How to Stop Overprescribing Antibiotics - The New York Times

Antibiotics are an indispensable weapon in every physician's arsenal, but when prescribed unnecessarily for nonbacterial infections like the common cold, as they too often are, they provide no benefit and create problems. They wipe out healthy bacteria and can cause side effects like yeast infections and allergic reactions. Worse still, they contribute to the rise of "superbugs" that resist antibiotic treatment.
The Centers for Disease Control and Prevention estimates that about half of outpatient antibiotic prescriptions in the United States are unnecessary. It also estimates that each year as many as two million Americans suffer from antibiotic-resistant illnesses, and 23,000 die as a result.

Clearly, we need to get doctors to prescribe antibiotics more selectively. But how can this be done?

Several strategies have been tried in recent years, without much success. Educating doctors and patients about the proper use of antibiotics has had only a modest effect, as most doctors already know when antibiotics are called for. Alerts sent to physicians through the electronic health record reminding them to not prescribe unnecessarily are often ignored because doctors are overloaded with such messages. And offering doctors financial incentives has had mixed results, in part because the payments are modest relative to a doctor's salary.

These strategies are all based on the assumption that physicians are rational agents who will do the right thing if provided proper information and incentives. But what if doctors are a little irrational, like the rest of us? They may overprescribe antibiotics out of an unrealistic fear that the patient could eventually develop complications and need them, or because it is easier than arguing with a patient who insists on getting them. (Doctors appear to take the path of least resistance as they get more tired. In a study published in JAMA Internal Medicine, we found that prescription of antibiotics increased over the course of four-hour clinical shifts, whether or not it was called for.)

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http://www.nytimes.com/2016/03/27/opinion/sunday/how-to-stop-overprescribing-antibiotics.html?

NYTimes: We’re More Honest With Our Phones Than With Our Doctors

In the late 1960s, an undergraduate psychology student at Wellesley College named Martha McClintock noticed something interesting: Women who spent a majority of their time together tended to get their periods around the same time. She suspected that menstruating bodies could influence one another somehow, but it was just a hunch. So she asked 135 of her fellow students to keep track of their cycles. Three times that year, she quizzed them about their period start and which women they socialized with the most.

Initially, it seemed McClintock was right: Close-knit groups of friends tended to start their periods together. The phenomenon of menstrual synchrony was nicknamed the "McClintock effect," and her work was lauded as one of the first mainstream studies to demonstrate how one person's body chemistry can trigger responses in another's. But McClintock's results have been difficult to replicate; now, the scientific consensus is that cycles probably don't sync up — a claim that rings untrue to anyone who menstruates. My friends and I joke that we even seem to sync up digitally, thanks to constant contact via iMessage, Snapchat and Twitter.

The unresolved nature of McClintock's investigation, now almost 50 years old, underscores the unnerving amount of opacity that still surrounds women's health. Even today, it's difficult for women to get a sense of what's normal and what isn't. When my friends and I talk about our bodies, we compare feedback from physicians, all of which seems to be slightly different; we warn one another about conditions like uterine fibroids and share horror stories about different methods of contraception. There still seems to be a combination of prudishness and ignorance around the unique, and sometimes idiosyncratic, functions of the female body — which is shocking, considering half the world is born with one.

But in recent years, mobile technology has granted me and countless others the ability to collect an unprecedented amount of information about our habits and well-being. Our phones don't just keep us in touch with the world; they're also diaries, confessional booths, repositories for our deepest secrets. Which is why researchers are leaping at the chance to work with the oceans of data we are generating, hoping that within them might be the answers to questions medicine has overlooked or ignored.

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http://www.nytimes.com/2016/03/27/magazine/were-more-honest-with-our-phones-than-with-our-doctors.html?

A Journey to the Medical Netherworld | Hazlitt

One day in early December, not so many years ago, my nine-year-old daughter caught sight of herself in the mirror at daycare, and noticed her face was bright red. All the kids had red faces, because they'd just come indoors after playing in the snow. But everyone agreed that hers seemed particularly bright. She felt hot, too, but a thermometer revealed she had no fever. She sat by an open window to cool down, and when I picked her up an hour later, she still felt hot and looked red, but she said it was going away. By the time we'd finished dinner, it was gone.

The next day, though, she complained of an earache. The winter concert was on that evening, so we let her go to school. She sang well. But when we got home that night, we could feel a small lump under her right ear. The following morning, we could actually see it, and we took her to the doctor.

All that day, the lump kept swelling. By nighttime it had grown to the size of a small mango. Her neck skin was stretched taut around it. By then, she was deep in pain: she couldn't chew, couldn't swallow, couldn't talk, couldn't even cry. We dosed her with Tylenol as we waited for the antibiotic to kick in. Finally, around midnight that night, a Friday, things began to turn around. The swelling receded. She fell asleep. Two days later, the lump was only a memory.

Parents learn not to dwell on illnesses that go away. Kids throw up. They get fevers. They stay up all night wheezing. Each event is a crisis as it unfolds, but when it is over, the adrenaline drops and you move on. And this event, we decided, was now over.

Little did we know.

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http://hazlitt.net/longreads/journey-medical-netherworld?