Monday, December 11, 2017

Big Tobacco Finally Telling the Truth About Its Products

By Sid Roberts, MD
Lufkin Radiation Oncologist

This blog post was originally published Dec. 10 at the Lufkin Daily News and on the Angelina Radiation Oncology Associates blog.

There was some big, big news recently you probably haven’t heard. After years of legal wrangling, the tobacco industry not only has been found guilty of fraud, conspiracy, and racketeering, but also has been ordered to run television and newspaper ads admitting the truth it fought so hard to suppress for decades.

Let’s go back to the beginning. It was more than 50 years ago, in 1964, when Luther Terry, the ninth surgeon general of the United States, issued a landmark report linking smoking to lung cancer and a host of other diseases. Since that time, Big Tobacco lied, deceived, and in every way engaged in a no-holds-barred battle against every attempt to regulate or curtail the sale of tobacco products. In the meantime, tens of millions of U.S. citizens have died prematurely from tobacco use.

In 1999, the Department of Justice took on Philip Morris and other tobacco giants under the Racketeer Influenced and Corrupt Organizations Act, alleging the tobacco companies had engaged in a decades-long conspiracy to (1) mislead the public about the risks of smoking; (2) mislead the public about the danger of secondhand smoke; (3) misrepresent the addictiveness of nicotine; (4) manipulate the nicotine delivery of cigarettes; (5) deceptively market cigarettes characterized as “light” or “low-tar,” while knowing those cigarettes were at least as hazardous as full-flavored cigarettes; (6) target the youth market; and (7) not produce safer cigarettes.

Seven years later, in 2006, Federal District Court Judge Judy Kessler ruled that Philip Morris and other tobacco companies engaged in fraud, conspiracy, and racketeering — all to deliberately deceive the American public about the health risks of smoking and secondhand smoke. Her ruling noted that Big Tobacco had “marketed and sold their lethal product with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.” Judge Kessler ordered that these companies admit their guilt publicly by running newspaper and television ads detailing their deception.

It took 11 more years — and a lengthy appeal process — for Big Tobacco to finally agree to any sort of public mea culpa about the health effects of smoking and its role in addicting hundreds of millions of people. Its watered-down admissions of guilt (known in legal parlance as “corrective statements”) will appear in about 50 newspapers and for a year on major television networks.

One startlingly honest (and obvious) fact that must be publicized is that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA intentionally designed cigarettes to make them more addictive.

Think about that. At a time when we rightly are criticizing pharmaceutical companies for how they market pain medications (which actually have a therapeutic use), we still give a pass to the companies that market the most addictive, useless, and deadly product around.

At least Big Tobacco now must admit publicly that “more people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes and alcohol combined.”

Other statements you may see: “Many smokers switch to low-tar and light cigarettes rather than quitting because they think low-tar and light cigarettes are less harmful. They are not,” and “There is no safe level of exposure to secondhand smoke.” Sadly, we have known all of this for years; decades, even.


(One of the court-ordered ads warning of the dangers of tobacco.)

These ads started on Nov. 26, but I have yet to see one myself. I wonder if anyone who needs to see them will see them. Major newspapers and even television are not the way our vulnerable youth consume media these days. I am sure Big Tobacco is counting on that.

In the meantime, tobacco sales continue at a brisk pace. A Wall Street Journal article in April of this year noted that revenues for U.S. tobacco companies hit $117 billion in 2016, up from $78 billion in 2001, despite lawsuits, rising taxes, and declining smoking rates. Americans spent more than $90 billion on cigarettes in retail stores last year.

Stores that sell tobacco products today are complicit in the very deception that Big Tobacco is guilty of. The retail markup of tobacco products, according to the Wall Street Journal, is 17 percent, higher than that on groceries. No wonder grocery and convenience store chains put tobacco products front and center in their stores — or even out in front of their stores. Easy money. Dirty money.

The conservative/libertarian argument about supply and demand and “personal choice” is, pardon the pun, smoke and mirrors when people are knowingly addicted to the product in question. Cigarettes are not sugar water. I don’t mind companies making a profit — even obscene profits — as long as it isn’t by addicting us and killing us.

If nothing else comes from this mea culpa — these “corrective statements” — I hope tobacco and related products become so regulated and taxed that not only is it not possible to become addicted, but also it is too expensive for our youth to even consider starting. Nothing short of a world without tobacco will do. Perhaps that is a pipe dream, but our kids are worth it.

Dr. Sid Roberts is a radiation oncologist at the Temple Cancer Center in Lufkin. He can be reached at sroberts@memorialhealth.org. Previous columns may be found at https://www.angelinaradiation.com/blog 

Friday, December 8, 2017

Old Medications a Potential Health Threat

Expired or unused prescription medications are a common sight in the medicine cabinet of a typical American home, but public health experts say leftover medications are an increasing health risk. A December Texas Medicine magazine article says patients who hold on to old prescription drugs might not understand the risk they pose for poisoning and misuse, but getting rid of old medications poses challenges too. The danger of keeping old medicine, or its improper disposal, is complex. If not disposed of correctly, medicine thrown in the trash or flushed down the toilet can eventually enter local waterways and hurt the environment. Yet teens and adults can abuse or misuse easily accessible medications in the home, experts say.

"Our medicine cabinets are the number one source of medications for teens to experiment [with] or abuse," said Jeanie Jaramillo-Stametz, PharmD, an assistant professor of pharmacy practice at Texas Tech University Health Sciences Center-Amarillo. "And there's a misperception by teens that it's better and safer to abuse a prescription medication than it is illicit drugs ― marijuana, heroin, cocaine ― when really these can be just as dangerous. Even regular non-narcotic prescriptions and over-the-counter medications can be abused and cause harm."

Old, unused prescriptions are a factor in the national opioid crisis. According to the 2013 National Survey on Drug Use and Health, 53 percent of people obtained opioids for nonmedical use from a friend or relative, 10.6 percent bought them from a friend or relative, and 4 percent stole them from someone they knew.

To confuse matters, in some cases, experts still advise flushing drugs away. For example, the Food and Drug Administration (FDA) says people should flush opioids like fentanyl because the drugs depress breathing in children who accidentally touch them.

Some participants in the health care system contribute to the problem of too many leftover drugs. Laredo gastroenterologist Sunny Wong, MD, who has worked with the Texas Medical Association (TMA) on effective ways to dispose of unused medicines, says many health insurance policies force patients to buy more medications than they need or know what to do with.

Pharmacist Dr. Jaramillo-Stametz agrees. "A lot of this is driven by the insurance industry," she said. "The physicians are doing what they can, and they're trying to provide their patient with the appropriate medication at the best rate that the patient would like. [The patients] want the $10 copay for a 90-day supply; they don't want the $10 copay for a 30-day supply. ... It's very difficult for [physicians] to manage all that and find a compromise where the patient will be happy without creating the problem of over-dispensing and accumulation."

"The cost of health care is going up," Dr. Wong said. "And one of the problems is the amount of drugs being given out ― whether they are used or not."

Federal and state agencies recommend disposing of medications at drop-off sites. But, currently, there is no all-inclusive program in Texas or at the national level that allow people to dispose of old medications at their convenience. There are some local options to drop off unused medicine across the state, including medication clean-out events Dr. Jaramillo-Stametz organizes in west Texas, but many Texans still do not have consistent options for safe drug disposal. Wong says disposing of old medications should be as easy as dropping mail in the mailbox. "The ideal situation for practices and patients is to [follow] the concept of a toner cartridge being shipped back to the manufacturer at no cost to the consumer," he said.

Dr. Jaramillo-Stametz says the best thing physicians can do now is educate themselves on ways to minimize the problem. "The physicians are doing what they can, and they're trying to provide their patient with the appropriate medication at the best rate that the patient would like. It's very difficult for [physicians] to manage all that and find a compromise where the patient will be happy without creating the problem of over-dispensing and accumulation."

Resources for Safe Drug Disposal:

Texas Medicine lists searchable websites to locate safe medicine disposal and drug take-back programs across Texas. In addition, local city and county government websites may also provide information on safe drug disposal.

To search local disposal sites, visit:



Tuesday, December 5, 2017

States — And 9M Kids — ‘In A Bind’ As Congress Dawdles On CHIP Funding

By Ashley Lopez, KUT and Selena Simmons-Duffin, NPR

Last week, Colorado became the first state to notify families that children who receive health insurance through the Children’s Health Insurance Program are in danger of losing their coverage.

Nearly 9 million children are insured through CHIP, which covers mostly working-class families. The program has bipartisan support in both the House and Senate, but Congress let federal funding for CHIP expire in September.

The National Governors Association weighed in Wednesday, urging Congress to reauthorize the program this year because states are starting to run out of money.

In Virginia, Linda Nablo, an official with the Department of Medical Assistance Services, is drafting a letter for parents of the 66,000 Virginia children enrolled in CHIP.

“We’ve never had to do this before,” she said. “How do you write the very best letter saying, ‘Your child might lose coverage, but it’s not certain yet. But in the meantime, these are some things you need to think about’?”

Children may be able to enroll in Medicaid, get added to a family plan on the Affordable Care Act’s health exchange or be put on an employer health plan. But the options vary by state and could turn out to be very expensive.

If Congress reauthorizes CHIP funding, states are in the clear. But they can’t bank on it yet, and states have to prepare to shut down if the funding doesn’t come through. Virginia would have to do so on Jan. 31.

“We’re essentially doing everything we would need to shut down the program at the end of January,” Nablo said. “We’ve got a work group going with all the different components of this agency, and there are many.”

For example, they will need to reprogram their enrollment systems, inform pediatricians and hospitals, and train staff to deal with an onslaught of confused families.

Joan Alker, who runs the Georgetown University Center for Children and Families, said most states need to give families 30 days’ notice.

“But [state officials] are hearing rumors that Congress might get this done in the next couple of weeks, and they don’t want to scare families,” she said. “States are really in a bind here. It’s very tough to know what to do.”

Colorado was the first to send out a notice, and other states are close behind. There are a handful that are starting to run out of money in December, Alker said, such as Oregon, Minnesota and the District of Columbia.

The exact deadline for when CHIP funding runs out in each state is tricky to calculate, because the amount of money each has depends on how fast a state spends it — and how much stopgap help the federal government gives them.

Some states are getting creative. Oregon just announced it will spend state money to keep CHIP running, said Alker, “and they’re assuming that Congress will pass it and they’re get reimbursed retroactively. That’s what they’re hoping.”

Texas is set to run out of CHIP funds a lot sooner than was expected just a few months ago. And there’s a big reason for that: Hurricane Harvey, said Laura Guerra-Cardus with the Children’s Defense Fund in Austin.

“Natural disasters are often a way that individuals that never had to rely on programs like Medicaid and CHIP need them for the first time,” she said.

Guerra-Cardus said that after Harvey a lot of new families enrolled in CHIP and that there was also a higher demand for services. “When there is such a traumatic event, health care needs also rise. There’s been a lot of post-traumatic stress in children,” she said.

And to help those families out, Texas officials also waived fees they usually have to pay to join CHIP. So, lately there’s been less money coming in and more money going out. Like Virginia, without reauthorization, Texas would have to shutter CHIP by the end of January.

For Amy Ellis in Alpine, Texas, that’s something she’s dreading. “Losing a lot of sleep,” she said. “Still losing a lot of sleep.”

Ellis has an 8-year-old daughter who has been on CHIP since she was born. The girl has asthma and allergies, Ellis said, and health insurance is really important because her family doesn’t make a lot of money. Her daughter’s allergy medicine is expensive.

Ellis lives in rural West Texas, nearly four hours southeast of El Paso and “three hours from the closest city,” she said.

The isolation means that Ellis doesn’t have many options other than CHIP, she said. One would be enrolling her daughter in the insurance plan she and her husband have through the Affordable Care Act marketplace, but Ellis said that would be expensive.

“It would cost $300 to $400 a month for us to add her to our plan, which would be a huge chunk of our income,” she said. “That’s our grocery money and our gas money.”

A lot of families in Texas could find themselves in the same situation if Congress doesn’t act soon, said Guerra-Cardus. “Kids with chronic or special health care needs, this is going to turn their lives absolutely upside down.”

Roughly 450,000 children are covered by CHIP in Texas. Officials say they are asking the federal government to give them money that will keep CHIP alive through February.

But because officials must give families 30 days’ notice if the program will end, families in Texas could get letters right around Christmas that say their children are losing their health insurance.

This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News. Selena Simmons-Duffin is a producer at NPR’s All Things Considered, currently on an exchange with Washington, D.C. member station WAMU.

Friday, December 1, 2017

PrEP Can Prevent the Spread of HIV

By M. Brett Cooper, MD
Houston Pediatrician/Adolescent Medicine Fellow

39,513. That is the estimated number of new HIV diagnoses in the United States in 2015, ac-cording to the Centers for Disease Control and Prevention (CDC). Although the number of new diagnoses fell nine percent from 2010-2014, certain populations remain most at risk, particularly men who have sex with men and IV drug users. These two groups together accounted for three-quarters (76 percent) of new diagnoses in 2015. With advances in HIV care, these numbers can be reduced even further. One of these medical advances is HIV pre-exposure prophylaxis (PrEP). PrEP is an oral medication taken once daily to prevent HIV infection. Truvada® is currently the only FDA-approved medication for use in patients aged 18 and older. When used in combination with other risk-reduction measures, PrEP can be more than 90 percent effective at reducing the risk of HIV infection when taken daily as prescribed. Both patients and physicians can help in-crease awareness and use of PrEP hopefully to achieve the goal of “Getting to Zero” new infec-tions. Here are some tips for patients and physicians.

Patients:
Even if your physician does not discuss your sexual history with you, empower yourself to speak up. If you frequently engage in condomless vaginal or anal sex and/or have sex under the influ-ence of drugs or alcohol, ask your physician about PrEP. PrEP may also be a good option for you if you are in a sexual relationship with a partner who is HIV positive. Ensure that you are tested for HIV and other sexually transmitted infections at least once per year. If you are concerned about the cost of PrEP, or you do not have insurance, do not worry. The manufacturer of the medication has a patient-assistance program that may make the medication free, depending on your income.

Physicians and other health care providers:
The CDC has developed a guide for clinicians to help them identify which patients would be good candidates to screen for PrEP. In order to identify at-risk patients, physicians should take a sexual history for every patient at least once per year. This includes what sites are used for inter-course, the gender of one’s partners, whether condoms are used, and whether intercourse takes place under the influence of substances. Admittedly, this can be an uncomfortable topic for many physicians to discuss. However, your patients may be just as uncomfortable initiating this conver-sation with you. In addition, all sexually active patients should receive an HIV screening test at least once per year, including adolescents. For those patients who screen negative and are at risk, providers can discuss PrEP and other risk reduction measures. For patients who screen positive, they should be promptly referred for treatment.

As we celebrate the 30th World AIDS Day today, let us not forget those patients whose lives were claimed by HIV/AIDS. PrEP and other HIV risk-reduction methods can bring us ever clos-er to the goal of zero new infections. Prompt identification of those who are HIV positive and referral to treatment can bring their viral loads (the amount of HIV in a person’s blood) to unde-tectable levels, effectively giving those patients no risk of transmitting the virus to others. With physicians and patients working together, we will one day be able to raise an AIDS-free genera-tion.

Thursday, November 30, 2017

World AIDS Day 2017 Is Tomorrow

By Alan Howell, MD, Temple Infectious Disease Specialist
Member, Texas Medical Association Committee on Infectious Diseases

The first World AIDS Day was marked on Dec. 1, 1988. The brainchild of two World Health Organization (WHO) public information officers, World AIDS Day serves to raise awareness of the AIDS pandemic. Dec. 1 also provides a day to mourn those whose lives were cut short by the disease.

During the past 29 years, significant strides have been made in respect to HIV/AIDS public education, diagnostics, treatment, and prevention. With the 2017 observance upon us, I thought this would be a great time to take stock of where we’ve been — and where we hope to go in respect to the pandemic.

HIV remains a significant global public health issue. To date, 35 million people worldwide have died as a result of the virus. In 2016 alone, 1 million people perished because of HIV. That’s approximately 2,700 people a day, or 114 per hour.

The WHO Africa region is the most affected region, where 25.6 million people live with HIV. This region also accounts for almost two-thirds of the global total of new HIV infections. Part of the problem is that far too many people are not aware of their HIV status.

Fewer than three out of four (70 percent) of people with HIV are estimated to know they are infected. The goal is for nine in 10 (90 percent) of people with HIV to be aware of their condition. To achieve this goal, an additional 7.5 million people need to have ready access to HIV testing. To this end, the Centers for Disease Control and Prevention (CDC) recommends HIV screening in the United States be performed routinely for patients aged 13-64 in all health care settings. Patients who continue to be at high risk for HIV need to undergo repeat screening at least annually.

Despite the grim statistics, antiretroviral therapy (ART) and education programs around the globe are working. Between 2000 and 2016, new HIV infections fell by 39 percent. HIV-related deaths fell by one-third, with 13.1 million lives saved because of ART. In 2016, 19.5 million people worldwide living with HIV were receiving ART.

On the topic of ART, many patients are surprised by the treatment’s convenience. For most people starting HIV treatment, one pill once a day will suffice. Occasionally, a physician or health care provider may determine two pills once a day or three pills once a day are necessary. Side effects are much improved compared to the medications used as recently as 10 years ago.

While there is no cure for HIV, treatment can successfully control the virus to the point it is no longer detectable in the bloodstream (viral suppression). This means people who take ART daily as prescribed, and achieve and maintain an undetectable viral load, have effectively no risk of sexually transmitting the virus to an HIV negative partner.

In addition to the aforementioned treatment as prevention, pre-exposure prophylaxis (PrEP) is another great option for preventing the spread of HIV. PrEP consists of a daily pill. When taken as directed, PrEP can reduce your risk of acquiring HIV through sex by more than 90 percent. Among patients who inject drugs, it reduces the risk by more than 70 percent. Additionally, PrEPcost.org is an online tool that can help individuals determine which plans offered in the Health Insurance Marketplace cover this prevention option.

World AIDS Day 2017 is a great time to celebrate the progress we’ve made curbing the pandemic. It also is a time to stop and reflect on the horrible human toll HIV has taken in the United States and around the world. To make this a truly successful World AIDS Day, consider these ways to show support:

  1. Wear red on Dec. 1;   
  2. Volunteer your time or make a monetary donation; 
  3. Take time to educate yourself and share your knowledge (hopefully this post helped in some small way, and I encourage you to share it); and 
  4. Get tested if you think you might be at risk.


Wednesday, November 15, 2017

Be Antibiotics Aware: Smart Use, Best Care


It’s Antibiotic Awareness Week — Nov. 13-19


Jane D. Siegel, MD
Pediatician/Pediatric Infectious Diseases Specialist
Chair, Texas Medical Association Committee on Infectious Diseases

Editor's Note: November 13-19 is Antibiotic Awareness Week. The following post offers recommendations to limit exposure to antibiotics to only those people who truly need them, in order to avoid development of bacterial infections for which there will be no effective therapy. 

No physician wants to see a patient with a serious infection for which we have no antibiotic to treat it effectively. That is why this week, the Centers for Disease Control and Prevention (CDC) is asking us — physicians and patients — to rededicate ourselves to improving the use of antibiotics. 

For physicians, this means limiting prescriptions for antibiotics to conditions likely to benefit patients, thereby reducing the risk of the emergence of antibiotic-resistant bacteria. If we overuse antibiotics, we run that risk, as treatments for infections from these bacteria stop working because the antibiotics no longer kill the bacteria.

The Texas Medical Association is collaborating with the Texas Department of State Health Services on activities to improve antimicrobial use. Antibiotic Awareness Week, which coincides with similar efforts in Europe, Australia, and Canada, and by the World Health Organization, reminds us to think about how we use antibiotics.

https://www.cdc.gov/antibiotic-use/community/materials-references/graphics.html
Here are two activities physicians can initiate or emphasize this week, incorporate into our practices, and explain to patients and their families:

1. Antibiotic time out: Right drug, right bug, right duration                                                          
This practice of fine-tuning of physicians’ decision-making involves a few straightforward steps to ensure we use antibiotics only when needed according to established recommendations. 

CDC has some excellent graphics and information for patients and their families so they understand how physicians make treatment decisions and why they might not prescribe an antibiotic in a given situation. This practice is applicable to long-term care facilities (LTCFs) and is a component of the antimicrobial stewardship program that the Centers for Medicare & Medicaid Services will require in all LTCFs in coming years. 

Patients: These are the rules your physician applies to prevent antibiotic overuse when they care for an ill patient:
  • Does this patient have a bacterial infection that requires antibiotics? If the physician believes a patient’s illness could be caused by a bacterial infection, he or she will run appropriate diagnostic tests and prescribe a drug that will be effective against the organisms likely to cause the infection.  The physician might write a prescription for three days with a refill to complete the medication course. If the physician and patient cannot determine whether the patient has a penicillin allergy, the physician may recommend testing the patient to know if drugs containing penicillin are safe to use. Alternatively, the physician may watch and wait without antibiotics and reevaluate later.                      
  • Reevaluate at 48-72 hours. The physician then assesses how the patient is feeling. If any diagnostic test results identify the cause of the infection, the physician may prescribe a more narrow-spectrum antibiotic (a drug that treats only a specific family of bacteria). This helps prevent antibiotic resistance by targeting only the specific bacterium in play and would be effective for the remainder of the patient’s treatment for this illness. If there is more evidence to support a viral infection, the physician will discontinue antibiotic treatment, as antibiotics do not treat viral infections.
  • The physician will determine the necessary duration of the antibiotic course, based on evidence-based clinical pathways, which are clinical guidelines physicians can follow to treat various clinical conditions. Such guidelines are developed by reviews of carefully conducted studies and are endorsed by professional societies. 
2. Buy meat and poultry products that come from animals NOT fed antibiotics as growth factors.   
                                                                                           
      The practice of using antibiotics as growth-promoting elements is an important risk factor for antimicrobial resistance. Antibiotics used this way encourage emergence of resistant bacteria in the animals. These resistant bacteria reside on the surface of meat or poultry products and are passed on to humans inadvertently if not handled safely.
Farmers and veterinarians have been educated to stop this practice, and we are making progress in the United States. But there is more work to do. When you go to the supermarket, buy only meat or poultry that says specifically, “No antibiotics used.” Designations such as “organic” or “no growth hormone” do NOT mean the meat or poultry is free of antibiotics. If you do not see this type of packaging in your market, ask the store to start carrying products from antibiotic-free animals. The more demand for these products, the more supply we will find. Both patients and physicians can heed this advice. Visit the CDC website for more information on antibiotic-resistant solutions, food safety challenges, and a U.S. Food and Drug Administration question and answer page


Monday, November 13, 2017

How Overuse of Antibiotics Is Creating Drug-Resistant Bacteria

By John P. Fardal, DO
Austin Family Physician

Editor's Note: November 13-19 is Antibiotic Awareness Week. The following post explains the differences between bacterial infections and viral infections, and how antibiotics can be used to treat bacterial infections but not viral ones. It also explains how overusing antibiotics can be harmful to public health, and urges patients to think twice before automatically asking their physician for antibiotics when they are ill.

Some bacteria split every eight minutes. They can go from a single cell to more than a trillion in less than half a day.

One of the most important advances in health care was the discovery of the antibiotic penicillin. It gave people a very big stick with which to fight bacterial infections. Unfortunately, one of the biggest health threats facing the world is the rise of drug-resistant bacteria, and part of the reason for that rise is the overuse of antibiotics.

How bacteria work:


Bacteria are everywhere, and are mostly beneficial. They help digest food, provide essential vitamins, and compete with bad bacteria. The bad bacteria, however, can make people very sick. Luckily, bacteria are different enough from human cells that scientists have been able to discover or invent chemicals that target them. This is how antibiotics usually work, either disrupting bacterial cell structure or shutting down their molecular workshops.

How viruses work:


Viruses, however, are very different from bacteria. While bacteria stay outside of human cells, viruses invade them and hijack our molecular workshops. Viruses then use their own blueprints to make what they need. They make thousands of copies of themselves in each cell they invade, and then burst out of the cell to invade more cells and repeat the process. Because they hide inside our own cells and use our own workshops, it's hard to shut down their production without shutting down our own normal body processes.

It's not possible to shut down viral workshops, but it is possible to go after the viruses directly. This is where antivirals come into play. They are the viral version of antibiotics, but they are different in an important way ― they generally target one virus strain, while antibiotics usually affect many different bacteria.  There are a lot of viral strains out there. The common cold has more than 200 viral strains all by itself. Antivirals are only effective for a few select viral infections.

How your immune system works:


Our immune system is usually very good at fighting both bacteria and viruses. In rough terms, it first has to notice that something is in our body that doesn't belong there. Once the intruder is noticed, our workshops ramp up production of antibodies that target it so the rest of our immune system can kill it. This can take a few days and is when people usually feel worst.

The problem with antibiotic overuse:


When we use antibiotics, they effectively kill a very large portion of the bacteria, but some bacteria are able to survive through variations of their genetic code ― also known as just being lucky. Usually, our immune system kills off those last few lucky bacteria, but every now and then one slips out with a cough or sneeze, and is able to set up shop in another person. Now there is a strain of the bacteria that can't be killed with that antibiotic, and it can make a trillion copies of itself in half a day. It's ironic, but antibiotics use is the single most important factor in the development of antibiotic-resistant bacteria worldwide.

Drug-resistant bacteria are scary ― really scary. In the days before antibiotics, people died from bacterial infections at a rate we would have a hard time believing today. Last year, about 2 million people in the United States were hospitalized with a drug-resistant bacterial infection. There are a few very strong antibiotics that are kept in reserve just to be used for those resistant bacteria, but eventually, the bacteria will become resistant to them as well. Luckily, it is possible to slow the development of this particular catastrophe by only using antibiotics when fighting a bacterial infection. And that's where the virus comes back into the picture.

Antibiotics are for bacterial infections, not viral infections


Most people go to the doctor with upper respiratory symptoms and expect an antibiotic prescription. They believe antibiotics can make their illness go away much faster than just relying on their immune system to do the job. And they are right ― antibiotics can be very helpful when someone has a bacterial infection. However, when they have a viral infection, all the antibiotic will do is kill off good bacteria. This may give the patient diarrhea, and every now and then cause a resistant bacteria to emerge, all without making the patient's infection any better. Nevertheless, some health care providers prescribe antibiotics when it's much more likely that their patients have viral infections, such as the cold, because they want to both keep their patients happy and cover a possible bacterial infection in situations where the diagnosis is not clear cut.

This is where we can all help to save the world in a very literal sense. If your physician thinks you have a viral infection and does not recommend that you use an antibiotic, please consider giving it a few days, to see if your immune system ramps up and fights the virus off on its own. If it doesn't, odds are better that it's bacterial, and a physician will almost always be happy to prescribe antibiotics at that point.  Waiting just a few days can make a really big difference.

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