IS THE ANTIBIOTIC OVER-PRESCRIPTION PROBLEM IMPROVING?
UNFORTUNATELY, VERY LITTLE
The latest installment of this unheeded message comes via a 48 page report released by the World Health Organization earlier this week; Antibacterial Agents in Clinical Development..... What's revealed is that there are only eight ANTIBIOTICS currently in R&D that show any hope of even slowing down the spread of "SUPERBUGS". There's just no money in it --- at least not the kind of money Big Pharma can make on drugs for chronic, long-term conditions such as AUTOIMMUNITY, or INFLAMMATORY DISEASES; or for big-ticket diseases such as CANCER. Thus, we end up in the frantic dilemma characterized by various articles from this year.
- "Nationally, antibiotic prescribing in outpatient settings like clinics, doctor’s offices, and emergency rooms decreased by five percent from 2011 to 2014. CDC still estimates that 30 percent of all antibiotics prescribed in outpatient clinics are unnecessary. A small CDC study of nine nursing homes showed that 11 percent of nursing home residents were taking antibiotics on any single day. In hospitals...use of the most powerful antibiotics increased significantly from 2006 to 2012, by nearly 40 percent for carbapenems and more than 30 percent for vancomycin. Data also indicate that roughly 30 percent of antibiotics used in hospitals are unnecessary or prescribed incorrectly." From the CDC's report called Antibiotic Use in the United States, 2017
- "GPs are prescribing antibiotics at a rate up to nine times higher than the current guidelines, according to research published in the Medical Journal of Australia. The five-year study showed Australian doctors over-prescribed antibiotics for acute respiratory infections such as bronchitis, influenza and tonsillitis — in the mistaken belief they were erring on the side of caution. But if doctors were to start prescribing antibiotics along the national guidelines, the number of pills handed out for some conditions would fall by nearly 90 per cent." From Angus Randall's July 10 article for ABC News Australia (Antibiotics: GPs Prescribing to Patients at Up to Nine Times Higher than Current Guidelines)
- "Prescribing an antibiotic when one is not needed (a very common problem), Overprescribing the correct antibiotic choice (a common problem), Prescribing the incorrect antibiotic (a common problem).... I have self-inflicted brain damage from the number of times I have banged my head against the wall on this point." From last month's issue of MJA Insight by Dr. Aniello Iannuzzi (The 10 Shades of Antibiotic Problems)
- "No one wants to contract a potentially deadly form of diarrhea, claiming roughly 30,000 lives a year in the U.S., that can take hold after antibiotics wipe out healthy gut bacteria. Yet, every day, patients are prescribed antibiotics that they did not need or that are not clinically indicated, exposing them to the risk of these harms. In clinics, 30% of prescriptions are unnecessary. In hospitals, 20% to 50% of antibiotic use is considered inappropriate; in long-term care, it’s 75%. This overuse and misuse also contributes to the spread of multidrug-resistant organisms, diminishing our arsenal of these agents." Johns Hopkins anesthesiologist, Peter Pronovost, writing for a June issue of the Wall Street Journal (How to Keep Doctors From Overprescribing Antibiotics)
- "A study published in the Sept. 19, 2016, issue of JAMA Internal Medicine found that “overall days of therapy of all antibiotics among hospitalized patients in U.S. hospitals did not change significantly” between 2006 and 2012. Researchers also found that the use of broad-spectrum agents in hospitals had grown significantly over those same years. But hospitals haven’t been very quick to respond. Only 39% of hospitals report having an antimicrobial stewardship program that meets all of the CDC’s criteria." From the February issue of Today's Hospitalist (Prescribing Too Many Antibiotics?)
- "The idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance." From the issue of the British Medical Journal (The Antibiotic Course Has Had its Day), that was published on July 28.
- "Inappropriate antibiotic prescribing is common in outpatient settings across the United States. A recent study by the Centers for Disease Control and Prevention and The Pew Charitable Trusts found that nearly 1 in 3 antibiotics prescribed at outpatient facilities—including physician’s offices, emergency departments, and hospital-based outpatient clinics—is unnecessary, equaling 47 million prescriptions each year. Patients or their families may expect to get a prescription at an office visit, even when an antibiotic is not necessary. Patient pressure may be particularly influential in a physician’s decision-making because doctors relate to patients as both a caretaker and service provider. As such, they must be conscious of both patient health and customer satisfaction." From a June edition of the website of the Pew Charitable Trusts (What Drives Inappropriate Antibiotic Use in Outpatient Care?)
- "Clearly, doctors often tend to overprescribe antibiotics. This occurs for a variety of reasons, including increased pressure from patients to 'give them something' for their ailments, as well as unwillingness to separate from long-standing guidelines in favor of new best practices for prescribing antibiotics. These departures from evidence-based best practices have been responsible in part for the rise of antibiotic-resistant superbugs – bacteria that have become immune to medications that once killed them. Best practices and guidelines are always changing and improving. Doctors and patients must be willing to re-examine what we once thought was “the best care” on an ongoing and dynamic basis. Doing so will foster a more positive doctor-patient relationship, which can help prevent medical crises such as antibiotic overprescription and resistant bacterial strains in the long term." Dr. Joe Ventimiglia, (M.D. / Ph.D.) from last month's article in UT Southwestern Medical Center (Antibiotics and the Breakdown in the Patient-Doctor Relationship)
- "Slapping educational posters in the exam room or issuing new clinical policies won't move the needle enough. Changing behavior is hard. We have to look at the social and behavioral fabric in which antibiotic prescribing decisions take place. One reason is that humans don't always behave rationally. The field of behavioral economics has identified tendencies and biases that can cause us to act against our own best interests, and against the best evidence." From a July blog post on Johns Hopkins website (The Psychology Behind Antibiotic Misuse)
- "When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right? For all the truly wondrous developments of modern medicine, it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades. In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade—2001 through 2010—that tested a current clinical practice. Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced; 138 articles supported the efficacy of an existing practice, and the remaining 79 were deemed inconclusive. There was, naturally, plenty of disagreement with the authors’ conclusions." David Epstein (Propublica) from a February issue of The Atlantic (When Evidence Says No, but Doctors Say Yes)
"There are perhaps 30,000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century. Yet only about 15% of medical interventions are supported by, solid scientific evidence, David Eddy, professor, of health policy and management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only 1% of the articles in medical journals are scientifically sound. and partly because many treatments have never been assessed at all. "If," said Professor Eddy, "it is true, as the total quality management gurus tell us, that ‘every defect is a treasure’ then we are sitting on King Solomon's mine." The weakness of the scientific evidence underlying medical practice is one of the causes of the wide variations that are well recognized in medical practice."
But that was back in 1991. Surely things have changed for the better in the nearly three decades since? But have they? Although we could ask expert in the field, DR. JOHN IONNIDIS, let's briefly look at the numbers quoted by Epstein above. If only 138 of the 363 studies published by NEJM between 01 and 2010 have solid evidence backing them, that only works out to a grand total of 38%. Granted, it's better than Eddy's 15%. But it's certainly not what the public is led to believe by "trust us" BIG PHARMA and the GOVERNMENTAL ORGANIZATIONS they control.
We've all heard that when it comes to antibiotics, best evidence or evidence-based practices are not being followed. Believe me when I tell you that antibiotics are just the tip of the tip of the tip of the iceberg. What if I told you that disregard for evidence is seen widely with any number of other common medical procedures, tests, and treatments as well? Things like routine colonoscopies, regular physical examinations, regular mammograms, annual female exams, certain kinds of vaccines (especially the annual Flu Shots), along with any number of others (HERE). But back to antibiotics.
Of all the studies discussed today, the one that I feel is most accurate (by far) has to be the Australian study. Eight physicians and researchers from the University of Bond (Gold Coast) showed just how bad things have gotten in the land down under. And don't believe for one single second that the United States is doing any better!
An estimated 5.97 million acute respiratory cases per year were managed in Australian general practice with at least one antibiotic, equivalent to an estimated 230 cases per full time general practitioner per year. Antibiotics are not recommended by the guidelines for acute bronchitis (current prescribing rate, 85%) or influenza (11%). They are recommended for .5–8% of cases of acute rhinosinusitis (current prescribing rate, 41%), 20–31% of cases of acute otitis media (89%), and 19–40% cases of acute pharyngitis or tonsillitis (94%). Antibiotics are prescribed for ARIs at rates 4–9 times as high as those recommended by [Australia's guideline book] Therapeutic Guidelines.
According to this study, doctors should be able to cut their antibiotic prescription rates by about 90%. Think for a moment about why this is. Antibiotics are contraindicated for most SINUS ISSUES. The same is true with most EAR INFECTIONS. And as for URI's (Upper Respiratory Infections), we know that about 90% are viral (antibiotics don't ever work for viral infections), and most of the rest will resolve on their own anyway.
You see, at least 80% of your body's entire immune system is found in the Gut, muchly in the form of bacteria. Antibiotics destroy bacteria, making no distinction between "good" or "bad". This means that every time you take an antibiotic, RESEARCH SAYS you are not only increasing your chances of cancer, you are increasing your chances of getting reinfected with the same infection you have, or whatever other infection happens to be coming down the pike (antibiotics are part of what makes IMMUNE SYSTEM SUPPRESSION America's #1 form of medical treatment). And when you get it, what's your doctor going to give you? That's right; more antibiotics. But there's more.
Antibiotic use always leads to varying degrees of something known as DYSBIOSIS (an imbalance of one's MICROBIOME characterized too many bad organisms in your system as compared to good organisms), which is the just-as-ugly identical twin sister of "THE LEAKIES". When you foul the health of your Gut, you will foul your overall health. Likewise, taking care of the HEALTH OF YOUR GUT goes a long way toward keeping you healthy, thin / muscular, and free of disease --- especially critical to understand once you realize that the vast majority of diseases are slightly different manifestations of the vary same metabolic dysfunctions (HERE). If you are interested in breaking the cycle and taking your life back, this GENERIC PROTOCOL should help most of you get started.