This week in the news, another report was released by the Centers For Disease Control saying that antibiotic overuse is creating "so-called superbugs." In this USA Today article (from which the graphic above was taken), it states that superbugs "cause at least 2 million infections and 23,000 deaths each year."
You know who is causing the problem, right? It's doctors like me. Depending on the report you read, I am the one who is giving antibiotics out like candy. Now, if you have the courage to dig deeper, Antibiotic Overuse is just a symptom of our broken health care system, unrealistic high expectations from society, and paralyzed government bureaucracy. Consider these factors:
- Where's the Tort Reform? In the United States, it is our right to sue anyone we want to at any time and for any reason. Many people yell at hospitals for using too powerful antibiotics and this is the cause of resistance. "Antibiotic Stewardship Programs" are being put forth to limit hospital antibiotic use. Will this really work? If I have a patient pass away from an infection, and the attorney asks me why I didn't use X antibiotic and I say it's because of the "Antibiotic Stewardship Program," of course I will be labelled as someone who is looking more out for the hospital and not for the patient. My career will be over. Why risk that? I'm gonna prescribe that antibiotic. Don't blame me. Fix the legal system, and then talk to me.
Where is Choosing Wisely? The Choosing Wisely campaign is designed to educate and make physicians order less "unnecessary" tests. It's no secret that I'm skeptical about this (read this post). I challenge the campaign to add appropriate use of antibiotics to their recommendations. Will they? Let's see.
- Yes, I get paid when you're sick. The broken payment system has been written about many times, and illustrated in movies like Escape Fire. I would rather be paid for high quality care, and not high volume of patients coming through my door. Many docs believe coming in for an office visit is quid pro quo for then giving an antibiotic. Or, in more awkward fashion, see the next item...
- I paid a $30 co-pay and didn't get an antibiotic? For the foreseeable future, there will be the expectation of antibiotic since, "I had to pay such a high copay to see you." Or, "next time, I'll take my business elsewhere." Or, "it doesn't matter what you do, I'll get my antibiotic here or at the urgent care." Which leads to the next item...
- Where's that rating sheet? Many patients know that patient satisfaction surveys factor into physician payment schemes. It has been written about many times that "The Customer Is Always Right" is maybe good business, but sometimes bad medicine. Check out the KevinMD site for multiple essays on this including this one, this one, this one. and this one.
- You're not making me get a flu shot. I already ranted in a previous post, so, I won't do that here. The unintended consequence of not immunizing is more and more use of antibiotics and antiviral meds - which, of course, will lead to more resistance. Just imagine how much Antibiotic Resistance could be slowed down if everyone received their recommended immunizations. Mind blowing, isn't it?
- Animals also get antibiotics. I only learned about this a few years ago. But, this is an easy fix, right? Here's a quote from the USA Today article, "In 2012, the FDA asked food producers to stop putting antibiotics in animal feed to promote growth, but the guidelines do not have the force of law." So, animals and humans will continue to get their antibiotics.
When it comes down to it, the medical issue of Antibiotic Resistance is like the political issues of trying to solve Mass Shootings, Government Spending, and Immigration. We all know what the problems are. But, there is no real emotional or political will to actually solve the problem. So, we will continue to have mass shootings, we will continue to raise the debt limit, we will continue to allow illegal/undocumented people in this country, and, oh yeah, we will continue to have Antibiotic Resistance. Go ahead. Tell me where I'm wrong here...
Addendum: For clarification, I did hear back from the ABIM Foundation this afternoon on a number of fronts. In addition to their comment below, which I appreciate, they also had the following tweets. Thank you for your response, and I ask the readers of this essay to also note their input.