Today we docs have some powerful prescriptions medications in our arsenal. Antibiotics, first used in the 1940s, saved many lives that would have been lost to infectious disease. They offered incredible hope, but almost as soon as they were invented, they began to be misused. My editor, who came down with mononeucleosis in 1948 at the age of four, was hospitalized and given penicillin shots every four hours night and day. The painful injections did nothing for the virus that caused her mononucleosis, and she recovered despite, not because of, the treatment. Her doll suffered many a pinprick as she worked through the trauma. Today, the appeal of a pill that will just "make you better" - be it an antibiotic or an antidepressant - is still strong. Sometimes that pill can save a life; sometimes it doesn't help at all. The challenge for both physician and patient is knowing when to take the pill, when to try something else, and when simply to allow the body to heal itself.
Prolonged Bronchitis - What To Do About that Hacking Cough
Section titled “Prolonged Bronchitis - What To Do About that Hacking Cough”Gimme a Pill!
You've had a cough for ten days. Nothing you've tried seems to help. You've promised to go to your nephew's wedding, and you don't want to show up hacking and looking like a corpse. Your friend had a similar cough, went to her doctor, and got an antibiotic. Within a few days, she was better. Your friend tells you to go to your doctor and get an antibiotic.
There's one trouble with this advice. It's wrong.
In almost every study of antibiotics for acute bronchitis, they've been shown to be worthless. Researchers at Rush Medical Center in Chicago gave azithromycin, one of our most potent respiratory antibiotics, to 112 people with acute bronchitis. At the same time they gave vitamin C to 108 people similarly afflicted. Seven days later 89 percent of each group had returned to normal activity. No difference. Why? Antibiotics kill bacteria, not viruses. Pour down the hatch all the azithromycin you want; a virus-caused bronchitis just ignores it and soldiers on. We eventually get well no matter what we do.
So What Can You Do?
Does that mean just leave bronchitis alone? Sometimes we can do better than that. Often people with prolonged bronchitis have developed an allergic response along with it. The allergy interferes with clearance of the virus causing the bronchitis; at the same time the virus keeps the allergic response going. When we find that to be the case, we can break the cycle with an inhaled bronchodilator to open up the lungs. The Rush researchers did the same in the study above, giving an inhaled bronchodilator to everyone in the study. That may be why, after seven days, they had an almost 90 percent recovery rate.
So, if your cough just won't go away, sure, visit your doctor. But expect that he or she will consider the whole picture. If doctors throw an antibiotic at everyone who comes in the door, they are also throwing away the advantages those antibiotics give us against bacteria. Bacteria are masterful survivors and they communicate with their fellows. If one bacterium has had to deal with an antibiotic and survived, it can pass on, chemically, that resistance to other bacteria.
The discomfort and disability of bronchitis is no joke, and requires intelligent treatment. There are a number of ways to ease the discomfort and speed healing. An antibiotic isn't necessarily one of them. We must take advantage of antibiotics when they can help us, and accept that there are times when they cannot.
Antidepressants - Dangerous or Helpful?
Section titled “Antidepressants - Dangerous or Helpful?”Antidepressants are some of the most common medications prescribed by doctors (http://en.wikipedia.org/wiki/Antidepressant). They are also some of the most controversial. As a physician who focuses on preventive medicine and makes ample use of natural remedies, you might think I'm opposed to them. I am not.
No antidepressant is a panacea. The cornerstone of mental health lies within us, not within a tablet. Yet there are times when life is better with the tablet than without. For example, look at people who abuse drugs. Many of those folks suffer from clinical depression, and they treat themselves with methamphetamines rather than Prozac. Which would you rather see your neighbor taking?
Unfortunately, the media find sizzle in stories of children supposedly driven to suicide by an antidepressant. Those stories badly distort the truth. Yes, we have known for two decades now that when severely depressed patients start on an antidepressant, some of those folks will commit suicide. We think it is because before treatment they were so vegetative that they could not muster the energy to act on their suicidal impulses. As the antidepressant improves their energy, they may reach a point when improved energy and suicidal impulses can co-exist and lead to self-destructive behavior. This is a dangerous moment that is usually soon passed. For a couple of decades doctors have been taught to carefully monitor people during this crucial time.
If, alternatively, we avoid the antidepressants, over time we see more suicide as the depression goes on untreated for years. Starting the antidepressant can be compared to surgery. When appropriately used, a short-term period of instability is most often followed by better health.
When the National Bureau of Economic Research looked at this question, they concluded that increasing use of anti-depressant medication has led to decreased suicide rates. You can see their report at http://www.nber.org/papers/w12906; it is pretty abstruse, but the graph on page 41 provides a quick summary.
Again, treatment of depression best involves not just medication, but a skilled human being. And, yes, the warnings about medication side effects are wise, just as we have warning on chemotherapeutic drugs for cancer. In my view, blanket avoidance of antidepressant treatment, without attention to the danger of untreated depression, is foolish.
Putting it All Together
Section titled “Putting it All Together”When you see your health care provider, sure, tell about your friend who took the antibiotic for bronchitis. Bring up articles you've read about antidepressants or other medications. Let your doctor know what you are thinking and feeling about whatever medical problem you bring. Then expect that this professional will be able to add something intelligent to the conversation and willing to collaborate with you. People differ, circumstances differ, and you deserve the best solution possible for your particular situation.