Map of life expectancy at birth from Global Education Project.

Wednesday, November 27, 2013

I basically have respect for the medical profession but this is ridiculous

Using data from the National Ambulatory Medical Care surveys (there are two because on covers outpatient practices and the other ambulatory care delivered in hospitals, mostly EDs), Drs. Barnett and Linder (no link because you need a subscription to JAMA Internal Medicine) give us some disturbing news.

Only 10% of people with sore throats have an infection that is treatable by antibiotics. And almost all of them have group A streptococcus. Good news about good ol' group A strep -- it's not antibiotic resistant, in fact it's 100% susceptible to good ol' penicillin, which by now isn't good for much else, and is also very cheap.

So most people presenting with a sore throat shouldn't get any antibiotics, and those who do, should get penicillin. Guess what? About 60% of people get antibiotics, and the vast majority of them do not get penicillin but other, more expensive antibiotics. This is ridiculous.

It's not only that this contributes to resistant bacteria. Taking antibiotics is bad for you! You should only take them if you really need them because a) there can be side effects of the antibiotics themselves and b) they wipe out your beneficial endosymbionts, in other words all that good stuff living in your digestive tract and elsewhere. You can wind up with diarrhea, and opportunistic infections such as thrush or something really nasty like C. dificile. (I had it when I was hospitalized, and believe me, es muy difĂ­cil.) We're learning more and more now about the importance of our microbiome, as it's called. Having your good bugs trashed can cause all kind of previously unsuspected bad results, including obesity. And it's wasting hundreds of millions of dollars every year.

Why do doctors do this? Beats the hell out of me. How hard is it to tell somebody, sorry, antibiotics won't do you any good, go with the chicken soup? Aaaarrrggh.

10 comments:

robin andrea said...

Doctors have to know that they are responsible for the upsurge in resistant bacteria and the consequences. I don't understand how they can continue this insane practice. Do pharmaceuticals pay them per prescription? I have heard doctors say that patients want these prescriptions. Really? I didn't know doctors routinely let patients decide what meds they should be prescribed.

Rest and chicken soup. That's the answer.

Cervantes said...

No, doctors don't get paid to write prescriptions, and drug companies don't particularly push antibiotics (not very profitable). It is something of a mystery.

Daniel said...

Not exactly on point for your post today, but referring to one a couplke of days ago...

This is anecdotal, but our company's experience with the ACA has generally been positive.

It started in a troubling manner. On 10/1 our employees received a notice that their insurance would be cancelled on 1/1/2014. They received the notice before the company was notified... stressful, we did not know what was going on. I think the company should have been given the heads up so that I, or my co-founder, could have discussed this with the staff before hand.

I went to the health.gov web site... useless, but from that point on things got better.

Our agent who handled our group policy for the last several years called and said not to worry, so I didn't. Some of our employees continued to worry based on the news reports they heard/watched.

I just completed our renewal forms. We are not purchasing through the exchange (perhaps next year) and our costs for 2014 are no higher than the previous year.

The policy reflects the requirements of the ACA and we have more preventive care benefits. We have had an HSA plan for several years and the insurance company premium for 2014 is actually about 20% lower than 2013. Deductibles are higher, but we will put the premium savings into the employees HSA accounts which will offset the higher deductibles and provide employees with a bit more flexibility in spending their health care dollars.

We work in software engineering and had to build some models that compared the 2013 plan with the plan we chose for 2014 as well as another option we considered. No single plan minimized the amount an individual or family would have to pay out of pocket based on thenumerous scenarios we fed into the model.

Our experience is positive. Although I was raised a Catholic it is hard for me to take seriously the contraception suit. I'm not a Christian Scientist so I won't take too seriously that suit that must be in the wings. And I don't believe in handling venomous snakes as a religious practice so I don't object if any of our staff get health care for a snake bite.

In our industry there is an often repeated quote, in the long run only the efficient survive. I hope we get on this train soon with health care.

Cervantes said...

Thanks Daniel. As has often been said, the Affordable Care Act is not a web site. Apparently small businesses are not going to go cyber until next year after all, and you'll continue to sign up the old fashioned way -- but as you have found, that still works. And yes, costs do seem to be better contained already.

The insurance companies are to blame for the way they notified people about non-conforming policies. That created a huge flap out of something that was generally benign.

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kathy a. said...

I think the default maybe 15-40 years ago was to prescribe antibiotics if they *might* help. You'll know better than I do, but when my kids were small [20+/-ish years ago], there wasn't much awareness that there might be a down side. The amoxicillin flowed for those prone to ear infections. For many years, I also took precautionary antibiotics ever time I went to the dentist, because I'd been diagnosed with a prolapsed mitral valve. [that protocol changed.]

I would guess that patients -- or their parents -- can be fairly insistent on occasion. Ear infections, for example, are painful and make everybody around the afflicted kid miserable.

It's fairly hard to see the big picture (drug resistant strains of bacteria; c. diff) when one or a loved one is suffering. Still, Rx for 60% of sore throats? Could part of that be that it costs and takes time to run the strep test?

Cervantes said...

I dunno Kathy, I remember when I was a kid the pediatrician would routinely take a throat culture if I had a sore throat. But you're right about the ear infections, they did use to prescribe for those routinely. The guideline now says you shouldn't, but the practice no doubt has not changed for most.

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