While visiting with the grandchilder, I dropped down the country to have lunch with my aged [97 and rising] mother, whom we last met having eye-drops following a cataract scraping. They didn't adequately inform her that a disagreeable side effect of cataract treatment is painful sensitivity to bright sunlight and she is currently determined not have the second eye done. As we chatted over lunch, she said that she'd stopped taking one of her pharmacopoeia of daily drugs because it made her feel depressed, started it again after a week to see if the symptoms returned (a scientist, my Mum) and then 'fessed up to her Doctor. The Doc's response was a shrugged "Whatever", almost as if she was prescribing random scripts without much interest in whether they were going to work.
I've previously mentioned my own experience with medical volte-face about cholesterol and proctological prostate palpitation PPP. The most striking aspect of these interactions is the bare-faced certainty with which the medicos held their contradictory positions. Okay okay, they aren't flip-flopping day to day but nevertheless they pushed out a clear message that would be brooked only at great risk to the patient and later said exactly the opposite with equal confidence.
Now let's go back 75 years to Spring of 1941. Florey, Chain and Heatley [prev] were doing some methodical mouse studies on the efficacy of penicillin in killing pathogens when Albert Alexander presented in the Radcliffe Infirmary with a horrific septic head which ultimately derived from scratching his face with a rose-thorn. Florey and co. were persuaded to treat the unfortunate man; but scaling up the dose appropriate for a 20g mouse to an 80,000g police constable used up their entire stock of penicillin. Despite recovering the active principle for PC Alexander's urine, and despite a remarkable ebb in his adverse symptoms, a four day course was all that could be offered and the gallant policeman died [horribly] five weeks after first treatment. Florey's team undertook to increase their production of the potential wonder-drug but also decided to treat only critically ill children in their clinical trials because they were less massive.
The devastation felt by the clinical team from the relapse after the almost miraculous recovery developed into the medical practice of completing the course of any antibiotic therapy. Failing to complete the prescribed course not only put the treated patient at risk; it also put the whole population and succeeding generations at risk because stopping early promoted antibiotic resistance about which I have sobbed and warned and railed. Well a new analysis in the BMJ has looked with extreme skepticism at this medical shibboleth. They find that there is no evidence that completing the course always leads to better outcomes than stopping when you-the-patient feel better. Me-the-patient may well require a different time-course to you because I am genetically different and my strain of pathogen is definitely different to yours; unless we have eaten from the same bag of dodgy chicken goujons. The usual suspects are, and I quote "The clinical threat comes mainly from species such as Escherichia coli and the so called ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp, Pseudomonas spp, Enterobacter spp), which are all found harmlessly in us, on us, or in our environment".
The WHO is updating their advice about antibiotic use and I guess we'll have a different message when Antibiotic Awareness Day 2017 comes round again in November. All the British broadsheets are tooting the failure of medical science to live up to its key evidence-based precepts: Independent - Telegraph - Guardian. There has been some push-back from the medical profession including the UK's Chief Medical Officer Sally Davies [previes]: "The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them." Commentator George Dvorsky at Gizmodo/io9 got all hot and bothered at the notion of change, asserting fair-enoughly that changing current practice isn't really evidence-based either until more research is carried out. Shockingly, there has been no research on the most effective time-course for treatment for most conditions treated by antibiotics: the profession has been too busy chipping 7 days or 14 days into stone tablets to hand out with the colourful tablets that you pick up at the pharmacy.