Flu Season is a Health-Reform Opportunity

Massive health-care reform schemes continue to dominate our political debates.  Yet something simpler and less expensive could go a long way towards improving health: applied medical knowledge.  As flu season looms, the best example of this is antibiotic stewardship—and the stakes could not be higher.

About 35 percent of Americans say they believe that antibiotics treat the flu.  That misunderstanding is one of the reasons patients leave U.S. clinics, doctors’ offices and pharmacies each year with upwards of 260 million courses of antibiotics.  Between 20 and 50 percent of these prescriptions are not necessary, depending on the health-care setting and region.  Antibiotics only help against bacterial infections and so they do nothing—nothing at all—against the flu, the common cold or most bronchitis, which are viral infections.  They also do nothing for the large numbers of coughs, sore throats, ear infections and sinus infections of viral rather than bacterial origin.  

Tens of millions of unnecessary prescriptions add up to billions of dollars of wasted money that the U.S. health-care system can ill afford.  If only money were the extent of the problem, however.  Overprescribing of antibiotics drives the rise of antimicrobial resistance, which is becoming one of society’s most serious health-care challenges.  Crafty bacteria constantly evolve new ways to defeat antibiotics, as they have been doing for billions of years.  It is a fascinating ability if it were not so deadly: a just-out Centers for Disease Control (CDC) report finds that about 2.8 million infections from antibiotic-resistant bacteria happen each year in the U.S., causing 35,000 deaths or the equivalent of more than a hundred large-airplane crashes.  

The more we let bacteria practice and evolve against the antibiotics we do not need, the stronger they will be against the treatments we do need.

Antibiotic stewardship is one of many workaday opportunities to apply existing medical knowledge and achieve substantial improvements in health care without remaking our entire system.  Others include patient-portable health-care records, comprehensive vaccination efforts, timely screening for early-treatable cancers, and of course sensible diets and exercise.

These knowledge-based reforms enjoy consensus and relatively low cost, but they also share another characteristic, which probably explains why they languish: they require health-care providers and patients to change their behaviors.

Clinical guidelines exist on the appropriate use of antibiotics.  Successful antibiotic-stewardship programs in clinics and hospitals stand ready for widespread imitation.  Reliable and easily available tests can determine the presence of a bacterial infection and therefore the advisability of an antibiotic.  However, too often guidelines, programs and tests fall by the wayside.  Antibiotics are prescribed because of a health-care provider’s misguided hunch, a crowded waiting room, or a patient or parent who refuses to take “no” for an answer.

This is Antibiotic Awareness Week, spearheaded by the CDC to raise awareness of the importance of appropriate antibiotic use.  We hope it prompts some politicians and pundits to add, “Don’t take antibiotics for the flu,” “Don’t placate your patient with a pill you know won’t work” and “Don’t beg your doctor for an antibiotic your kid doesn’t need” to his or her stump speech.

For our parts, industry and medical groups will continue to develop scientific solutions and treatment protocols to fight antimicrobial resistance, which touches all of us.  Meanwhile, get your flu shot.

Dr. Alan Wright is Chief Medical Officer of Roche Diagnostics Corporation and Dr. Joseph Toscano is Clinical Content Advisor of the Urgent Care Association and Chief of Emergency Medicine at Northern California Emergency Medicine Group.