Freakonomics M.D. Podcast: Why Doctors Prescribe So Many Antibiotics?

 

This week's Freakonomics M.D. podcast episode asks a provocative question: "Doctors Know They Prescribe Too Many Antibiotics. Why Don’t They Stop?"

Antibiotics save lives. There's no question about that. But what happens when we use them too much? 

Too often, patients demand "medicine" from the doctor and advice about taking over-the-counter medications seems inadequate to many. Of course, taking an antibiotic can be a self-fulfilling prophecy, since the patient will eventually get better from a viral infection and attribute recovery to the antibiotics. 

Moreover, antibiotic resistance is a significant threat now, when modern medicine has few tools to battle antibiotic-resistant bacteria.

Taking antibiotics can also have serious side effects, including the good bacteria in a patient's microbiome. Clostridium difficile colitis results from disruption of normal healthy bacteria in the colon, often from antibiotics. C. difficile can also be transmitted from person to person by spores. It can cause severe damage to the colon and even be fatal.

Symptoms include diarrhea, belly pain, and fever. Treatment includes antibiotics. Even when treated with antibiotics, the infection may come back. In rare cases, fecal transplant or surgery may be needed.

Host Dr. Bapu Jena investigates how changing physician behavior could help prevent a major public health disaster, with help from Jeffrey Linder, chief of general internal medicine at Northwestern University Feinberg School of Medicine.

Among other things, they discuss a new study Dr. Jena co-authored, which looked at patients who had gone to urgent care facilities for an upper respiratory infection. Patients who had seen an urgent care provider who had a high rate of antibiotic prescribing were, a year later, more likely to then go back to seek care for an upper respiratory infection again. "It’s sort of this confirmation bias that a patient goes to see a doctor, they happen to walk out with an antibiotic," Dr. Jena explains. "They get better, and when they look back, they might attribute their improvement to the antibiotic, whereas they would’ve just gotten better anyway. And so it creates this sort of self-fulfilling prophecy."

Listen to the episode now at freakonomics.com or wherever you get podcasts.