Magic bullet misfires

This morning it was announced that GPs and dentists might actually be punished for prescribing antibiotics inappropriately. The reasons for this are clear and have been known for a long time. In 1976 a famous research paper was published by Nigel Stott and Robert West which showed that unless the patient was coughing up green sputum or had definitive signs of infection in the lung fields, then giving antibiotics did not speed recovery. I was in my vocational training to become a GP at the time, and it gave our tutors ammunition to demonstrate that even then antibiotics were being misused and that a new approach was needed. The problem, as we all now know, was that bacteria evolve very rapidly and adapt to antibiotics, becoming resistant and requiring the development of progressively more powerful and (potentially dangerous) agents.

Unfortunately the damage had already been done. Decades of unnecessary prescribing had educated the public to believe that antibiotics did work for self limiting ailments; that is to say, if you are given ABs on day 3 for a condition which your own immune system will clear up in a week, you are still inclined to believe the antibiotics were what cured you. This led to patients demanding treatment for colds and so on, and often hostility on their part when the treatment was denied.

It took a long time for GPs to modify their practices, and even longer for patients to take the message on board, but eventually the message permeated through and we are now in a very different place from where we were back in '76. But some GPs have hung on to the "easy way" and these are the recalcitrant medics the plans intend to punish. 

There are two points I want to make here. First, let's not forget the role of vets in this whole scene. Like the doctors and dentists, they too have been guilty of overusing antibiotics to a massive degree. Second, we must guard against going too far in the opposite direction. A close friend of mine went to her doctor after she had endured a horrible cold for 2 weeks. And even though she was coughing green phlegm, the doctor still refused to treat her. Only after 2 more weeks of suffering did the doctors relent and give her the treatment she should have had two weeks before. Doctors need to work according to recognised guidelines, not fundamentalist zeal.