Medical Science Develops Harmful Products

It’s always convenient to have somebody else to blame, but I’m afraid that doctors are mostly to blame on this one.   They call them “hospital acquired infections” and they are killing patients who should otherwise be just fine.

Like this writer’s father, who walked into a ritzy New York academic hospital with what used to be called “walking pneumonia.”  He went on to die of – you guessed it – a “hospital acquired infection.”

Walking pneumonia is basically an infection of the lungs that may cause a cough — or even a painful cough — and makes it hard to breathe. Typically, it does not hurt the patient’s general well being enough to make her or him an invalid, a hospital inpatient, or certainly not an intensive care inpatient. This guy’s dad should have easily made it home.

I remember my bacteriology professor – “Big Sister Jeannie” — with affection and the deepest of respect.  She taught us, “Whenever you prescribe an antibiotic, you are not just treating your patient.  You are treating the entire globe.”

What she meant was that every antibiotic treatment that was effective would create bacteria that were resistant to that treatment. That meant the worst and hardest to treat bacteria of all the world would be those in — hospitals.  They would be harder to treat, for they had been exposed to the most antibiotics and resistances.

I remember being young, still mostly pre-clinical, and very impressionable when I asked Big Sister Jeannie how we could get out of this mess.  I thought maybe by disinfecting the walls.  When I heard her answer, I was shaking a little and started to cry.  Because I knew then that if Big Sister Jeannie was right — and she always was — there was no way to get out of this.

There was no way to get out of this?  The drug reps would come and tell us about newer and scarier “generations” of antibiotics.  And of course, there would be more generations of bacteria that were craftier than we were smart.  There would always be some bacteria around that were naturally resistant.  They would live and the others would die. It’s called “natural selection.”

But it was our fault, too, as doctors.  Wait, our fault?

In France then, there were plenty of people alive who remembered the introduction of antibiotics to the public after WWII.  More people were generally seen by doctors for minor than major things.  Someone might have influenza, for example, with a fever and cough and whatever bodily symptoms.  If they were given antibiotics, patients were happy.  Oh, how joyous to get a miracle drug!  It meant the doctor was not only competent, but up to date and using the best and latest treatment.  The patient would sing the doctor’s praises and return with the next cold.  Then they would speak well to a neighbor, and the practice and the income would grow.

There was only one problem.  Most “flu” type symptoms are caused by viruses, not bacteria.  And they are likely benign viruses — viruses that would not live very long in the body and would just go away on their own.  They don’t really need any help from antibiotics.

About the only things that antibiotics are doing in this kind of very common and mostly harmless situation is creating resistances.  What this means is that it will become harder to use them later — when it is actually necessary to do so to get rid of a bacterium that is causing real sickness and maybe even death.

Hospital acquired infections seem to cause about 100,000 deaths every single year.  Mostly of people like the father of the writer who told the tale above.  People like him who are ambulatory when they enter a hospital for treatment, and acquire the infection that will kill them while in the hospital.

In general, the number of people who die annually in American hospitals because of either medical error or a condition acquired or caused by that hospital is about 250,000.

The best way I have found to understand what that number means is to realize it approximates the number of people who died at Hiroshima and Nagasaki as a result of atomic bombs.  But that happened in just one year.  Those same numbers of deaths occur in American hospitals at about that rate – every single year.

When I was but a medical student grappling with bacteriology in the Somme Valley of Northern France, we had pre-WWII buildings as part of the hospital campus.  Ancient and picturesque brick buildings with concrete labels in what seemed to me like art deco lettering.  Those most concerned about hospital acquired infections seemed relieved when talking about tearing them down.  The bacteria had probably colonized plumbing and air ducts and the walls and God knew what. They were starting to tear them down and build a new hospital center when I left.  They wanted to prevent the problem from occurring again.  But I do not think anyone – then or now — knows exactly how.

There are different factors at play here.  One is the doctor, who even in France’s alleged socialized medicine had often chosen the profession for the freedom of “exercise libre” or “free practice.”  He or she could set up as a generalist anywhere there was enough traffic to make a living. There was still enough of an older generation around that the doctor’s family would be a kind of minor aristocracy– along with lawyers, politicians, notaries, and the more lovable and community-conscious businessmen.

One young and handsome father of two preschoolers with a fashionable and somewhat aristocratic wife told me, “You need them to think you are smart and trust you and think you care.  You need them to bond with you and respect you and send their families and neighbors.  There is always competition, always a large city with a university, but you need to make them be your practice in the community you share, to keep your wife in nice dresses and send your kids to nice schools.”

I do not think an American general physician would have spoken any differently at all.  He gave antibiotics for the flu.

I was surprised to learn – but probably shouldn’t have been – that doctors and their associations have not traditionally been friends of health care reform.  Some say it is because we want social status and fear losing it with insurance and populist movements to improve health.  I don’t think we have ever been politically active.  Me, I am good at pushing molecules around people’s bodies. But moving about society is harder.

So I was near tears and worrying about the fate of the world and hoping Big Sister Jeannie would have an answer.  She came up with a real shocker.

“It’s not that hard.  For one thing, doctors could wash their hands.”

She said that getting doctors to wash their hands was nearly impossible, but would help a lot.

I have been fairly compulsive about washing mine. I will admit I am imperfect in such habits, especially since I wear a lot of rings on my hands.  But modern disinfectants ought to have made this a bit easier, for me and others.

The article cited above references a hand washing protocol for doctors — wildly effective but apparently too quickly abandoned.  People seem to need the same lesson taught over and over again.  Acquired knowledge seems to keep disappearing.

Even Oliver Wendell Holmes, famous Boston physician, published something relevant at the close of the nineteenth century.  He said that puerperal fever — the horrible childbirth infection of that time and place — could be well nigh eradicated with physicians’ hand washing.

Why would a doctor seem to avoid so simple a rule that could help so many?  For one, giving antibiotics for the flu to keep the patients that will put your kids through college — that one is easy.  But why do doctors just keep forgetting to wash their hands?

Some people call medicine a “pseudoscience” because too few decisions can be made on cold, hard facts.  It has been estimated that most are made on not over 70% of facts.  Areas are not amenable to biopsies, patients lie, and patients are human.  You never seem to get all you need and you all too often go on some kind of “gut” reaction — something too subtle to cerebrate clearly.  You have to rely on ego at least somewhat to do this job.  I think this makes it easier, but some think they are God.

Whatever gets you through the day, I guess.  And maybe whatever gets you through the day may be the same thing that makes you feel you are above washing your hands.