Antibiotic Resistance: Cultural Issue not Medical Science

We must tackle a cultural problem around overuse of antibiotics.

It doesn’t matter whether we keep coming up with antibiotics: we simply breed for the most drug resistant pathogens by increasing the selective pressure in bacteria. We do this by over-prescribing antibiotics.

But wait. This isn’t necessarily about getting doctors to stop over-prescribing antibiotics. If it were that simple….

When a patient comes in complaining of what a physician judge to be “a cold”, the physician may very well tell the patient, “Go home, sip lots of hot tea and chicken soup, get plenty of rest, and take some decongestant for the symptoms.”

Then that patient says, “But I waited in your damn office for 45 minutes! You’d better get me SOMETHING.”

In other words, the patient EXPECTS the doctor to write a prescription for what the patient perceives to be “more than just” a cold.

If that doctor tries to educate the patient on the broader consequences of antibiotic overuse, the patient may very well continue to demand (DEMAND!) that the doctor write a prescription for an antibiotic (yes, here in the U.S. many patients aren’t afraid to tell doctor what they want prescriptions for). If that doctor refuses, the patient simply goes to another doctor, who is willing to write the prescription.

So I don’t care if we come up with nth generation macrolide / cephalosporin or we engineer a quinolone that won’t cause such serious adverse events that half of the drugs in that class has been pulled off the shelf…

I don’t care if we start ‘designing’ antibiotics that overcome a microbe’s awesome drug-effluxing receptors…

it is only a matter of time that we create enough selective pressure for a bug to breed and mutate into a superbug that not only will clip whatever enzyme an antibiotic uses to disable the superbug’s replication system but will pump and dump that antibiotic faster than you can say “vancomycin”.

The most important thing we can do is to curb society’s demand for antibiotics for conditions that does not warrant antibiotics, and hope that pharmaceutical sciences can catch up with the superbugs.

Sibling Aggression is Bullying and not Benign

A new study that will be published in the July 2012 issue of Pediatrics suggest that bullying is bullying, no matter whether it came from a brother or sister – versus another peer.

I’d be interested to see the actual data on this (I don’t get this without an expensive subscription) — I wonder if the distress may be even more when the bullying behavior comes from a sibling because a child would trust that his own brother or sister would not hurt him as he may expect a stranger.

This study is making headlines all over Google this week.

Association of Sibling Aggression With Child and Adolescent Mental Health

Corinna Jenkins Tucker, PhDa,
David Finkelhor, PhDb,
Heather Turner, PhDb, and
Anne Shattuck, MAb

+ Author Affiliations

aDepartment of Family Studies, and
bSociology Department, University of New Hampshire, Durham, New Hampshire

Abstract

OBJECTIVE: Sibling aggression is common but often dismissed as benign. We examine whether being a victim of various forms of sibling aggression is associated with children’s and adolescents’ mental health distress. We also contrast the consequences of sibling versus peer aggression for children’s and adolescents’ mental health.

METHODS: We analyzed a national probability sample (n = 3599) that included telephone interviews about past year victimizations conducted with youth aged 10 to 17 or an adult caregiver concerning children aged 0 to 9.

RESULTS: Children ages 0 to 9 and youth ages 10 to 17 who experienced sibling aggression in the past year (ie, psychological, property, mild or severe physical assault), reported greater mental health distress. Children ages 0 to 9 showed greater mental health distress than did youth aged 10 to 17 in the case of mild physical assault, but they did not differ for the other types of sibling aggression. Comparison of sibling versus peer aggression generally showed that sibling and peer aggression independently and uniquely predicted worsened mental health.

CONCLUSIONS: The possible importance of sibling aggression for children’s and adolescents’ mental health should not be dismissed. The mobilization to prevent and stop peer victimization and bullying should expand to encompass sibling aggression as well.