Infections 10 : Drugs 7

Infections 10 : Drugs 7

The world is going through a health crisis. It is not (yet) the pandemic we all suspect is coming. That may not appear for a while. What we have now is not so clearly visible. Infections are beating the drugs. It’s not happening in some faraway Nigerian village or a devastated Syrian war zone. It is happening here, wherever you are. There is no need to panic because panic will not solve the problem and may make it worse.

Antibiotics work only as long as the bugs they are designed to kill actually die. But bugs are a resilient lot. Miniature by comparison with the insects we see, infections are nevertheless the cockroaches of the body. Their most powerful attribute is that they adapt to attacks from drugs in a way that soon makes them drug-resistant. So doctors have been told not to issue them so “freely” – a word that will make those who have to pay for them shudder.

In an attempt to avoid the bug-drug battle being lost to the bugs we were all told to make sure we finished our course of antibiotics. If we didn’t, we were told, the bugs would work out how to return, fortified by their victory over an unfinished dose. Now, it seems, that may be the wrong instruction. Just feeding the little blighters may be exactly what they want. If you finish your course, they may well finish theirs.

Part of the cause of so much infection is overcrowding. Seven billion people can carry and spread a lot of infections, especially when they are herded into cramped conditions in cities. Not for nothing that Hong Kong has a record of some of the worst ‘flu epidemics – one in progress right now. Nobody has suggested compulsory population reduction – indeed, the estimates are that it will grow to over nine billion in the next fifty years. A sort of sick transit.

This will not be helpful because another cause of bug battles is the warming climate. You need a good frost now and then to remove a large swathe of the lethal attackers. A warmer world is just what they want and it is surprising that those concerned about climate change haven’t made more of the fact. Meanwhile, the drug companies are beavering away at new warriors to beat the bastards. They will have some success but don’t look for a panacea.

As if that wasn’t enough the world’s communications system is now so extensive that everyone expects their Quality Life Expectancy to be improving by leaps and bounds. Grandparents who live to 70 expect their great grandchildren to live to well over 100, bugs notwithstanding. This has bred a sense of entitlement to medicine and, indeed, to healthy living far beyond the original aspirations of anyone over 40.

We need clear laws to accommodate a national or international healthcare business, as President Obama discovered. First we need to sort out the roles and rewards of doctors. To make the medical profession financially dependent on being the drug companies’ salesmen is demonstrably daft. Doctors are worth a decent wage, not commissions on sales. The incentive to over-prescribe is obviously there and no amount of protestation about professionalism will convince me or anyone else that it doesn’t happen.

‘Free at the point of delivery’ is a fatal mantra. Once spoken you can never retreat from it. It has brought the British National Health Service to its knees. So sad for the finest social advance of my lifetime. It is not just the Health Service that is in trouble, the British Economy is, too, and a fair slice of that is down to health costs. We won’t even mention Brexit.

Perhaps the biggest scandal of all is health insurance. Its abuse from within the industry pales into insignificance by comparison with the distortion heaped on it by both customers and medics. The reason you are first asked by whatever medical source you approach if you are insured is so that the source can load the insurer with charges others should be bearing. Since the insured pay additional premia as a result of such loading it isn’t a good outcome.

We all want everyone to have good, prompt, expert medical attention. As a goal it is some way off yet. We shall begin to head for it when who pays what is aligned with who does what and who gets what, not a scramble for more by counter-professional and inaccurate motivation.

Let sanity prevail.