(Extraído de guardian.co.uk)
The overprescribing of antibiotics by under-pressure GPs to a public convinced they cure colds could prove fatal in the long run
by Andrew Brown
A recent survey found that 97% of people who asked their doctor for an antibiotic last year were given one. Photograph: Alamy
The news that doctors are under pressure to prescribe antibiotics for colds and flu offers a tremendous opportunity to make complementary medicine work for us all. The Health Protection Agency has just released a survey showing that antibiotics are overprescribed because the public believes they will cure colds and flu.
The problem with antibiotics for colds and flu is not just that they don't work. If that were all, they would be only a waste of money. But the long-term danger is that they will spread antibiotic resistance, which really would kill very large numbers of people. The spread of organisms like MSRA in inadequately cleaned hospitals could lead us back to the state that prevailed for most of history, where a hospital was where you went to die, not to get well. A European report reckons that antibiotic resistance could soon cost €1.5bn to combat.
The view we have today that medicine works the way that magic ought to is pretty new. The expectation that doctors will cure us has only really taken root in the last 50 years, and although it is often wonderfully well-justified, it brings its own problems. A huge amount of any GP's time is taken up with people who are unhappy and perhaps unwell, but for whom no medicine exists.
Yet people expect health, and demand it. So they demand antibiotics, which are understood as a magic medicine. And, when you take them, your cold goes away, as it would anyway. It's obvious that some doctors, with 10 minutes a patient, are crumbling under the pressure to overprescribe. According to the HPA survey, 97% of the people who asked their doctor for an antibiotic last year were given one. We are heading for a classic tragedy of the commons.
What is to be done? One solution is to send patients away empty-handed. The HPA says that patients should be educated to understand that antibiotics don't work against viral diseases like colds and influenza. But that's not working and it's not going to work. The ignorance of the public will remain immovable. The answer requires a little creative thinking. So let's give up efforts to defeat the ignorance and tendency to magical thinking, and take advantage of it instead.
Let us invent a class of medicines called "antivirotics". They will need to be quite heavily marketed as a breakthrough in the treatment of common inconveniences: the kind of medicines that work when Lemsip is helpless. They will only be available on prescription, so that we know they are dangerously powerful.
They will work at least as well as antibiotics on colds and flu, as the marketing will make abundantly clear. They could, like vitamin supplements, be specially formulated for men and women, and come in different sizes and packaging for different ages. They would be absolutely free of side-effects.
But they would work. In an ideal world, the NHS would get through millions of them every year. And when you think of it, the government would hardly need to do anything. The private sector could handle all the marketing and public education campaigns, providing it could make a profit from these antivirotics.
They would, of course, be placebos. The main ingredients would be sugar and flavouring: the active ingredient would be the patient's trust. They would work solely because people believed in them. But they would work. Colds would clear up more quickly, and flus would miraculously change into a heavy cold. They would save money, since antibiotics are expensive; and they would save lives, since the abuse of antibiotics is in the long run quite literally lethal.
This is ethically interesting because it's clearly a case where it is right to deceive people and wrong to tell them the truth. This is, I think, true in almost any system of ethics. For if you tell the patient that you are giving them a powerful medicine for a complaint which will clear up by itself, then you are in fact telling the truth.
Of course, no government would seriously consider doing what I propose. The large-scale deception of the public is only thought necessary in wars or economic crises. But I can't for the life of me see why. If the art of politics consists of making our vices work virtuously together, antivirotics are a political masterstroke – and they may soon be the only advances in healthcare that any European country can afford.