Treating Sam’s Bronchitis While Ignoring His Principles of Health Care Reform

Dreary_snow_Feb2015February is one of the dreariest months of the year for those of us trying to embrace a northern climate. This year, the bleakest month has been belabored by more snow, wind, and cold in the Northeast than has been recorded for decades. For my own part, a case of flu and subsequent bronchitis has put me in and out of bed for nearly two weeks. I am ready for March.

Disease creates an interesting tension

In fact, the microcosm of a comparatively small, mundane illness (the flu) mirrors the macrocosm of resistance to health care reform. We are so conditioned to believe that “medicine” is the answer, or that “medicines” are the answer, that we cannot see the truth. When we are sick, we cannot see the forest for the trees.

Take acute bronchitis as an example. This is an illness that frequently accompanies another upper respiratory infection (URI), be it a simple cold or the actual flu. In the case of the flu, the debility of malaise and body aches (myalgia) is depressing enough. Add the hacking cough of acute bronchitis and the result is frustration for both the patient (me) and the caretaker (Debbie).

Stop coughing.

I am not trying to cough, I can’t help it.

Stop trying to clear your throat.

I am gagging.

Stop.

Antibiotics are over prescribed

One of the great failures of medicine over the last 70 years is the explosive, extensive and excessive use of antibiotics for URIs. We doctors have conditioned the public to expect an antibiotic at the end of an office visit even when most of the infections are viral.

Viruses are not responsive to antibiotic therapy. They must run their course. We have conspired to rationalize the treatment as “preventing pneumonia,” “clearing up a secondary bacterial infection” or the like when one of the primary motivations is to move the patient out of the office and to give them some hope to deal with the frustration of waxing and waning symptoms. We all have come to believe in hope over science.

Yet all the science related to acute bronchitis finds minimal to no evidence of benefit with antibiotics. A 2014 meta-analysis of 17 randomized studies of antibiotics for acute bronchitis revealed that the cough was reduced by 12 hours for the antibiotic treated group.

This means that if the average cough duration was 12 days for the placebo group, the antibiotic group coughed 11½ days. In return for the 12-hour reprieve the antibiotic group had side effects of nausea, vomiting, diarrhea, headache, rash or vaginitis in 1.5% of recipients.

Another large study noted that antibiotics can decrease the risk of subsequent pneumonia in patients with acute bronchitis who are 65 years old or older. But the conclusion was that 39 patients must be treated with antibiotics to prevent one case of pneumonia.

The negative side effects of antibiotics

Yet another negative side effect of antibiotics is antibiotic-induced colitis (an inflamed colon). This presents as bloody diarrhea. It can be fatal. I cannot begin to describe how many patients I cared for with this condition over the years of my practice. It is a particularly frustrating condition to deal with when it didn’t have to happen. In other words, the indication for the inciting antibiotics was weak. Clearly, my experiences with this illness have influenced my anti-antibiotic perspective.

But I’ve been sick for 10 days…

So, where am I now? I am in my tenth day of debilitating symptoms and heated philosophical debate with my caretaker. After a few days of possible improvement I have had two days of relapsing cough and congestion. Intellectually, I am without clinical signs of bacterial super-infection but emotionally I am at my wit’s end. Even I have begun to believe in hope over science. I am closing in on 65 years of age. Might I be the 39th person on antibiotics who forestalls a case of pneumonia?

March seems to be a long way off.

And I have travel plans. I must get better.

I’m succumbing to the hype

But isn’t this one of the fundamental problems in our health care system? At every level we would rather believe the hype than live the science. We would rather believe that technology is a panacea when study after study shows exponential cost with minimal, linear benefit.

We would rather believe the Big Pharma exaggerations than recognize the adequacy of generic medications. We would rather believe that Dr. Oz holds the secrets to our health than recognize most of what he promotes is unsubstantiated and much of what he says is scientifically inaccurate.

I am too tired and sick to stand up for science. I am calling for antibiotics ASAP.

Postscript

It is now two days later. I am feeling slightly better. Although it is snowing again outside my window, I believe I am on the mend. Antibiotics or not, things are looking up.

Coincidence? Just saying…

Photo: the view from our back door snapped by Debbie

8 Responses to Treating Sam’s Bronchitis While Ignoring His Principles of Health Care Reform

  1. Andy Franklin February 20, 2015 at 10:23 pm #

    Let me tell you a story. In January 2014 I went to Austria with friends for hot air ballooning and skiing. Before leaving, I started to get a cough and from previous experience, believed there was a chance it could turn into bronchitis. As a preventative measure, I asked my doctor for a Z-pack (antibiotic) in case I needed it. After arriving in Austria, it did turn in into bronchitis so I took the Z-pack thinking that would cure me in a day or two. I was still hacking and coughing continuously a week later, when I finally went to an Austrian clinic. They sent me away with an inhaler (probably a steroid) and some pills that fizzed when dropped in water (something like Alka Selzer) and I was cured in two days. Did the disease just run its course or was I cured by the medicine? I personally think the inhaler did the trick. No antibiotic needed. Coincidence? I’m just saying…

    • Sam February 21, 2015 at 9:44 am #

      Andy, thank you for proving my point – or not. I thought that the bronchodilator helped me but the science on the subject indicates it does no measurable good. Go figure.

      Appreciating good health, Sam

  2. Your Kid February 21, 2015 at 5:26 am #

    I got bronchitis in December which started out as some VA special URI viral influenza fever sore throat torture that then settled into a disgusting bronchitis and coughed for two weeks. I think I was making patients uncomfortable. I put myself on a steroid inhaler. It didn’t help. I told you and you didn’t care. Which was somewhat reassuring and the usual amount of irritating. An intern wanted to prescribe me a z-pack and I said don’t be silly. This is viral. I just need to sleep. By day 14, I couldn’t take it any more and I let the intern prescribe me the antibiotics. I felt 80% better in 24 hrs! I told everyone about these magic pills and they laughed at me. But then a chief whispered conspiratorially: “you should have gotten antibiotics a week ago, you idiot.” Go figure.

    • Sam February 21, 2015 at 9:58 am #

      Dear Kid, thank you, too, for proving my point – or not. I wish I had listened. My reading of the scientific literature is that acute bronchitis is a lose-lose situation. Maybe there is a surgical cure to be found. Glad you are better despite me. Your Dad

  3. Peter Smith February 21, 2015 at 9:12 am #

    Sam,

    There is a simpler approach. Just listen to what Debbie says and make sure she is smiling.

    Wishing you both well.

    Peter

    • Debbie Weil February 21, 2015 at 9:51 am #

      Peter,

      Ha! If only. When Sam the doctor and Sam the patient are at war, it is a messy business. He does not listen to me. Nor to his physician daughters. Hope you’re weathering the snow in Boston.

      Debbie

  4. Nancy February 21, 2015 at 1:08 pm #

    Sam, you are only feeling better because when you look out the window, it is Debbie you see shoveling the infernal snow and you are not the one doing it. As someone who is allergic to any antibiotic I take a second time, and by now I’ve run through most of them, I find that moving enough to heat up the body to melt the crap seems to work the best. A little stationary biking or yoga or Pilates does wonders. Short term more coughing but long term seems to help. This is of course at the other end of the “what doctors don’t want to hear” spectrum. Hope you’re feeling better soon, travel is the first priority!

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