Tag Archives: public health

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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Is your school ready for measles?

I was wondImage of sign at public school announcing measles outbreakering 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.

To make it easier for parents, I have made a list, by state, on how to get school-based vaccination data. There are gaps, however. Some states have websites so poorly organized that I couldn’t find it (if you know it, send me the link, please). And some states I contacted said they don’t publish the data but said I could just contact schools directly. Finally, some states claim they cannot release the data due to privacy concerns. FERPA (Family Educational Rights and Privacy Act) clearly prevents a school from releasing the names of the kids who are non-vaccinated (for example), but it does not prevent schools from sharing the overall vaccination rate. States and schools citing FERPA just need to be educated about this, which is partly why I’m compiling this list (parents can share it with school officials who didn’t get the memo).

If the links below don’t work, try asking your school principal for the data. (Don’t ask the school nurse, because s/he’ll will instinctively cite FERPA.) When you get your data, please share it with other parents in your community via Facebook or Nextdoor. Only communities that know their vaccination coverage can determine whether they are prepared for disease outbreaks. If your school has rates below 96%, parents need to formally request to school board and principals that fewer exemptions be granted. Yes, the principal can deny requests if they are unwarranted.

Alabama (I could only find county data)
Alaska (I can’t find anything; maybe too cold for viruses?)
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois

Indiana
Iowa
Kansas
Kentucky (county data)
Louisiana
Maine (have to ask your school nurse)
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana (county data)

Nebraska (need to ask your school, Health Dept said HIPPA prevents schools from releasing data)
Nevada (they are working on this right now; until then, ask school)
New Hampshire
New Jersey
New Mexico (ask State Dept of Education)
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania (county data in PDF near bottom)

Rhode Island
South Carolina (see PDF at bottom of page)
South Dakota
Tennessee (partial county data)
Texas (district data)
Utah (district data; ask school, and if they balk, contact this person for help)
Vermont
Virginia
Washington
West Virginia (ask this person for PDF)
Wisconsin (district data; county)
Wyoming

 

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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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