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Tag Archives: science
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 bacteria, antibacterial 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.
On November 24th, 1859, Charles Darwin published The Origin of Species by Means of Natural Selection, Or, The Preservation of Favoured Races in the Struggle for Life. Eventually shortened (thank, God) to, On the Origin of Species. First editions can easily fetch $200,000 at auction. Not all copies have been accounted for, so check your shelves. This one is owned by the American Philosophical Society, which also has a huge and entertaining collection of translations and even the draft title page that Darwin sent to Lyell. If you’re shopping for a gift for a young science fan, get Dr Jan Pechenik’s version, The Readable Darwin: The Origin of Species, As Edited for Modern Readers.
If you wonder why most people think antibiotics can treat viral diseases, one reason is that when people use search engines to understand what antibiotics do, they are informed that antibiotics do target viruses. Examples below.
antibiotic: a medicine (such as penicillin or its derivatives) that inhibits the growth of or destroys microorganisms.
microorganism: a microscopic organism, especially a bacterium, virus, or fungus.
antibiotic: any of a large group of chemical substances, as penicillin or streptomycin, produced by various microorganisms and fungi, having the capacity in dilute solutions to inhibit the growth of or to destroy bacteria and other microorganisms, used chiefly in the treatment of infectious diseases.
microorganism: any organism too small to be viewed by the unaided eye, as bacteria,protozoa, and some fungi and algae.
antibiotic: a substance produced by or a semisynthetic substance derived from a microorganism and able in dilute solution to inhibit or kill another microorganism.
microorganism: an extremely small living thing that can only be seen with a microscope.
antibiotic: A substance, such as penicillin or erythromycin, produced by or derived from certain microorganisms, including fungi and bacteria, that can destroy or inhibit the growth of other microorganisms, especially bacteria. Antibiotics are widely used in the prevention and treatment of infectious diseases.
microorganism: any organism, such as a bacterium, protozoan, or virus, of microscopic size.
antibiotic: chemical substance produced by a living organism, generally a microorganism, that is detrimental to other microorganisms. Antibiotics commonly are produced by soil microorganisms and probably represent a means by which organisms in a complex environment, such as soil, control the growth of competing microorganisms.
microorganisms: living things that are too small to be seen with the naked eye. They are normally viewed using a microscope. Bacteria, viruses, and some molds are examples of microorganisms.
antibiotic: Any substance that can destroy or inhibit the growth of bacteria and similar microorganisms.
microorganism: An organism that is too small to be seen by the unaided eye, especially a single-celled organism, such as a bacterium.
In depressing medical news this week, the World Health Organization reported that 64% of adults believe that antibiotics can be used to treat flu and colds. That’s terrible because those 64% are likely to pressure their doctors for antibiotics when they don’t need them, which in turn will speed the evolution of bacteria resistant to the drugs … and then people die from bacterial infections that used to be treatable.
There are several beliefs that contribute to this statistic, and I think it’s important to tease them apart so we can better craft outreach strategies. The one that gets the most attention, of course, is when people (e.g., Robin in the popular Batman meme I based on original by Dr Nick Bennett and his wife) think that colds are caused by bacteria. A second reason is that some people think viruses are a kind of bacteria and thus treatable with antibiotics.
But there’s a third, even more important explanation that gets almost no attention: people thinking antibiotics are effective against a wide range of microorganisms (i.e., not just bacteria). Why on Earth would people think this? I think kids are almost certainly to blame. When young kids are sick, they don’t really care about the whole virus-versus-bacteria thing … they just know something is infecting them and that the parents keep chanting “antibiotic” over and over again. So I think it’s unavoidable that kids construct a definition for antibiotics before they even start kindergarten (pollsters: can you ask?). Kids are also genius at figuring out word meanings when they don’t get full information from teachers or parents, so it is probable that many assume that the anti (against) and biotic (living) parts of “antibiotic” mean that the drug kills all life. (This is, indeed, what the word “antibiotic” used to mean before microbiologists commandeered it to mean something else.) Although kids might be told later in life (in high school, college) that antibiotics target only bacteria, the correction might not stick in the average person’s brain. In addition to the above, ignorance about antibiotic efficacy is probably increasingly pulled from the Internet. If you doubt me, just type “antibiotic definition” into Google and read the top five or so definitions: they all say that antibiotics can kill microorganisms.
If “antibiotic” (the word) is the source of so much confusion, replacing it with a better word might cause people to stop asking for it, which could save lives via preserving antibiotics. Luckily, the word “antibacterial” is just waiting there, perfect for the job. The anti and bacterial parts of the word convey its meaning unambiguously, plus it’s an old word (older than antibiotic!), and is already used by the general public. You can even Google the definition if you don’t believe me: all the definitions indicate it is a drug that kills bacteria (and only bacteria). It would join other words such as “antifungal” and “antiviral”, all of which tend to be used and understood by both doctors and patients.
There would, of course, be a certain amount of work associated with the switch. For example, websites promoting antibiotic awareness would need to run a Search and Replace macro to insert “antibacterial” everywhere instead of “antibiotic”. That might take 10 minutes for a large site. And brochures and cartoonish wall art for waiting rooms would have to reprinted, but the result would be that waiting patients and parents would be measurably less confused on what antibacterials do. And once everything was converted to “antibacterial”, outreach organizations like WHO and CDC could focus on the more important issues such as making people understand what colds are (please see Batman comic #2) and making sure that the full course of antibacterials is taken.
Note that I’m not suggesting everyone stop using “antibiotic” altogether. But in terms of public outreach, discussion with patients, and the names on drug containers, we should give it a try.
What would also be great is if pollsters could replace “antibiotic” with “antibacterial” for half of the survey participants. Currently, most physicians and “antibiotic awareness week” coordinators LOVE the word “antibiotic” and can see no fault in it; they blame ignorance levels on the educated, ignorant masses. But if poll data could show them that ignorance goes down by (say) 50% after adoption of “antibacterial,” they might rethink their opposition to change.
BONUS FACT: Alexander Fleming used the word “antibacterial” 19 times in his paper describing the isolation of penicillin. He used “antibiotic” 0 times. He got a Nobel prize for the work.