Saturday, April 05, 2008

Washing Hands and Creating Killers

When I was working at the Med School in Birmingham, UK, all the clinicians and researchers I ever spoke with were aware of the anti-biotic resistance that is now prevalent around the world because of a misuse and overuse of antibiotics. Indeed, NHS trusts have received recommendations to try and reduce unnecessary prescriptions of anti-biotics for short illnesses of unknown origin. Most such illnesses are self-limiting anyway as the doctors will point out, when asked. They are all aware of the epidemic of prescription-led multi-drug-resistant strains that have sprouted. And yet, when I walked into the ladies room, everyday I was faced with the soap we were to use- Triclosan. At a medical school where medical research is being carried out and medical policy being created, how can another soldier in the war to create resistant bacteria be deployed so wantonly?

My puzzlement may be a sign of my frustration. I still have conversations with my neighbors and friends (here in the United States) that judge a doctor's efficacy and "caring-ness" by how quickly anti-biotics are dispensed. But instead of fighting back with education and information, these doctors do not "first do no harm". They cave in. I know that it is not so hard to talk to lay people about this issue because I do it all the time. And while my background and education give me some credibility, it is far less than that wielded by a family physician. In the absence of their physicians backing up what they have heard or read on the outside, these people (my friends and neighbors, for instance) go right on believing that anti-biotics in general are harmless and helpful- and I end up having these conversations again and again, appearing like the quintessential pushy person, or giving up.

How many people have you seen carrying those little anti-bacterial washes for their hands? They are even advertised on TV (well they used to be till recently, though I must admit, I haven't seen one recently). They are sold everywhere, not just at pharmacists'. We treat medicine quite cavalierly without recognizing its true benefits and costs of use. And let's not delude ourselves- even the anti-bacterial hand wash is medicine. I am reminded of an experiment narrated to me by Jurriaan who went to medical school in the Netherlands. Students are asked to rub a finger in a petri dish, then wash their hands with soap and rub the same finger in another petri dish. Which dish do you think had a denser bacterial population after a day?

In India, you can buy prescription drugs (such as anti-biotics) at pharmacies without prescriptions. People store them in their first-aid kits for years and use them as needed (the need is self-determined). In the US, many doctors will hand out prescriptions if you complain of a flu-like cold or throat pain, etc. And if you are (un)lucky enough to end up with one who doesn't follow this practice you can try brow-beating them with your conviction of a need for anti-biotics or threaten to go to a doctor who will comply. In some cases, you may actually have to go to a different doctor, but this doesn't happen very often. In the UK, it depends on your luck generally but doctors are less prone to being brow-beaten because in the NHS, your choices are more limited than in a private health care system. But as we saw, the anti-bacterial hand wash are somehow not even being considered as another culprit in the development of drug-resistance bacterial strains in the UK. How self-defeating!

The fact is we humans, just like most other animals, are prone to getting sick from time to time. Most illnesses are self-limiting in that even untreated they will eventually resolve themselves while leaving you a little worse for the wear. It is not easy to tell, especially early in an illness, what causes it- the two major outside causes being a viral or a bacterial infection. This is especially true of the kinds of occasional flus, colds, stomach upsets, inflammation, etc., that we seem to catch at work, play,... life.

Anti-biotics and anti-bacterial hand washes kill bacteria- the latter is weaker and widely-used, and thus, even more dangerous as it leaves stronger bacteria alive to reproduce. Anti-biotics do nothing to viruses. A progressive viral illness can eventually leave your immunity weakened enough so that you will then be open to some other opportunistic bacterial infection (this is what happens with AIDS). But starting all treatment for any illness with anti-biotics makes as much sense as starting the treatment for AIDS with anti-biotics. All it will do is deplete the existing bacterial reserves in your body which protect you in many ways and also serve a vital function (such as in digestion). In most healthy people (and animals) the occasional viral or bacterial infection will resolve itself. This is good for your immune system as well as for your body in general since it does not have to recuperate from anti-biotic use. That diarrhea, the mal-absorption, weakness, dehydration & the occasional pregnancy after anti-biotic use despite being on a pill... can usually be attributed to the medicine.

Now admittedly, some (viral or bacterial) infections can be quite severe and in the immuno-compromised (such as sick or older people and young children) there is a place for responsible anti-biotic therapy where the benefits outweigh the costs; but, make no mistakes, there are still costs. To ignore these, as we have done, is to ask for trouble.

But this still does not justify the use of anti-bacterial hand washes. Anti-bacterial washes and sprays only create a greater problem for immuno-compromised individuals as well as the general populace by wiping out benign bacteria and allowing virulent strains to become more common. You are helping no one and harming many individuals by using these products. It is irresponsible public health policy that allows these products to be widely available to the public.

It was the second petri dish that had more bacteria, in case you were wondering.

[This post is dedicated to my friend Teresa.]
[The first picture shows MRSA and the second Salmonella. Both were found without attributions on different websites. The MRSA picture was found on & the Salmonella picture was found on]

1 comment:

Radhika said...

Lakshmi left this comment on the blog feed on facebook.

fantastic! wouldn't hv figured out that one....i've seen several people, esp ladies using these washes (and there are wipes as well!)....very informative Radhika. keep up the good work. I may pass on this article to my friends, hope its ok.

From me: Yes, I hope more people become aware of this issue and pass the information on to others.