Tuesday, March 12, 2013

Things That Piss Me Off Tuesday - the public health edition

I had a couple things I planned to write about today, then I found inspiration for a theme. A few news stories broke in the past week that interest me deeply.  They have to do with public health issues.

In my former life, I was planning to be an attorney specializing in health law.  I followed the Medical Board of California as part of an oversight organization, I took all the health law classes I could in law school.  I minored in Bioethics in college, and enrolled in a MPH program as my last foray into the education world.  I technically was in a public health management focus, but my heart found it's true passion in epidemiology, which is the study of disease patterns.

My career ambitions were motivated by things that happened to members of my family as a result of a doctor's misdiagnosis and resulting negligence. I worked in risk management for a while.  I worked with HIV+/AIDS patients, assisting them in all legal issues for a while too.  I've sat in on ethics committee meetings, I've seen the patients, I've mused about the legal ramifications of any and all treatment decisions.  I've watched people get forced into isolation because of contagion risks.  I've seen up close and personal what damage cigarettes and poor diets can do to the human body.

Public health is a true passion of mine, and it's with that obvious bias that I write about the things pissing me off today.

Off we go.

Antibiotic Resistance 
Over the past few decades, more and more antibiotic resistant strains of bacteria have emerged.  Broad spectrum antibiotics, the strongest ones we currently use, cannot treat all the strains that exist currently.  There is a very real threat to the safety of the entire world if this trend continues, which it almost certainly will.  One need only to look to the past epidemics of untreatable diseases to understand the inherent dangers involved here.

This past week, Sally Davies, the Chief Medical Officer in England urged a global response to this issue. She is encouraging development of new antibiotics and the preservation of the arsenal currently at our disposal.  She urged better tracking of resistant disease, and cooperation between industries and nations, for the sake of us all.

Antibiotic resistance is a catastrophic threat to medicine, she said.

This is a topic that has been unsettling in the health care field for a long time here in the US, but one that has largely gone unnoticed by those in positions of power that could actually address the issues.

The causes of growing resistance are many and varied, and need to be addressed at the level of nations, not individuals.

First, there is some degree of resistance that comes naturally as the bacteria evolves on it's own.

Second, it's not news that antibiotics are overused quite often, given as prophylactic treatment and for viral infections where they will do no good.  Patients need to get out of the habit of asking for/demanding antibiotics and doctors need to stop writing the scripts for them.  Not only is it bad for everyone in the long run, it creates drug resistance within individual patients as well, requiring them to be placed on stronger and stronger medications when they actually do have infections.  There is also a strong argument to be made that habitual antibiotic use damages the human body's "good" bacteria as well, creating additional problems for the patients down the road.

Methicillin-resistantStaphylococcus aureus, commonly known as MRSA.
Might look pretty under a microscope, but this could kill you.
Third, patients need to take antibiotics as they are prescribed.  Far too many patients stop taking the medications a few days into treatment, because they begin to feel better.  What happens is that the weakest bacteria are killed, leaving the stronger ones festering.  Repeat it a few times, multiply it by thousands or millions of patients, and you quickly find yourself fighting bacteria we can't treat.

Fourth, we need to crack down on the antibiotic use in our food supply.  Over 80% of the antibiotics sold in the United States are given to livestock, not to treat diseases, but in the hopes of avoiding them so that the ranchers can grow bigger animals faster.  These animals harbor resistant bacteria, which they can transmit not only to other animals, but to humans who eat them.  Again, these drugs are routinely administered in low (sub-treatment) levels to otherwise healthy animals, and no one in the United States tracks that use or regulates it.  The European Union banned the use of antibiotics for the purpose of growth in 2006.

Fifth, we need to stop using antibacterial soaps, gels and cleansers.  Used originally only in healthcare settings, these products have flooded the consumer market feeding on the fears of germaphobes.  There is no evidence that they work better than an old fashioned hand washing.  They expose skin, the largest organ, to dangerous chemicals.  They kill good bacteria, and encourage further growth of superbugs.  There is no legitimate reason for these products to be sold in the public market, and the fact that some schools are now requiring children to use them bothers me tremendously.  Just wash your hands.  With soap.  Regular old fashioned soap.

These are huge problems that need to be addressed from the level of the individual sitting in a physician's office, to corporate responsibility, to nation-wide funding of research and regulation of the use of the drugs we have.  If we keep ignoring them, we are just tempting fate to throw another plague at us.  During the Black Plague, a third of the people in Europe died.  A third.  It is not outlandish to suggest that we are at an ever-increasing risk of history repeating itself, and we need to take the necessary steps to ensure we are armed with the tools to fight it.

Bloomberg's Soda Ban
NYC Mayor Michael Bloomberg doesn't care much about making enemies, which is often the personality trait of his that gets people to love or hate him.  His most recent crusade has to do with serving sizes of beverages that have sugar added to them.  Just yesterday, a judge in New York blocked application of the law, claiming it is arbitrary and capricious because it applies only to restaurants and certain other entities under the thumb of the health inspector.

Bloomberg vowed immediately to appeal the decision.  He has previously fought for limits on trans-fats, labeling in restaurants, and public smoking bans, all in the name of public health.

Love him or hate him, he's passionate.  And he's got a point, a valid one.  Individuals make poor choices, society pays the price.

We live in a free country, yes.  We also live in one populated by people who make very poor health choices, and where those choices result in long term disabling conditions like diabetes and cancers. One soda of the designated serving size almost surpasses an adult's daily recommended sugar intake. If people really want a 2-liter bottle of soda, they can still buy one in a grocery store, even in NYC.

The whole reason that the field of public health exists is to oversee society as a whole, to steer behaviors, to force manufacturers to be truthful, to protect people from the harms out there, and yes....sometimes to protect them from themselves.

It is absolutely condescending, but to some degree, it's also necessary.

Public health isn't supposed to be popular, it's supposed to save lives and improve health, not just for individuals, but for all of us.


  1. Yes YES YES!! Over use of antibiotics has been going on for DECADES! And even those of us that have had GOOD Doctor's in our lives, the ones who counseled against over use and explained what would happen in the long run, we too will pay the price! For although regular antibiotics will work better for us as individuals, and we can feel better faster when it comes to non-morphed bacteria... the morphed bacteria will be unaffected in us all. And just as the Black Plaque marched through Europe, we will have MUCH HIGHER consequences in modern times! We are over populated and very mobile! LQQK what happened recently with the Swine Flu!, how far and how fast it traveled, We are scary and damaging unto ourselves, and even those of us that DO take care, and DO follow the "rules" will pay the price, eventually.

  2. I have been anti-anti-bacterial soap since the 90's AND I taught pre-school.

    Also avoided antibiotics with the kids until absolutely necessary-much to Hubs frustration at times. Homeschooled three kids: two of which are now in a public highschool. They (we all) are rarely sick.

    Let the body do what it was meant to do!

  3. Thank you for the write-up on antibiotics!! That is so common sense but it is sad that parents insist on getting antibiotics for their child anytime there is any kind of infection; even viral. And, antibacterial soaps etc are just extreme!
    About Bloomberg, I must say I was indignant at this condescension, but I agree with you that "Individuals make poor choices, society pays the price"

  4. Yes, yes, yes yes yes. And all that other yes.

  5. Ok, I have to tell you this...I just used this post as a reference on my Econ paper this week. He he he...I had to choose an article about government policy and it's effects on goods and services, I choose the soda ban. :-)


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