Last summer, a relative called me, told me about a rash that had appeared on her leg and emailed me a picture: an ugly, swollen red spot about two inches in diameter with a small dark spot in the center and a border like a marker. Most of all, it resembled a target. Since it was summer and she lived in Connecticut, two words immediately came to mind: Lyme disease.
I recommended starting a course of antibiotics immediately. She took the medicine every day until the rash disappeared, and a few days after, even when she felt better – the course must be completed completely.
The medicine cured the infection, and we were both glad. And I want it to stay that way. Once again, I’m not their opponent, as well as not the enemy of ice cream – and both perform their functions remarkably, but if you touch, it’s bad. Excessive use of antibiotics and too many caesarean sections are problems that need to be addressed urgently.
They can be both personal: world views and specific decisions related to them, and institutional: the policy that should be carried out by the medical establishment or the state, the priority areas of research that they should set. Sometimes the border is blurred as in the case of antibiotics.
First, we need to curb our appetite for these powerful drugs. This is the largest, easiest and most feasible step that can be taken in the short term. There is no turning back time, but at least it is possible to slow down the daily destruction of our microbial diversity.
Everyone is personally responsible for the use of drugs. Tell your doctor you want to wait a few more days before taking amoxicillin for a cough that lasts a week. Or do not rush to run for a prescription for a runny nose for the child. Do not force the doctor to prescribe funds that alleviate, first of all, your anxiety. Without parental pressure, they will probably be able to better understand whether the drug is needed.
Tell the dentist that you will not take antibiotics unless he can convince you that the benefits of them in this case are greater than the risk. The axiom of any good medicine is”do no harm.” Since we could not calculate the harm from antibiotics, these drugs were beyond suspicion. With many dental diseases easier to cope or surgery, or measures of oral hygiene.
Stop using so many disinfectants. Their key ingredient, triclosan, of course, is not an antibiotic, but it kills bacteria on contact {190}. What’s wrong with good old soap and water? I only use disinfectants in the hospital when I see patients and during flu epidemics. Most of the microorganisms on my skin live not the first year. I know them and they know me. I can get bacteria from other people, like the handrail in the subway. Of course, stick your fingers in your mouth will not, but itself, a disinfectant wipe, too. I’m afraid I’ll remove the good bacteria that help fight the bad ones that periodically try to attack me.
Let’s return to the question of what to do if the child is ill. I’m not saying “look and wait” in all cases. Sometimes they look very bad, and you need to immediately go to the doctor. Maybe your kids are fussy, have high fever and trouble breathing. Or they are depressed and react badly to light and sounds. Or a swollen stomach, severe diarrhea or a terrible rash. This is really an emergency.
In such events, parents should carefully restore the events of the day when the symptoms first appeared, and tell the doctor everything they remember. Don’t panic. After an examination, possibly including blood tests and x-rays, many children with acute illness should be given antibiotics immediately to avoid irreversible damage or death. Postponing treatment for fear of damaging the microbes-the inhabitants of the child, in this case – a terrible medical error. Serious infections aren’t going anywhere.
Thus, doctors are faced with a dilemma: drugs are vital, but American children receive too many – more than 41 million courses in 2010 alone. Most people don’t really need antibiotics.
It is not as easy to assess the situation as it seems. Many years of experience may be needed to make an accurate assessment. For a doctor who is in a hurry, it is much easier to simply prescribe an antibiotic to any child who has come with snot, sore throat or reddened eardrums. On careful inspection, discussion with parents, why medication it is necessary to wait, answers to questions, explaining that it portends danger and a reasonable sentence “If the condition does not improve, call back tomorrow morning”, you need much more time.
Pediatricians and other health care professionals need to be taught to think twice before prescribing medicines. Every situation must be carefully weighed. Is it a dangerous infection, or, more likely, a mild one, which the vast majority will pass itself?
Pediatricians need not only better training, but also better to pay them. Paradoxically, the doctors involved in the primary care of our children – first – line doctors, who are treated daily by tens of thousands of parents-are perhaps the lowest-paid doctors in the United States. Something is wrong with our system, where a doctor who performs a brief diagnostic procedure – for example, doing an x-ray or a simple 15 – minute operation-gets much more than the one who makes the most important decisions related to the health of our children.
Pediatricians need to pay enough so that they can methodically evaluate patients who are brought for examination, and reward for what they discuss with their parents each diagnosis. Since the current system underestimates such care, it is not surprising that 70% come to the doctor with SARS, and go with a prescription for an antibiotic.
Many enlightened parents and good doctors and nurses are trying to change these behaviors and practices, but the system is rebelling against it. We are everywhere confronted with unconscious prejudice. It is believed that reducing the time of a doctor’s visit from twenty to fifteen, and then to ten minutes, will save money. In fact, by giving doctors less time to examine and diagnose, we are throwing away a lot more money for excessive tests and treatment.
And doctors and patients should know how the number of prescribed drugs affect local customs. Southerners drink 50% more antibiotics than residents of the Western States {192}. I strongly doubt that bacterial infections are one and a half times more common in the South than in the West. Like the number of caesarean sections or episiotomies. This difference indicates differences in medical practice.