Is The Fear Of Litigation Causing Us To Prescribe Too Many Antibiotics?

“Hey, come and look at this,” Johann Föekel, PhD, said to his senior colleague and mentor. Sebastian Lith, PhD, did not like being summoned to look at something his young microbiologist could not identify.

“Another perfunctory finding,” Lith grunted as he ambled toward the other eyepiece of the microscope. “I have never seen this before this year and now this is the 10^th one we’ve seen,” the mentor stated apologetically. 

It was the 10^th new resistant strain of bacteria their lab had identified this year and, like the others, it was resistant to almost all of the known antibiotics we have in the United States. “What should we call it?” the junior scientist asked. 

Lith paused and then said, “Let’s call it Attorniensis faecalus.”

“Really,” Föekel exclaimed with a widening smile on his face, “that’s good!”

“It is the least we can do after all that those bastards have done to us,” Lith shot back. He added with a very somber tone, “It is trial ‘science’ that has brought this whole debacle upon us.”

“When Alexander Fleming gave his Nobel Laureate acceptance speech in 1945 for his 1928 discovery of penicillin, he cautioned that the overuse and improper use of his discovery would lead to resistant forms of bacteria very quickly. Sadly, he was prophetically spot on,” Lith told his younger protégé.

Föekel pushed back from his station at the microscope, now intrigued by the history of antibiosis, and the serious misuse and misunderstandings that were passed down to the present. “Keep going,” he implored.

“Well, this was a great discovery and maybe saved more lives than anything else developed in the medical arena since that time. Think about it,” he said. Lith pulled out a relatively recent compendium on the history of microbiology and dusted it off. He carefully leafed through the pages until he found the following table:¹

“So after the development of antibiotics, you can see the dramatic effect they have had on survival for our species from certain death. In comparison, the use of aspirin or clot-busting drugs has only decreased the death rate about 3 percent,” Lith said after they both digested the data for a moment. 

Föekel headed back to the microscope and peered down at the growing culture. He reported to his mentor that by his calculation, this new strain, under optimal conditions, could replicate up to 69 billion (yes, billion with a B) times in 12 hours.

“How many have now died from these resistant strains this year?” he asked.

“Hundreds!” echoed back. “Seventy-two just from bunionectomy infections,” Lith added.

Knowing the answer to the question before he asked it, Föekel exclaimed rhetorically, “How did we get to this point? 

“I’ll tell you. Surgeons are routinely using antibiotic prophylaxis on cases that have no implants and an extremely low risk of infection. They do it because of trial ‘science.’ Poor bastards have to do it when they know it is absolutely the wrong thing to do,” Föekel continued.

“Yes siree,” Lith agreed. “Ironically, the legal system itself is contributing to a horrible negligence when it comes to appropriately prescribing antibiotics.”

Föekel quickly added, “Even the pediatricians are writing the recipes daily for the development of superbugs, knowing full well that they are perpetuating the biological scam when Little Johnny has a sore throat that is clearly viral and they write for an antibiotic because Little Johnny’s mom is demanding it. Power of the pen and the pad! And oh, what better way to shut soccer mom’s demanding mouth. Give the kid the cephalosporin. Ironically, it is probably weaker than the antimicrobial infusions in her free range chicken.”

Lith nodded in complete agreement. “Bugs are mutating faster and developing resistance, and we are making them mutate at a faster rate every year. It only took three years for resistance to show up for penicillin, and with vancomycin and erythromycin — the stalwarts — resistance started at 32 and 36 years respectively.”

Föekel jumped up and went back to the book Lith pulled off the shelf. Pounding his index finger on the page, Lith said, “Look here.” His colleague peered down at the next fact: A single bacteria can replicate itself 69 billion times in 12 hours under the right conditions. Of every 69 billion bacterial “kids” propagated, approximately 1.5 million will show signs of resistance.

“They have been roaming the planet far longer than we have,” said Lith. “In fact, they have been strutting their stuff for more than 3.5 billion years while we have only ambled about for about 4 million years. If you want to go pound for pound, all the bacteria on the planet outweigh the cumulative weight of humanity by more than double at 5x10¹⁶ metric tons. Now that is a Mike Tyson power punch of reality.”

“So what is the solution?” Föekel asked Lith. 

Lith paused and sighed. “The solution is that we must really be judicious in our use of the precious few antibiotics we have left and not use them indiscriminately because of fear of litigation, or pressure from patients who do not really know what they are ultimately incurring.”

Then Lith walked over to the cabinet behind him and pulled out a large white tube. He quickly tossed the tube to Föekel. “What is it?”

“They call it CurX™ and it is pretty incredible stuff. It is PHMB (polyhexamethylene biguanide hydrochloride) suspended in a special concoction of water molecules and petrolatum,” Lith explained.

“Hell, PHMB is in everything from cosmetics to swimming pool chemicals and has been proven to be extremely safe,” Föekel added. “Yep and it is absolutely killer against a whole bevy of nasty microorganisms ranging from Pseudomonas to fungus, which is in an extended release formulation.”

So Föekel, Lith and colleagues sat around the lab musing about why we did not use this more in medicine and surgery, and use antibiotics less. Maybe it came down to that single, most vile organism, Attorniensis faecalus, which has become endemic in the U.S.

Disclosure: This story was inspired by a lecture by Bradley Burnam, the CEO of Global Health Solutions, at the Alabama State Podiatric Medical Association meeting in Destin, Fla., last month. I have no financial interest in this company or the product CurX.

Reference

1. Gabbay F. How do we get the antibiotics we need: Opportunities and challenges poses and lessons learned from recent submissions. Presented at Drug Information Association 24^th Annual EuroMeeting, March 26-28, 2012, Copenhagen, Denmark.