Every time I look up something related to medicine it seems that the folks who call themselves “scientists” have reversed their previous conclusions. Americans have been told to finish every course of prescribed antibiotics, for example, contradicting the common sense idea to stop ingesting pills once you’re perfectly healthy.
Here’s a Discover Magazine article from 2014 confirming the common sense perspective and referring to published medical research papers as “science.” Here’s another one from The Guardian, reporting on a paper from Australia.
Related:
Well, bacteria type, infection location, and unknown numbers of individual factors probably mean the ideal course is somewhere between “feeling better” and typically regimen. Feeling better Infection free — where is the ideal?
I’ve been reading you for a long time, so I know you aren’t claiming, ala Jenny McCarthy, that personal intuition is superior to evidence-based science. And I’m confident you would acknowledge that “best available science” is always provisional and subject to revision. So, honestly I’m a little lost. What exactly is the gripe here?
When I was a kid, my mother, a public health nurse, would not let me and my brothers go swimming for 40 minutes after eating because, “scientists knew” that this would lead to debilitating cramps and we would drown. Forty years later, I read that scientists discovered that this was not true, that swimming after eating does not cause cramps and does not put you in danger of drowning. So much for all that staying out of the water.
The gripe is that how do they get away with this stuff? How did they come up with the forty minute rule in the first place? You get the feeling that public health recommendations are made by people in white coats who just sit around making stuff up.
Read Gary Taubes on the (non-existent) evidence behind most scientific nutritional recommendations. “Drink 8 glasses of water a day?” Somebody else made that one up. Its remarkable how many mainstream health recommendations are not based on science.
RobF: What is the gripe? Modern antibiotics go back about 70 years. It doesn’t bother me that doctors can’t figure out how to use these drugs. But if the drugs haven’t changed and human physiological hasn’t changed, if one calls the people who can’t figure out how to use these drugs “scientists” this will result in a lot of public skepticism regarding “scientific” statements and conclusions.
See also: the 60 Minutes report “Treating Depression: Is There a Placebo Effect?”
http://www.cbsnews.com/news/treating-depression-is-there-a-placebo-effect/
The report suggest anti-depressants (a $15B cash cow) are largely useless, and the drug approval process not nearly as rigorous as we believe.
The logic is that unless you kill 100% of the bacteria the most antibiotic resistant ones will survive and make a comeback and the antibiotic will become worthless. Even if this is not true it makes sense.
The FDA just announced a ban on trans-fats. 30 years ago, all of the experts were telling us to eat trans-fats instead of eggs and butter.
Medical science has a poor track record.
The theory was that the antibiotics would kill the least antibiotic resistant bacteria first, so if you stopped after a few days when 99% of the bacteria were dead (and you were feeling better because most of the infection was gone), then the remaining bacteria might make a comeback and it would be worse the 2nd time (and from those you spread the infection to) because these would be the ones that were most antibiotic resistant. Not taking the full course was like setting up a breeding experiment for antibiotic resistance. You were supposed to take the full course so that you could be sure that 100% of the bacteria were dead, even the most resistant ones. I assume what happens in real life is that once the antibiotics have killed or weakened most of the bacteria, your immune system then takes care of the rest (assuming your immune system is in good working order).
Food-science, nutrition and fitness, in particular have a terrible track record regarding it’s “scientific claims”. Fats, salt, wine, cholesterol, etc. Seems every decade we revers the previous decade’s consensus.
Regarding the antibiotic course length, there is no doubt that the shorter the presence of the antibiotic agent, the lower the risk of mutagenesis and hence resistance. However, you need an sufficient time to kill off the bacterial agent. It does not shock me that we improve and refine the optimal timing for these things, especially when we learn more about the side effects of these treatments.
I can’t find the reference now but I’ve read that only 2% of medical of medical decisions are based only gold standard scientific studies.
I’m a regular reader of https://www.sciencebasedmedicine.org/
Ben Goldacre’s Bad Pharma is a good read https://en.m.wikipedia.org/wiki/Bad_Pharma
Phil, this kind of snark is unworthy of you.
As you mentioned, antibiotics are a very new thing, only dating back to the 1920s or so. It’s not surprising that over the course of less than a human lifetime we’ve learned a few things.
It took hundreds or thousands of years for humanity to learn things like “riding a horse is easier with stirrups” or “the earth revolves around the sun, rather than the reverse.” I think we can cut medical science a little slack given the tremendous advances it has made in the 20th century.
In the 1920s it was not known that bacteria can exchange genes with one another. People back then didn’t even know what a gene was, physically speaking… DNA had not been discovered and wouldn’t be until the 1950s. The idea that different species of bacteria could exchange genes would have seemed outlandish.
If you don’t know that different species of bacteria can exchange antibiotic resistance genes, then there is (apparently) no reason not to just use the longer course of treatment. Even if you create resistance in some other strain of bacteria, the thinking was, the resistance can’t spread to a different species.
It’s also not entirely clear to me that erring on the side of longer courses of antibiotic treatment is worse than erring on the side of shorter courses. It only takes a few people to have a relapse after taking a shorter course of treatment to dramatically increase the antibiotic resistance of the pathogen. The pathway from shorter courses of antibiotics to drug resistance seems “shorter” in some sense than the pathway from longer courses, since it doesn’t involve a hop through another species of bacterium.
Brian Gulino: “When I was a kid, my mother, a public health nurse, would not let me and my brothers go swimming for 40 minutes after eating because, “scientists knew” that this would lead to debilitating cramps and we would drown.”
Did scientists actually make this claim?
Philg: “Every time I look up something related to medicine it seems that the folks who call themselves “scientists” have reversed their previous conclusions. Americans have been told to finish every course of prescribed antibiotics, for example, contradicting the common sense idea to stop ingesting pills once you’re perfectly healthy.”
I’m not sure if you are being careless or trying to be funny. Whatever the reasons, these posts mostly sound ignorant.
* Is “feeling healthy” an accurate measurement for being “perfectly healthy”? Probably, not. Is it possible that we have better tests for being “perfectly healthy”.
* The longer courses, some of them, at least, where based on research. The shorter courses are based on additional research on more-closely defined populations, accumulated experience, observing outcomes of actual treatments (shorter courses in the first place).
* 70 years ago, the issue of antibiotic resistance wasn’t known. There was less need to tune the treatment course.
* “they’re no better than shorter courses and actually promote antibiotic resistance.” Without the issue of antibiotic resistance, maybe, a longer course makes sense.
* Is a modification of a treatment a “reversal”? Not really. No more than improvement in computers is a “reversal “.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522/ says that bacteria evolving to become resistant to an antibiotic was discovered no later than the early 1950s (i.e., more than 60 years ago).
Maybe this is simply an example of human arrogance: how was it possible that bacteria and viruses would turn out to be smarter than people?
“arrogance […] how was it possible that bacteria and viruses would turn out to be smarter than people?”
Arrogant conceptual blindness about them being smarter than people, or just ordinary misfire of Occam’s Razor by failing to anticipate how their genetics would exhibit deep weirdness lacking conspicuous parallels in what had been worked out earlier about genetics and evolutionary history of larger organisms?
See e.g. http://profiles.nlm.nih.gov/ps/retrieve/Narrative/BB/p-nid/159 “The Joshua Lederberg Papers Transduction, Plasmids, and the Foundation of Biotechnology” particularly the paragraph which begins “to their surprise”. I don’t think it was just dismissive arrogance about human superiority that led people to be surprised by such phenomena. (Antibiotic resistance being transmissible by what turned out to be persistent gene-splicing viruses baked into the DNA of a representative lab strain of bacteria, occasionally jumping out of the bacterial genome with significant chance of dragging a random chunk of nearby bacterial DNA along with them, and spreading the trait when they infectively modified the DNA some other bacterium that they later collided with.) To me that doesn’t seem like a superior trait nearly so much as it seems like a bizarre trait. It’s just a weird combination of effects, and it was not the kind of thing you would naturally expect — either as an arrogant highbrow scientist working from genetics of peas and fruit flies, or as a humbly practical farmer with some experience in breeding stuff — from experience with larger organisms.