in, or they find another source.  They take the pills and the cold clears up, just as it would have had they not taken the pills.

This seems harmless enough except for that nasty ability of bacteria to adapt.  When doctors prescribe too many antibiotics, which they do 30% of the time, some bacteria become resistant.  The CBS News story takes it from there.  “According to the Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections affect 2 million people and lead to about 23,000 deaths annually.”

Those 23,000 are not necessarily the same ones who caused the over-use.  They just happened to catch a very strong disease, one strengthened by its newly gained antibiotic resistance.

The second, related story also from CBS News tells us about another pill problem.  In the opinion of the former head of the FDA, opioid addiction in the US amounts to an epidemic.  Over 28,000 people die each year from an overdose of painkillers.  This is a major problem, but unlike the antibiotic problem, someone else overdosing will not put you in danger.

Similar to the antibiotic problem though, the focal point is the interaction between the patient and doctor and the understanding, sometimes on the part of both parties of what constitutes proper use.  Up to now, both have assumed that the pain is the problem and the answer was to keep popping pills until the pain went completely away.  This leads to the unrealistic expectation of a totally pain-free life and on from there to addiction.  The CDC now recommends that doctors first offer over-the-counter medications before turning to the addictive opioid drugs in more limited quantities.  This, again, becomes more difficult when patients are nagging for a particular drug they saw on TV, putting the advice of pharmaceutical ads over the advice of the doctor.

Both problems call for better education and more responsibility.  We can put the blame on government agencies for being lax and the proliferation of drug advertising with the “Ask Your Doctor” tag line, but then we become victims, giving up our very real ability to fix these problems. The doctors need to be more aware.  Their patients need to ask more questions instead of initiating the conversation with a request for medicine.