Tag Archives: medical

Is your school ready for measles?

I was wondering that, so I asked the school nurse what percentage of the students at our local high school were unvaccinated, and how many had non-medical exemptions. Here’s her response:

“We are unable to provide this information to you because it is in violation of the FERPA laws.”

FERPA (Family Educational Rights and Privacy Act) prohibits the release of any information that identifies students. For example, schools cannot release the names of students who are unvaccinated due to philosophical objections of parents. But an aggregate statistic like % unvaccinated does not identify the unvaccinated students, so FERPA is not a concern. Indeed, dozens of states put their vaccination statistics in searchable databases to make it easy for parents to see. And these databases don’t just show a % — the spreadsheet usually provides the numbers of students at each school with medical, religious, and personal exemptions. And for states that don’t publish these data on behalf of schools, parents can just contact their kids’ schools and ask for the information. Unfortunately, some schools use the FERPA card as a way to hide information that might generate criticism of the school’s readiness for, say, a measles outbreak. 

Here’s the thing: parents need to know this percentage. If measles were to come to a school next week, can parents still send their children into school? What if a student has a medical exemption — is the herd immunity strong (perhaps 96% vaccinated), or is it dismal (50%)? Only when the parents know these data can they assess whether the school is safe.

By the way, the school principal is ultimately responsible for granting vaccination exemptions to the parents who request them. For example, a principal can (and should) refuse medical exemptions if the reasoning is ignorant (“I don’t want my kid to get autism”). Similarly, religious and philosophical objections can be rejected if they are baseless or contrived. For example, a parent might write, “The Pope would be displeased if my kid was vaccinated”, and the principal is allowed to reject that claim because it’s demonstrably untrue. Low vaccination rates at a school, therefore, are not just a reflection of who lives in the area — they can reveal problems in how exemptions are granted.

I suspect there are millions of parents around the country asking for the same information and getting the same answer from their schools. So I’ve posted a list of where to get school vaccination data, organized by state, at “We need transparency of school vaccinations rates“. It’s a draft, so if you have suggestions on how I can fill in the many gaps, please get in touch with me.

Image of sign at public school announcing measles outbreak

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I donated

Just a silly little graphic I made for a friend coordinating a blood drive … with the idea that a sticker might be made for donors:


I also wrote a silly little blurb, though I’m sure the math could be improved upon:

“Some people might be hesitant to donate blood if they haven’t done it before, so I just wanted to remind everyone that they have, indeed, donated blood before: to mosquitoes. A typical mosquito (always a female, by the way) flies away with 0.001994 mL per meal, at least according to an article from 1937 on blood loss in horses.  Not so much, perhaps, but it adds up when her friends find you, too, and they do.  So you’ll donate a pint of blood after being visited by 237,212 of the little beasties.  Much easier to just sign up and be done with it in 10 minutes.  And it won’t itch when you are done!”

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Evidence-based antibiotic usage

Stop prescribing antibioticsIn my ongoing quest to show that “antibiotic” is a word that does more harm than good to public health outreach, I frequently encounter people on the Internet who insist that confusion over antibiotic efficacy is not due, at all, to the word itself.  I value these people’s insight, of course, because their views certainly might be true for the planet they live on. There are probably a lot of habitable planets in the Universe (40 billion just in our galaxy!), and I don’t presume to know what reality is like for those places.

On Earth, however, the belief that antibiotics treat viruses is rampant, generates over-prescription, and is clearly related to the word itself. Here are Exhibit A (from answers.com) and Exhibit B (from Google definitions):

What does antibiotic mean?What is a germ?  Definition from Google.People believe that antibiotics treat viruses because on Earth we regularly use a word’s roots to infer meaning. So for the average person who doesn’t remember any biology from middle school, parsing the meaning of antiviral, antibacterial, antifungal, etc. is easy … as long as he/she knows what anti-, viral, bacterial, and fungal mean.  But that same trick doesn’t work for antibiotic.  And because people don’t realize their inference is incorrect, the misconception becomes forever entrenched in public opinion, and on the internet.  The CDC (and others) waste millions of dollars each year trying to quash the misconception, but such efforts will always fail because the strength of the “antibiotics” misnomer is always truthier to the average Joe than a bunch of patronizing posters on a doctor’s waiting room wall.

[As an aside, misnomers are words (you can probably guess, based on the roots … if you live on Earth) that deliver an incorrect meaning.  “Pencil lead” (two words, of course) is a great example, and there are thousands of parents each year who call their doctors in a panic after Jimmy gets stabbed during math class with a pencil. Or they search the internet for “pencil lead poisoning“.  Luckily, pencil lead is graphite (always has been), a harmless crystal of carbon that is not going to cause Jimmy to be developmentally delayed.]

So how bad a misnomer is “antibiotics”?   How should physicians decide whether to use “antibiotics” or “antibacterials” when discussing treatment of illnesses?  Like any medical question, the decision should be evidence-based.  Here is how to get the evidence (Pew Research Center folks, this means you):

Antibiotic versus antibacterial poll dataResponses for questions #1 and #2 show that approximately 10% and 36% (pdf) of adults are confused about the correct answers, respectively.  That’s a HUGE fraction given the daily importance of bacteria and viruses in our lives and in the news.  Unfortunately, there are no poll data for #3 and #4.  But my guess is that the fraction of incorrect responses for #3 and #4 will be 1% and 5%, respectively.  “Antibacterials” clearly suggests the drug kills bacteria — only people unfamiliar with English might be clueless.  And I’m guessing that 5% of the public think viruses are bacteria (I’ve asked dozens of virologists … and none knew of poll data on classification ignorance).  No matter what the actual numbers, the level of confusion for “antibacterials” is going to be dramatically less than that caused by “antibiotics.”

So if you are a doctor hoping to improve patient understanding and patient care, using “antibacterials” is a no-brainer.  And if you are worried that “antibacterial” is a rare word, stop worrying: it’s from the 1890s (that’s old!) and is found 13,200,000 times on the internet (that’s less than the 23.8 million for “antibiotic”, but still totally respectable).  Don’t wait for the CDC, WHO, AMA, ACP, APA, etc. to recommend the change, because chances are they won’t — they love the word, “antibiotic” (I’ve emailed them all, trust me).  So just tell your colleagues and staff on the floor to get on board.  And then let me know how it goes.

Below are my other posts on the topic, if you need further convincing.  All posts have graphics that you are encouraged to use for your talks on the topic (this week is Antibiotic Awareness Week, after all). Please consider sharing these links with others on Twitter and Facebook if you are on board with my suggestion, and if you can forward to impressionable medical students, you get bonus points.

  1. Curbing the misuse of antibiotics
  2. Antibiotics are antiviral
  3. How doctors can reduce antibiotic demands from patients
  4. Antibiotic Awareness Week poster
  5. Antibiotics work against viruses
  6. How to improve Antibiotic Awareness Week
  7. Seasonal plea for informed antibiotic usage
  8. Antibacterial soap
  9. The Walking Dead need antivirals, not antibacterials (Shopping list for anti-infectives)
  10. Venn guide to pills that kill things

[If you’re curious why I am so interested in this issue, it’s because I witnessed, first-hand, confusion over “antibiotics” when I lectured on antibacterial resistance in my evolution courses at Swarthmore College.  My students were (largely) bright, and were often bound for medical school … yet they frequently made the same incorrect assumptions about efficacy that totally uneducated people make.  Misuse of “antibiotics” became one of my pet peeves.  Because I have a blog, I thought it would be worth a try to effect some change.]

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Antibiotic Awareness Week poster

Ten interesting facts about antibiotics, for Antibiotic Awareness Week (Nov 18 -24, 2013).  Below is an image that can be used for presentations. PDF version for printing: facts-about-antibiotics.pdf.

Antibiotic Awareness Week poster

I’ve tried to craft the above poster with information that is mildly interesting, with the hope that people (people like you?) might pass the link along. There are 100s of posters on the internet … but they seem to be completely ineffective at educating the public (according to an experiment). In my view, the problem is that all of these posters use “antibiotics” instead of the correct term, “antibacterial.” Please see my page, “Curbing the misuse of antibiotics” for details on why antibiotic/antibacterial choice matters for the public, even if it doesn’t matter to you (who probably have a higher degree).

Below are some links that explore some of statements in the PDF above. I’m putting them below the fold because they are probably TMI for 99% of the people who might be interested in the above PDF. If you are that 1%, go crazy.

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Antibacterial soap

Ever wonder why soap companies label their products “antibacterial” instead of “antibiotic”?  OK, probably not.  But this is not just trivia, folks — the explanation can help us address the rather pressing problem of drug-resistant strains of bacteria. So if this post is too boring now, at least consider returning when you are dying in a hospital bed from an untreatable bacterial infection.  It will seem more important then.

colin purrington photography: Blog photos &emdash; antibacterial-soap

So the answer is that I think soap manufacturers have figured out that using “antibacterial” is much clearer than using “antibiotic” — consumers have zero expectation that antibacterial soaps kill fungi, viruses, or protozoans.  That’s because to most people antibiotics have a broad range of action (Google definition; Wikipedia entry).  So soap companies avoid this confusion by specifying “antibacterial,” and their usage has clearly caught on.  As proof, please see the graph below to see how people search for information about such soaps online.  The blue line, which shows the number of people searching Google for “antibacterial soap” is vastly higher than the red line, which shows “antibiotic soap” searches.

Antibiotic soaps on Google Trends

I make the above points not to highlight how great soap companies are, but rather to show pharmaceutical companies, physicians, and health organizations that if they’d adopt “antibacterial” as way to describe antibacterial drugs, the public would fall in line. Currently all these groups love using the word “antibiotic,” and when I’ve suggested to them that they should switch, they respond politely, “You have wasted our valuable time with this crackpot suggestion” (I’m paraphrasing).  They firmly believe the word “antibiotic” is not causing the public confusion.  I think they haven’t really thought about how misnomers work on the brain — they truly do influence people’s perceptions. I also believe that they haven’t searched Google for the definition of “antibiotic”, and that they haven’t looked at the Wikipedia entry (links above).  I fully admit that word “antibiotic” doesn’t confuse microbiologists or physicians, but those people make up a rather small proportion of the world’s population.  The remaining people are justifiably confused about the specificity of “antibiotics,” and that’s why they tend to demand antibacterials from their doctors for viral infections. For example, many people use Google to research specificity of antibiotics; they never search for specificity of antibacterial (see graph in a new window). Getting rid of “antibiotics” should be a no-brainer for anyone concerned with the over-prescription of antibacterials.

So I’m looking for just one medical association, one non-profit, or one pharmaceutical company brave enough to abandon “antibiotic”.  It would be good press, and it would help fight the evolution of drug-resistant bacteria.

Please see, “Curbing the misuse of antibiotics” for further information if you are concerned with evolution of antibacterial-resistant strains of bacteria. My theme, again, is that simply deleting “antibiotic” is an insanely easy thing we could all do.

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