By Mary R. Anderlik
Health Law & Policy Institute
Often, progress has a price. To borrow a phrase from Edward Tenner, "things bite back." In the realm of computing, we have the Y2K bug. In the realm of medicine, we have superbugs—multi-drug resistant bacteria. While evidence of the problem is growing, policy solutions remain elusive.
Consider the following:
One seemingly simple fix is to speed up the development and approval of new drugs for treating bacterial infections. There is some cause for optimism. On September 21, 1999, the Food and Drug Administration gave fast-track approval to Synercid, a drug effective in treating about 50% of patients with the vancomycin-resistant strain of the enterococcus bacterium. Synercid may also serve as an illustration of the weakness of this strategy: Synercid is a chemical cousin of a common agricultural food additive, and the development of strains of bacteria resistant to Synercid is likely to be rapid.
Another possible policy response is to emphasize prevention. We could have more intensive—and intrusive—regulation of antibiotic use. In the health care context, any attempts at "bureaucratic micromanagement" of prescribing would surely meet with strong resistance. The fallback is always education. Studies of doctors (typically pediatricians) reveal that many attribute overprescription of antibiotics to pressure from patients or parents of patients. But blame can surely be shared; doctors may do little to educate patients (parents) concerning the viral-bacterial distinction or the dangers associated with antibiotic use. These considerations suggest that an effective educational strategy would focus on increasing doctors’ knowledge of the dimensions of the public health problem, and of the importance of allocating precious clinical time to patient and parent education, while seeking to raise the level of awareness of the public at large. At a minimum, a broad-based public information campaign should make people more receptive to explanations from their doctors when they receive them and as ready to challenge a quick prescription as they are to demand one.