Physicians Reportedly often Ignore Evidence-Based Clinical Practice Guidelines — For Example, Even When the Continued Efficacy of Antibiotics Is Partially at Stake

21 May 2014

Physicians, surgeons, bankers, and hedge fund managers belong to an elite group of the upper crust — which we pretty much allow to do whatever it wants, even when their doings demonstrably harm society

Consider this insight from the Journal of the American Medical Association:

For more than 40 years, trials have shown that antibiotics are not effective for acute bronchitis.

Despite this, between 1980 and 1999, the rate of antibiotic prescribing for acute bronchitis was between 60% and 80% in the United States.

During the past 15 years, the Centers for Disease Control and Prevention (CDC) has led efforts to decrease antibiotic prescribing for acute bronchitis.

Since 2005, a Healthcare Effectiveness Data and Information Set (HEDIS) measure has stated that the antibiotic prescribing rate for acute bronchitis should be zero.

© 2014 Michael L. Barnett and Jeffrey A. Linder, Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010, JAMA 311 (19): 2020-2022, DOI:10.1001/jama.2013.286141 (21 May 2014) (at Summary) (paragraph split)

In more detail, from USA Today:

The researchers reviewed records of 3,153 visits to doctors' offices and emergency rooms for acute bronchitis between 1996 and 2010. They included only adults who were otherwise healthy, not those with immune deficiencies, cancer, lung disease or other conditions that might complicate decision-making.

Result:

An average of 71% got antibiotics and, after a possible dip in 1999-2001, the rate appeared to rise a bit over time. The numbers sampled in each time period were too small to produce firm year-by-year estimates, but the trend is clear, Linder says:

"There's all this effort, but we're not moving the needle at all."

That failure reflects a larger problem, Linder and other researchers say:

Patients keep demanding and doctors keep prescribing antibiotics for problems they can't cure.

As a result, patients suffer unnecessary side effects, such as diarrhea and allergic reactions, and they play a part in the development and spread of germs that no longer respond to over-used antibiotics.

The moral? — When we put self-interested Establishments on pedestals, they abuse authority and privilege

Medicine is among the most interpersonally arrogant of professional establishments. Consequently, one would think that society would be justified in expecting the Hippocratic Group to exhibit a corresponding willingness to confront ignorant patients in the name of fulfilling the greater public interest. But it is evidently easier for the reported majority of doctors to:

(a) dole out bacteria-killing or inhibiting pills under harmful circumstances

and simultaneously

(b) hope that — when the pre-antibiotic era returns — these same degree-toting folk will be safe inside filtered neighborhoods and far from the hopelessly disease-ridden masses.

Agriculture, another entrenched Establishment sector, is no better with regard to its own vastly more extensive misuse of antibiotics.

Cynics can be forgiven for laughing.

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Physicians Reportedly often Ignore Evidence-Based Clinical Practice Guidelines — For Example, Even When the Continued Efficacy of Antibiotics Is Partially at Stake