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Swine flu

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mdg
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« Reply #15 on: August 21, 2009, 17:18:28 PM »

 
Quote from: Mefiante
However, doctors prescribe them in cases of viral infection in order to prevent or obviate the effects of secondary infections since the immune system is already taxed with fighting off the primary one.


This is the reason my doctor gives me too. I don't take anti-biotics unless I really,really have to - i.e. only if I'm at death's door.
Anyway, isn't the overuse of anti-biotics responsible for drug resistant strains of diseases? That and the fact that people don't finish their prescriptions.

I think people just need to be sensible and use their common sense when it come to swine flu, going to your doctor and demanding Tamiflu for healthy children is a little silly, taking an anti viral has side effects. I've heard that the test for H1N1 is also very expensive, so unnecessary money and time is being wasted testing "regular" cases, instead of testing the people who really matter - the ones who have other factors that may increase the severity of the flu for them.

mdg
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AcinonyxScepticus
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« Reply #16 on: August 21, 2009, 17:46:23 PM »

... going to your doctor and demanding Tamiflu for healthy children is a little silly, taking an anti viral has side effects.
Not only that, but taking a healthy child to a waiting room full of infected people is, to me, counter-intuitive and probably counter-productive if their GP decides to dissuade them from their idea and the child happens to pick something (else) up.

James
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Fluxosaurus
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« Reply #17 on: August 27, 2009, 20:06:05 PM »

I still don't understand why anti-biotics are prescribed for viruses, and I never think to ask the doctor. Anybody know?
Indeed, antibiotics are ineffective against viruses.  However, doctors prescribe them in cases of viral infection in order to prevent or obviate the effects of secondary infections since the immune system is already taxed with fighting off the primary one.  In other words, it’s a proactive step that has as benefits (a) that the immune system doesn’t need to deal with additional threats; (b) that it makes the patient (and doctor, too) feel better for having some medication prescribed, and (c) that it supports the pharmaceutical industry, quite besides building more resilient bacteria.

(Point (c) is why people at times call me “cynical,” if can you believe that!)

'Luthon64

Interesting to do some Google research on this issue of antibiotics.

I found this site listing a study, seeming to support the notion of prescribing antibiotics for respiratory tract infection:
http://www.chestjournal.org/content/135/5/1163.abstract

This would seem to provide support for Mefiante's point (a), but when you see that it was written by

"Dr. Winchester {who} is employed as a medical writer by Oxford PharmaGenesis Ltd. "
then one is inclined to see more credence in Mefiante's point (c), cynicism not withstanding :-)

It reminds me to be observant of the source of a particular claim or piece of information - it does not obviate the contribution of that information outright, but it requires that we weight it accordingly, and with recognition of possible bias and vested interest on the part of the writer.

They do go on to say that "Dr. Macfarlane has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.", but that does not provide a great degree of comfort and reduce my level of caution about possible bias.

Further on this point though, the resource lists various levels of confidence - 95% confidence interval [CI], 0.58 to 0.92 - and this would indicate that there is more science here, the possibility of obtaining the original research, and the possibility of reproducing the study to re-test the veracity of the claim / result. And this is precisely what I love about science - that it is open, and grows in complexity, yet gets us closer to some greater point of understanding - small incremental steps towards the truth, but never so definite that it becomes dogmatic and blind to new information.

It would seem that antibiotics are indeed overprescribed:

"Conclusions  The use of prescription antibiotics far outweighs the predicted incidence of bacterial causes of acute and chronic rhinosinusitis. Frequency of antibiotic class used was not congruent with reported antimicrobial efficacy of the respective classes. Despite contradictory efficacies reported in the literature, inhaled corticosteroids were frequently used to treat acute rhinosinusitis. Antibiotics and inhaled nasal corticosteroids are being used more often than their published efficacies would encourage." http://archotol.ama-assn.org/cgi/content/abstract/133/3/260

But the reason why this is necessarily a bad thing is still unclear to me at least.

I can understand that perhaps the population represents a context / environment into which we are pumping all these antibiotics, unintentionally selecting against current (possibly weak strains) and selecting for super kick ass, killer strains that have not evolved yet. So at a population level, over a long period of time perhaps, this is a dangerous practice, but humans are notoriously in the market for instant gratification, hence the feeding of the psychological need for both the patient and doctor to feel prescribed for and effective, respectively.

I have tried both methods - not taking them when under the attack of a cold (long duration, utter misery, extreme drop in productivity, grumpy like a bear too), and taking them (with an accompanying dose of decongestants) which usually means shorter duration, and less symptoms, and the added promise of the prevention of secondary infections.
I have not tried just the decongestants - perhaps an experiment for next time.

The promised benefit of NOT promoting the creation of drug resistant strains seems to be a distant, population benefit, whereas the promise of less symptoms, and a greater degree of comfort for the patient, strikes me as a localised, immediate effect - I will leave the reader to decide which of these forces are more likely to motivate behaviour in the general populace.

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Fluxosaurus
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« Reply #18 on: August 27, 2009, 20:19:50 PM »

Another reason to always suspend judgement until a wide ranging set of research has been done.

Check this out - this site had some interesting claims about antibiotic resistance:

http://www.silver-colloids.com/Pubs/antibiotic-resistance.html

But when I saw this I felt unease:
"Support The Health Freedom Protection Act - FDA and FTC Censorship robs the American people of health information indispensable to their exercise of freedom of choice. FDA and FTC Censorship benefits large drug companies by protecting them from competition and destroying innovation. The solution lies in a new law, one that will strip FDA and FTC of their censorship powers."
Bottom of the page - http://www.silver-colloids.com/Reports/reports.html

Then Wikipedia adds momentum to my skepticism:

"From approximately 1990, especially with the emerging problem of antibiotic resistance [2], there has been a resurgence of the promotion of colloidal silver as an alternative medicine treatment, marketed with claims that it can prevent or treat numerous diseases.[9] In vitro evidence of an antimicrobial effect of colloidal silver is mixed; some studies have found it to lack any antibacterial effect,[10] while others have reported colloidal solutions of 5-30ppm as being effective against staph and e.coli[11][12] There are no clinical trials showing that any preparation of colloidal silver is effective in vivo.[1]

Colloidal silver products are legally available at health food stores in the United States and Australia and are marketed over the Internet as a dietary supplement. It is illegal in the U.S. and Australia for marketers to make claims of medical effectiveness for colloidal silver, but some websites still list its use for the prevention of colds and flu, and the treatment of more serious conditions such as diabetes, cancer, chronic fatigue syndrome, HIV/AIDS, and tuberculosis, among other diseases.[13][14] There is no medical evidence that colloidal silver is effective for any of these claimed indications.[15][16] Silver is not an essential mineral in humans; there is no dietary requirement for silver, and no such thing as a silver "deficiency".[1]

Currently, there are no evidence-based medical uses for ingested colloidal silver. There are no clinical studies in humans demonstrating effectiveness, and several reports of toxicity.[3] The U.S. National Center for Complementary and Alternative Medicine has issued an advisory indicating that the marketing claims made about colloidal silver are scientifically unsupported, and that the silver content of marketed supplements varies widely and can pose risks to the consumer.[1]" http://en.wikipedia.org/wiki/Colloidal_silver

Well, lets just say I wont be buying any of that sh!t just yet!
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Mefiante
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« Reply #19 on: August 28, 2009, 10:56:28 AM »

The reason why the overuse of antibiotics is detrimental becomes clear when one considers what it takes to get a new drug to market.  The financial investment (time, expertise, technology) by the large pharmaceutical companies is considerable, as are the scientific, social, safety and legal requirements and hurdles that need to be met and overcome.  Needless to add, drug companies are not in the business of altruism; they are primarily in the business of making money for their shareholders, however unpalatable some might find that reality.  I mean, there’s something a little sordid and jaded about making money off the illness or debility of another, isn’t there?

Antibiotic overuse (and not completing a course of antibiotics) not only promotes but also accelerates the emergence of ever more resistant bacteria, and this acceleration cannot be adequately countered with the usual timeframes and strictures involved in drug development.  Thus, it is to everyone’s benefit if the inadvertent culturing of superbugs is delayed for as long as possible.  In this regard, the case of tuberculosis is instructive: how many people in Africa and Asia will prematurely die of MDR or XDR TB strains because there is presently no drug available to combat a disease that had not long ago been thought virtually eradicated?

One also needs to ask how much one wants to pay for effective medicines, assuming that they are available in the first place.  The drug development lead-time and cost are clearly factors here, as are the useful lifetime of the antibiotic and economy-of-scale considerations.  An antibiotic that can remain on the shelves longer can be manufactured more cheaply in greater quantity, and consequently sold at lower cost, which can be even further reduced because the recoupment period can be extended.  Moreover, a longer-lived drug frees up research resources to investigate the varieties of superbug that an antibiotic might lead to, and so to begin early with pre-emptive development of appropriate medicines.

The bottom line is that antibiotic overuse is greatly aggravated by severely delayed reaction in bringing about new drugs and also because in this context drug development is presently reactive rather than proactive.

'Luthon64
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