Tag Archives: physician

Antibiotic confusion in the Wall Street Journal

If you follow me on Twitter, you’ll know I have a thing against antibiotics. I love to take them when I have a bacterial infection, but I think it’s a terrible synonym for ‘antibacterial’, an older word that doesn’t mislead people into thinking the drug can work against viruses and other microorganisms. The problem with “antibiotic” is that people (as in “folks” who are not scientists, doctors, and science journalists) typically assume that they can treat non-bacterial infections, and this encourages people to demand antibiotics for anything that ails them. Part of this confusion is from the word itself (it sounds like it should work against all types of microorganisms). In addition to it sounding like it should be broad drug that can kill all things living, many dictionaries actually suggest exactly that, and that’s actually what the word used to mean. Unfortunately (and this seems to be the bigger problem), scientists, doctors, and science journalists don’t think “antibiotic” is at all confusing to lay people.

So last week I begged Ben Zimmer (Wall Street Journal) on Twitter to explore the origin of the word “antibiotic”, with the hope that people (folks and otherwise) would listen to him. Here’s his column: A Cure for ‘Antibiotic’ Confusion? It’s short and sweet, so just read it, but here’s my favorite sentence:

In current usage, “antibiotic” is roughly synonymous with “antibacterial,” though technically speaking antibiotics can act on microbes other than bacteria. [italics mine]

Two comments about the column.

First, I wish the article had explored just how common the confusion is. It’s not just that some people are confused. I think most people are confused. Again, I’m talking about “folks”, not the overeducated people who might be reading this nerdy blog post. But to be honest, some of the overeducated people I’ve talked to don’t understand antibiotic specificity, either. Because terrible word.

Second, Zimmer asked two people whether “antibacterial” could ever float as a substitute for “antibiotic”. They answered that it couldn’t because (essentially) the disinfectant lobby would object. That’s an odd reason because just as antibacterial wipes kill bacteriaantibacterial drugs kill bacteria. That’s because they both contain antibacterials, though the sources might differ. Zero conflict. Similarly, disinfectants and pills can contain antivirals. Or antifungals. And if there really was a conflict, I think the original use of antibacterial should trump the wipe lobby. Regardless, some scientists and physicians are already using “antibacterial” as synonym for antibiotic, so it’s not like there isn’t a precedent; it’s just too rare that they are doing so.

The issue is more that it’s hard for older people to avoid a word they have been happily using for their entire life. Good examples are “life preserver” (now “personal floatation device”) and suntan lotion (now “sunscreen” or “sunblock”), words that will probably only fully die when we do. But if properly motivated, people can make switches much faster. Two good examples are demonstrated by the employees of BackRub.com and Beaver College, now Google and Arcadia University, respectively. So I think a bunch of PhDs and MDs can summon the mental power to say “antibacterial” when speaking with impressionable patients or when designing outreach graphics. But they’ll only do so if some higher power (CDC, WHO) makes it clear that doing so might reduce overprescription of antibiotics. Even if using “antibacterial” would only reduce overprescription by 5%, the change would be worth doing.

I’m not suggesting that we stop using the word, “antibiotic”. The word is totally fine for conferences, publications, and situations where the context is clear or when there is plenty of time to clarify that they are antibacterials. The word is also invaluable when socializing with people from the powerful wipes lobby.

Thanks, Ben Zimmer!

Here are my previous posts on the topic, if you’re interested. If you conduct “science literacy” polls, you should read them. The reason is that asking something like, “Will antibiotics treat colds?” is a terrible question. You should be asking, “Do antibacterials kill viruses”. That will assess the science literacy more directly. Sticking with the old question just demonstrates that pollsters are unfamiliar with what “antibiotic” actually means.

You keep using the word antibiotic

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Seasonal plea for informed antibiotic usage

The Centers for Disease Control recently announced that the 2012 flu season is gearing up to be heavy, so I wanted to make my yearly plug for greater clarity in antibiotics names.  Here’s why: according to a Pew study, approximately 36% of adults believe that antibiotics can help treat viral infections.  This percentage, the study contends, reflects a populace that is ignorant and fingers these people as contributors to the rise of antibacterial resistance (they ask their physicians for antibacterials when they have the flu), which is an enormous public health problem worldwide.

Graphic illustrating the types of antibioticsA painfully easy and cheap solution to the ignorance problem is for everyone to stop misusing the word, “antibiotic.”  When people hear the word “antibiotic,” they quite reasonably assume that it describes a drug that is effective against “biotic” thingies (that’s the technical term) and thus might treat viral infections, too.  Indeed, when “antibiotic” was first dreamed up as a word, it meant “anti-infective” (see details in last year’s plea).

Imagine, for example, if the CDC starting using “antibacterial” in all instances when it meant antibacterial.  Doing a search/replace on their website and PDFs could catalyze similar changes across the planet and could lead to a marked drop in the lay confusion about the efficacy of antibacterials on viruses.   Of course, the reply I usually get is, “but everyone knows that antibiotic means antibacterial, plus the medical community has been misusing it for years, and it would be a pain to change.” For all the billions of dollars that are spent on public awareness programs and development of new antibacterials worldwide, a virtually  cost-free switch to a more explicit naming scheme for anti-infectives should be a no brainer. Come on, folks, give it a try.

At the very least, if you poll people about the specificity of antibacterials, try asking, “Are antibacterials effective for treating viral infections?” I’d wager that the percentage saying, “yes” would be about 3%, not 36%.

If you’re on board, here’s printable version of this post’s graphic to print for your patient waiting room: antibiotic-wall-chart (PDF).  Patients who are gearing up to ask for antibacterials will be 90% less hostile when you say “no.” OK, I made up that 90%. You can also leave a stack 8 1/2 x 11″ versions on the counter along with a box of Crayons for the little ones.  Can’t start too soon in fighting ignorance.

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