vaccine - curious question

[rback33]

Some good came from it though in that it gave me a good laugh.

Well if laughter truly is the best medicine then I have cured a LOT of people today... the amazing thing is that this is the first time I have done this

 

[IslandTractor]

We're not really in disagreement .... But I would never criticize another doctor's work (or anyone else's) when I don't have the necessary facts to justify it.....And in the case at hand, the facts aren't there. Period.

You are correct we are not that far apart. However, the attitude that the doc is always right unless the evidence is absolutely nailed down and totally without question is something I don't accept. I was critical of a series of interventions that is unfortunately quite common and far more often than not are the result of sloppy thinking/medicine. My read on the original post was that 1) doc thought it was definitely a sting and 2) the thought there was a local allergic rxn. There are many reasonable ways to manage that situation including observation and follow up without any therapy much less multiple prescriptions. Of course there are situations where empirical therapy is justified, happens every day in every practice. However there is also a lot of polypharmacy (for you tractor nuts out there that is prescribing lots of drugs without good cause in a shotgun type approach) out there and I think the public needs to be more tuned in to it so they resist and don't foster it. Docs often complain that their patients demand medication but part of the reason for that is that through over prescribing the docs train the patients to expect it and because it it faster to write a few scripts than to take time and explain the situation. Whatever happened to patient education and watchful waiting? I don't mean to suggest the doc's actions in this situation were outrageous, unfortuantely it is fairly common practice around the world. It just isn't good practice.

I'm getting back to important tractor stuff now.

 

[IslandTractor]

Rust is not a requirement for tetanus.

You're completely correct. I have no idea where the notion that rusty nails were critical came from except through association with puncture wounds in the outdoors. The organism is primarily found in the soil especially where there is contamination with animal or human excreta. Tetanus as a disease is extremely rare in the USA these days with less than a few dozen cases a year. It is a good idea obviously to have a tetanus booster every decade but you don't need one after a skin puncture indoors in most situations and you don't need one after a bug bite.

 

[Bird]

Docs often complain that their patients demand medication but part of the reason for that is that through over prescribing the docs train the patients to expect it

I'm sure that's right, but I also wonder how much of it is due to the huge number of TV commercials. If those commercials weren't selling those drugs; i.e., if they weren't working, the manufacturers would quit running them after awhile. And usually the tail end of the commercial makes it sound as if the side effects are worse than the problem the drug is supposed to treat.

 

[IslandTractor]

Commercials and ads for public viewing have been part of the equation for the past decade or so at most. The general phenomenon is much older so I don't think the commercials started it. Also, there aren't any commercials for antibiotics by and large and those are some of the most commonly overprescribed drugs.

Human nature is probably to blame. When we get sick we want to put something magic into our bodies to remove the sickness. Even the most primative societies behave the same way. Even animals do it. Current over prescribing is just a modern high tech varient on the theme. While old "remedies" were often harmless placebos (chicken soup, tea, etc etc), modern pharmaceuticals typically are double edged swords and are less safe when used inappropriately.

 

[N80]

It is interesting that after nearly 20 years in medicine I have never seen a case of tetanus. Never seen a case of small pox, never even seen a case of mumps. It has been a while since I saw a case of chicken pox. There are several reasons for this: 1) the immunization program in this country works pretty well and 2) I've never practiced outside the US.

In WWI tetanus was a major source of battlefield casualties, I've heard it accounted for more than bombs and bullets.

 

[N80]

Commercials and ads for public viewing have been part of the equation for the past decade or so at most.

Actually, the historical root of the problem does lie with advertising and the problem of overprescribing antibiotics started with penicillin. When it first became widely available it 1) was a virtual magic bullet in a world in which the vast majority of deaths resulted from infectious disease and 2) it was utterly unregulated, sold without prescription and was advertised widely and wildly as a cure for virtually any medical problem, infectious or not. Thus the popular and persistent view of antibiotics as a cure all.

But, as mentioned, I don't know of any current direct to consumer ads for antibiotics.

And let me explain what we med geeks are talking about. First, the more antibiotics are used, particularly for conditions in which they are not actually useful, the more the bacteria become resistant to the antibiotics. This often leads to very common types of bacteria not responding to even powerful antibiotics. This is mostly a problem for people who are very sick and in the hospital (in which case such infections can be fatal) but it can also be a problem in simple skin wounds in healthy people and even with some things like sinusitis.

Second, the most common way antibiotics are overprescribed is when they are used to treat conditions that are porbably viral. Antibiotics kill bacteria not viruses. Bacteria cause things like wound infections, sinusitis, some ear infections, pneumonia, bladder infections and some intestinal problems. Viruses can cause similar infections but most commonly virus present in the form of the common cold or a stomach 'bug'. A common cold caused by a virus will make you perfectly miserable for 7-10 days, 14 in some cases. As we all know "there is no cure for the common cold" and you just have to treat the symptoms and ride it out. Antibiotics do little or nothing to help a cold go away.

So why do doctors prescribe antibiotics for a cold? Well, it is very complicated. Many symptoms of a cold can be similar or identical to those of a sinus infection, tonsilitis, pneumonia, etc. So there can be confusion. Also, a common cold can lead to a secondary infection such as sinustis, pneumonia or an ear infection. That complicates things even more.

But, the main reason is this: A person gets a cold. Fever, cough, runny nose, nasal congestion, sore throat, body aches, fatigue. For 3-4 days they fight it with over the counter meds, etc. By day 5 they are fed up and go to the doctor. Doctor looks them over, thinks its probably a cold, but could be a sinus infection. Doctor also wants to feel like he's helping and giving patient his money's worth and so prescribes him a Z-pack (popular 5 day antibiotic with a cool sounding name and red pills). Two days later, bingo, they are cured and happy as a clam and the doctor looks so smart and helpful. Right? Nope. What really happened is that the patient came in on day 5 of a virus that got better on day 7 like they almost always do. The antibiotic didn't have a thing to do with it. But to the patient is seems like it did and he tells his friends and family to go in and see Dr. Smartguy next time they get a cold and he'll fix 'em right up with a Z-pack.

Then it gets even worse. This patient's friend now gets a cold and comes to see Dr. Smartguy on day two of his cold. He tells Dr. Smartguy he really wants a Z-pack. Dr. Smartguy knows better but wants to make patient happy. Patient gets his Z-Pack and two days later (4th day of cold) he's no better. Worse even. Why? Its the natural history of a common cold. So he goes back on day 5 and tells Dr. Smartguy that the Z-pack didn't work. He needs something stronger. Dr. Smartguy has now painted himself into a corner and he's too busy to go into details about microbiology and gives the patient a big gun, gorillacillin antibioitc, usually reserved for serious infections. Patient starts gorillacillin on day 5 of illnes and two days later, bingo! he's well again. Thank goodness for gorillacillins right? Nope. He just got better because his cold followed its natural course and got better on its own.

Then it gets worse. This guys now requests a gorillacillin every time he gets a runny nose and tells his friends and family to do the same. That's how it all gets out of hand. And when thousands of doctors do this with many thousands of patients, the bacteria start to become resistant to our gorillacillins and then we have no gorillacillins.

So, let a cold run its course. And if your doctor tells you that you have a cold, trust him, give it some time.

This has been a public service announcement for the benefit of non medical folks so I don't want to hear any Ivory Tower egg heads making technical corrections. It is obviously way more complicated than this, but, you get the picture.

 

[Tom_Veatch]

...
And usually the tail end of the commercial makes it sound as if the side effects are worse than the problem the drug is supposed to treat.

I especially like those commercials for sleep aids where the stated list of side effects include ... drowsiness...

Well, duhhh!!!

 

[roxynoodle]

I am a person for whom antibiotics were overprescribed for sinusitis. Ok, they might have worked had my sinuses been able to drain. You may have read my post in the farm animal forum. I was kicked in the face by a horse and had multiple fractures. My right maxillary sinus had numerous pieces of broken bones that formed a large mass. Well, for 4 years that mass remained because nothing had been seen on the initial catscans other than that my sinuses were filled with blood. I am not a doctor but to me sinuses filled with blood = a problem. They didn't even believe me when I told them my jaw was moving around. The jaw ended up having to be cut off and bolted back on because it had healed in the wrong place. Needless to say my doctors gave me antibiotic after antibiotic to cure the sinus infection. I now have had a sinus infection for 10 years. It isn't fun and my hearing has been affected. I eventually changed doctors and the new doctor seemed to be sympathetic to the overly prescribed antibiotic problem. Now he's looking for the easy way to get a patient out of his office and everytime he sees me, that's all he wants to give me. I know doctors are extremely busy, but the prescribe meds, get out of my office tactic is not helpful. Right now I suspect I could have West Nile virus. At the least I have something I've never had before and others in the area have had it (and I have the symptoms of a mild case). What did he give me? An antibiotic. I have been sick since last Monday (week and a half). I may be looking for a new doctor again.

 

[IslandTractor]

....

So, let a cold run its course. And if your doctor tells you that you have a cold, trust him, give it some time.

This has been a public service announcement for the benefit of non medical folks so I don't want to hear any Ivory Tower egg heads making technical corrections. It is obviously way more complicated than this, but, you get the picture.

I agree with every single word of that entire post.